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Purpose: To evaluate the association between the contact areas of primary molar teeth and approximal caries after three years of observation. Methods: This prospective cohort study included 1,119 caries-free children, aged three to four years, from Puducherry, India. At baseline, 4,476 contacts were assessed using the OXIS criteria, which denotes O for open contact and X, I, and S for closed contacts. X contact represents a point contact, I is a straight contact, and S is a curved contact. Two calibrated dentists measured dental caries at one-year intervals following the International Caries Detection and Assessment System for three years. Poisson regression analysis with a multilevel approach was used to determine the association between contact type and approximal caries. Results: Of 3,848 contacts observed at the end of three years, 499 (13 percent) were carious. The adjusted analysis revealed a significant association between contact type and approximal caries (P<0.05). The risk ratios for the development of approximal caries were 2.3 for X-type contacts (0.5 to 11.4, P=0.307), 12.7 for I-type (4.1 to 39.6, P<0.05), and 22.5 for S-type (7.2 to 70.6, P<0.05) when compared with O-type. Conclusions: Compelling evidence suggests that variations in contacts between teeth are significant in the development of approximal caries. The S-type contact is the most susceptible to approximal caries, followed by the I-type. [ABSTRACT FROM AUTHOR]

The present prospective cohort study was conducted to evaluate the susceptibility of OXIS contact areas, namely, O (open type), X (point type), I (straight type), and S (curved type) in the development of approximal caries. We conducted this study among 953 school children with 3,812 contacts in Puducherry, India. At baseline, the contacts were assessed in accordance with OXIS criteria. At the end of 12 months, two calibrated dentists measured dental caries following the International Caries Detection and Assessment (ICDAS) criteria. Information about feeding practices, diet, and oral hygiene was collected by means of a structured questionnaire from each child's parent. Data were analyzed by unadjusted and adjusted Poisson regression analysis with a multilevel approach. The two levels of analysis were tooth and child. Of 3,812 contacts observed during the follow-up, 127 (3.3%) were observed as carious. Poisson regression analysis revealed a significant association between type of contact and caries prevalence (p < 0.05). The risk ratios for the development of approximal caries in X contacts were 2.4 (0.3–17.2), p value 0.38; in I contacts 4.9 (1.2–19.9), p value 0.027; and in S contacts 8.2 (1.9–34.2), p value 0.004, when compared with the O contacts. Among the child variables, male gender (relative risk [RR] = 2.1; 95% confidence interval [CI], 1.3, 3.5), parental supervision while toothbrushing (RR = 1.6; 95% CI, 1.1, 2.4), and the use of toothpaste (RR = 1.9; 95% CI, 1.3, 3.1) were found to be associated with approximal caries after adjustment for the other variables. Among the OXIS contacts, the S type was most susceptible to approximal caries due to its complex morphology, followed by I, X, and O. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy, duration, and certainty of diagnosing approximal caries in bitewing radiographs displayed in 3 monitors under 2 luminance conditions., Methods: A total of 39 teeth without evident caries were selected from 11 patients undergoing partial jaw resection. Before the operation, 13 bitewing radiographs were captured by a digital imaging system. Eight observers evaluated the images under dark (9 lux) and bright (200 lux) conditions, using 2 medical-grade monitors and a commercial monitor. Using histological results as the gold standard, the areas under the receiver operating characteristic curves under different conditions were compared using the Z-test. Multivariate analysis of variance was conducted to assess the impact of various factors on diagnostic duration, while ordinal logistic regression was used to examine factors influencing diagnostic certainty level. It was considered significant when P < .05., Results: No significant difference was found in the diagnostic accuracy or duration for diagnosis of approximal caries under 2 luminance conditions with the 3 distinct monitors (P > .05). Ambient light, clinical experience, and the pathological grade of approximal caries have influence on the degree of diagnostic confidence (P < .05)., Conclusions: Different monitors and ambient luminance didn't influence the diagnostic accuracy or evaluation duration. Ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence., Advances in Knowledge: The study employing bitewing radiographs from real patients indicates that ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Institute of Radiology and the International Association of Dentomaxillofacial Radiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The International Caries Classification and Management System (ICCMS) advocates for nonsurgical approaches in early carious lesions and minimally invasive restorations in advanced cases., Aim: This study investigated Thai dentists' adherence to ICCMS guidelines for managing caries in children and adolescents and explored factors influencing their decisions., Design: A web-based questionnaire collected demographic information and routine treatment preferences for various stages of carious lesions from participants. Descriptive statistics and regression analyses were employed to examine relationships between management strategies and demographics., Results: A total of 442 dentists participated. Their agreement with ICCMS guidelines for occlusal caries ICDAS 2, 3, and 4 in primary dentition was 39.6%, 53.9%, and 42.5%, respectively, and in permanent dentition was 34.4%, 46.8%, and 39.6%, respectively. The agreement rate with ICCMS guidelines for approximal caries RA1, RA2, RA3, and RB4 in primary dentition was 69.6%, 78.0%, 12.4%, and 99.5%, respectively, and in permanent dentition was 70.8%, 68.3%, 19.0%, and 97.7%, respectively. Factors associated with restorative treatment decisions included years since graduation, postgraduate education, and practice type., Conclusions: Participants did not comply well with ICCMS recommendations for occlusal caries, some employed destructive techniques instead of noninvasive approaches. However, most participants followed ICCMS guidelines for approximal caries, except for RA3 stage., (© 2025 The Author(s). International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

Objectives: This systematic review and meta-analysis aimed to investigate the diagnostic accuracy of Artificial Intelligence (AI) for approximal carious lesions on bitewing radiographs., Methods: This study included randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) reporting on the diagnostic accuracy of AI for approximal carious lesions on bitewing radiographs. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A systematic search was conducted on November 4, 2023, in PubMed, Cochrane, and Embase databases and an updated search was performed on August 28, 2024. The primary outcomes assessed were sensitivity, specificity, and overall accuracy. Sensitivity and specificity were pooled using a bivariate model., Results: Of the 2,442 studies identified, 21 met the inclusion criteria. The pooled sensitivity and specificity of AI were 0.94 (confidence interval (CI): ± 0.78-0.99) and 0.91 (CI: ± 0.84-0.95), respectively. The positive predictive value (PPV) ranged from 0.15 to 0.87, indicating a moderate capacity for identifying true positives among decayed teeth. The negative predictive value (NPV) ranged from 0.79 to 1.00, demonstrating a high ability to exclude healthy teeth. The diagnostic odds ratio was high, indicating strong overall diagnostic performance., Conclusions: AI models demonstrate clinically acceptable diagnostic accuracy for approximal caries on bitewing radiographs. Although AI can be valuable for preliminary screening, positive findings should be verified by dental experts to prevent unnecessary treatments and ensure timely diagnosis. AI models are highly reliable in excluding healthy approximal surfaces., Clinical Significance: AI can assist dentists in detecting approximal caries on bitewing radiographs. However, expert supervision is required to prevent iatrogenic damage and ensure timely diagnosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: The purpose of this study was to evaluate the progression of incipient approximal caries lesions in permanent teeth of children and adolescents with and without silver diamine fluoride (SDF) application. Methods: A retrospective analysis of dental records and radiographs was performed. Baseline and follow-up bitewing radiographs were evaluated and scored using International Caries Classification and Management System (ICCMS) criteria to assess lesion progression. Results: A total of 131 lesions from 68 subjects (mean age equals 9.6 years) were evaluated radiographically and followed for up to 41 months (mean time equals 13.61±6.8 months); 23.6 percent of lesions in the SDF group progressed compared to 38.1 percent in the control group (P<0.001). On average, lesions in the control group increased more per month compared to the study group (P<0.001). The odds of lesion progression in the control group were 2.76 times the odds of progression in the study group. There was a statistically significant difference in lesion progression based on application method; lesions where SDF was applied with Superfloss progressed more per month, on average, versus microbrush application. Conclusions: Silver diamine fluoride may be an effective therapy to slow caries progression of incipient approximal lesions in permanent teeth in high caries-risk populations. Future studies are needed to detect differences in application methods. [ABSTRACT FROM AUTHOR]

Aim: This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. Material and methods: PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. Results: From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81–0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. Conclusion: The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. Clinical relevance: BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the recommendations relating to the use of approximal cleaning aids given by dental hygienists and dentists, the self-care practices in a Swedish population and the ability to remove dental plaque. Materials and Methods: A structured questionnaire was randomly distributed to 500 dental hygienists and 500 dentists and a similar questionnaire was distributed to 1000 randomly selected individuals, divided equally into the following age groups: 15 to 20, 21 to 40, 41 to 60 and > 60 years. A clinical examination evaluating the ability to remove approximal dental plaque was also carried out in a total of 60 regular users of approximal cleaning aids. Plaque was scored before and after cleaning with a toothpick, dental floss or an interdental brush. Results: The response rate was 82%, 79% and 68% for the three groups. The results reveal that dental hygienists give more detailed information about a majority of the aspects that are related to the use of approximal cleaning aids compared with dentists (P < 0.01 or P < 0.001). The majority of the dental staff give recommendations to children and adolescents firstly to prevent dental caries and to older individuals to improve periodontal health. The use of different approximal cleaning aids on a daily basis varied with respect to age group (2% to 42%); dental floss dominated in the younger age groups and interdental brushes in the two oldest groups. In the clinical study, the largest plaque reduction was produced by the interdental brush (83%), followed by toothpicks (74%) and dental floss (73%). Conclusions: The present study indicated the importance of individual recommendations related to the use of approximal cleaning aids. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficiency of Ultraspeed, Ektaspeed Plus, and Insight radiographic films, and radiovisiography in detecting approximal carious lesions. Method and materials: Eighty approximal surfaces of 40 extracted human molars and premolars were evaluated. Radiographs of teeth blocks were taken with three different films and radiovisiography under standard conditions. The presence or absence of approximal caries was evaluated by three observers according to a five-point confidence scale. The actual status of each surface of the teeth was histologically determined from the teeth sections. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of the imaging modalities were calculated, and observer responses were assessed with Kendall's tau and Spearman's rho tests. Results: The sensitivity values for Ultraspeed, Ektaspeed Plus, Insight, and radiovisiography were 0.39, 0.48, 0.45, and 0.49, respectively while the specificity values were 0.91, 0.88, 0.84, and 0.90, respectively The difference in detecting approximal carious lesions between the systems was not statistically significant. Conclusion: This study suggests that there is no significant difference between the four imaging modalities in detecting approximal carious lesions. [ABSTRACT FROM AUTHOR]

Abstract Background Although numerous studies have used digital intraoral imaging, only a few studies have used photo-optical methods for the diagnosis of caries. Moreover, several limitations exist in terms of observers (experience and specialty) and the caries lesion itself. Hence, the aims of this study were to evaluate the diagnostic capability of near-infrared light transillumination (NILT) and PSP-Bitewing radiographs and to compare the interobserver and intraobserver differences in addition to observers’ experience level to detect early interproximal caries lesions in vivo. Methods A total of 52 untreated posterior teeth with and without varying degrees of early interproximal carious lesions were included. Bitewing radiographs using digital phosphor plates (PSP-Bitewing) and NILT were used to clarify the diagnosis. An oral and maxillofacial radiologist and a restorative dentistry consultant evaluated the images twice. A separate appointment for clinical validation and restoration was made. Kappa coefficients were calculated to assess both intraobserver and interobserver agreements for each evaluation method. Scores obtained from PSP-Bitewing and NILT were compared with the clinical validation via receiver operating characteristic (ROC) analysis. Results No significant differences were found between PSP-Bitewing radiography and NILT for detecting early interproximal carious lesions with high average Az results. Both intraobserver and interobserver agreement values were relatively higher for NILT evaluation. The Az values increased at second evaluations for both caries detection methods. Conclusions NILT examination has an appropriate sensitivity and diagnostic accuracy for detecting early interproximal caries lesions and can be considered as a method of choice for detecting caries without the use of ionizing radiation.

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the "low" subgroup, those with 1-3 into the "moderate" subgroup and those with ≥4 into the "high" subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to evaluate a visible-light-transillumination (using Digital Imaging Fiber-Optic Transillumination machine: DIFOTI) method using occlusal view (DIFOTI-occl), axial view (buccal and lingual: DIFOTI-axial), and combination of all views (DIFOTI-all) for detecting non-cavitated approximal caries and to compare its performance to visual examination (International Caries Detection and Assessment System: ICDAS). Materials and methods: Thirty extracted human premolars were selected (sound to lesions into the outer one-third of the dentine) based on micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DIFOTI (Electro-Optical Sciences Inc., Irvington, NY, USA) images were obtained from the occlusal, buccal, and lingual views. DIFOTI image and ICDAS examinations were performed and repeated by three trained/calibrated examiners. Sensitivity, specificity, area under receiver operating characteristics curve (Az), inter- and intra-class correlation coefficients (ICCs), and correlation were determined. Results: Sensitivity/specificity was for DIFOTI-occl: 0.42/0.75, DIFOTI-axial: 0.86/0.93, DIFOTI-all: 0.91/0.69, and for ICDAS: 0.89/0.83. Az for DIFOTI-occl was significantly lower than that of DIFOTI-axial (p < 0.001), DIFOTI-all (p = 0.002), and ICDAS (p = 0.005). Spearman correlation coefficients with μ-CT for DIFOTI-occl (r = 0.39) showed weak association, while DIFOTI-axial (r = 0.80), DIFOTI-all (r = 0.91), and ICDAS (r = 0.90) showed moderate association. ICCs for intra-examiner repeatability/inter-examiner agreement were for DIFOTI-occl (0.64/0.58), DIFOTI-axial (0.92/0.89), DIFOTI-all (0.85/0.83), and ICDAS (0.79/0.72). Conclusions: The results of the current in vitro study suggest that, for detection of non-cavitated approximal caries lesions, DIFOTI performs better using axial than occlusal view. Clinical relevance: Approximal non-cavitated caries detection is challenging. DIFOTI can observe images from occlusal-, buccal-, and lingual views. DIFOTI and visual (ICDAS) examinations of buccal- and lingual- and all-views are more suitable than those of occlusal view for a detection of non-cavitated approximal caries. [ABSTRACT FROM AUTHOR]

Background/purpose: Detection of approximal caries may be difficult using conventional methods including visual inspection (VI) and radiography. The purpose of this in vitro research was to evaluate the efficiency of light-emitting diode (LED) and laser fluorescence (LF) devices, and radiographic and visual examination in approximal caries diagnosis. Materials and methods: One hundred and fifty-six approximal regions were evaluated. All approximal regions were investigated using LED and LF tools after radiography and VI were performed. Histological evaluation of teeth was performed using stereomicroscopy. The area under the receiver operating characteristic curve and accuracy, specificity, sensitivity values calculated regarding approximal caries diagnose. Results: The specificity of the bitewing examination was higher for both T1 and T2 thresholds (0.97 and 0.99, respectively), and the LF device showed better sensitivity at each threshold compared with the other devices used for caries diagnosis (0.94 at T1 and 0.79 at T2). The receiver operating characteristic curves presented that the LF device was more successful than the other techniques at T1 threshold and VI was better than the other caries detection methods at T2 threshold. The kappa values for interobserver agreements were 0.43 (LF pen), 0.33 (LED device), 0.55 (VI), and 0.75 (bitewing examination). Conclusion: The ability of bitewing radiography to identify sound surfaces was better than that of the other methods. The LF device was the most sensitive tool for detecting approximal surfaces with caries, followed by the LED device.

Objectives: We aimed to determine the relation between the radiographical depth of approximal lesions and the presence of bacteria in the dentine in posterior teeth in both dentitions.Material and Methods: Sample 1 consisted of 34 approximal lesions in primary molars in children aged 5-7 years old. Sample 2 consisted of 48 approximal lesions in molars and premolars in adult patients aged 18-67 years old. All lesions were in need of restorative treatment according to the dentists. During the operative interventions dentine biopsies were collected with a sterile bur just pulpally of the enamel-dentin junction. Two authors evaluated the presence/absence of bacterial colonies. The lesions depth on bitewing radiographs (RSCORING) were assessed independently by two examiners twice using the ICCMS classification system: RI=initial-; RM=moderate-; RE=extensive caries.Results: In sample 1, the RSCORING was distributed as follows: RI=15; RM=12; RE = 7. In 9 cases the lesions were clinically cavitated. Bacteria were visible on the agar plates in one case (7%) of the RI lesion, 86% of the RM lesions and in all the RE lesions, (p < .001). In sample 2, RSCORING was distributed as follows RI=14; RM=23; RE=9. In 15 cases, the lesions were clinically cavitated. In 2 cases (14%), there were visible bacteria on the agar plates among the RI lesions, while this was the case in 86% of RM lesions and in 100% of RE lesions (p < .001).Conclusions: RM and RE lesions seem to harbor bacteria in the dentine and are candidates for invasive treatment. In contrast, RI lesions should in general be managed non-invasively. [ABSTRACT FROM AUTHOR]

Objectives: With this in vitro study we aimed to assess the possibility of precise application of sealant on accessible artificial white spot lesions (WSL) on approximal surfaces next to a tooth surface under operative treatment. A secondary aim was to evaluate whether the use of magnifying glasses improved the application precision.Material and Methods: Fifty-six extracted premolars were selected, approximal WSL lesions were created with 15% HCl gel and standardized photographs were taken. The premolars were mounted in plaster-models in contact with a neighbouring molar with Class II/I-II restoration (Sample 1) or approximal, cavitated dentin lesion (Sample 2). The restorations or the lesion were removed, and Clinpro Sealant was placed over the WSL. Magnifying glasses were used when sealing half the study material. The sealed premolar was removed from the plaster-model and photographed. Adobe Photoshop was used to measure the size of WSL and sealed area. The degree of match between the areas was determined in Photoshop.Results: Interclass agreement for WSL, sealed, and matched areas were found as excellent (κ = 0.98-0.99). The sealant covered 48-100% of the WSL-area (median = 93%) in Sample 1 and 68-100% of the WSL-area (median = 95%) in Sample 2. No statistical differences were observed concerning uncovered proportions of the WSL-area between groups with and without using magnifying glasses (p values ≥ .19). However, overextended sealed areas were more pronounced when magnification was used (p = .01). The precision did not differ between the samples (p = .31).Conclusions: It was possible to seal accessible approximal lesions with high precision. Use of magnifying glasses did not improve the precision. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of a pen‑type laser fluorescence device (DIAGNOdent 2190; LFpen, KaVo, Germany) and bitewing radiographs (BW) for approximal caries detection in permanent and primary teeth. Materials and Methods: A total of 246 anterior approximal surfaces (102 permanent and 144 primary) were selected. Contact points were simulated using sound teeth. Two examiners assessed all approximal surfaces using LFpen and BW. The teeth were histologically assessed for the reference standard. Optimal cut‑off limits were calculated for LFpen for primary and permanent teeth. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (Az) were calculated for D1 (enamel and dentin lesions) and D3 (dentin lesions) thresholds. The reproducibility was assessed by intraclass correlation coefficient (ICC) and Cohen′s weighted kappa values. Results: For permanent teeth, the LFpen cut‑off were 0– 27 (sound), 28– 33 (enamel caries) and >33 (dentin caries). For primary teeth, the LFpen cut‑off were 0– 7 (sound), 8– 32 (enamelcaries) and >32 (dentin caries). The LFpen presented higher sensitivity values than BW for primary teeth (0.58 vs. 0.32 at D1 and 0.80 vs. 0.47 at D3) and permanent teeth (0.80 vs. 0.57 at D1 and 0.94 vs. 0.51 at D3). Specificity did not show a significant difference between the methods. Rank correlations with histology were 0.59 and 0.83 (LFpen) and 0.36 and 0.70 (BW) for primary and permanent teeth, respectively, considering all lesions. ICC values for LFpen were 0.71 (inter) and 0.86 (intra) for permanent teeth and 0.94 (inter) and 0.90/0.99 for primary teeth. Kappa values for BW were 0.69 (inter) and 0.68/0.90 (intra) for permanent teeth and 0.64 (inter) and 0.89/0.89 for primary teeth. Conclusion: LFpen presented better reproducibility for primary and permanent teeth and higher accuracy in detecting caries lesions at D1 threshold than BW for permanent teeth. LFpen should be used as an adjunct method for approximal caries detection.

Background: Although numerous studies have used digital intraoral imaging, only a few studies have used photooptical methods for the diagnosis of caries. Moreover, several limitations exist in terms of observers (experience and specialty) and the caries lesion itself. Hence, the aims of this study were to evaluate the diagnostic capability of nearinfrared light transillumination (NILT) and PSP-Bitewing radiographs and to compare the interobserver and intraobserver differences in addition to observers' experience level to detect early interproximal caries lesions in vivo. Methods: A total of 52 untreated posterior teeth with and without varying degrees of early interproximal carious lesions were included. Bitewing radiographs using digital phosphor plates (PSP-Bitewing) and NILT were used to clarify the diagnosis. An oral and maxillofacial radiologist and a restorative dentistry consultant evaluated the images twice. A separate appointment for clinical validation and restoration was made. Kappa coefficients were calculated to assess both intraobserver and interobserver agreements for each evaluation method. Scores obtained from PSP-Bitewing and NILT were compared with the clinical validation via receiver operating characteristic (ROC) analysis. Results: No significant differences were found between PSP-Bitewing radiography and NILT for detecting early interproximal carious lesions with high average Az results. Both intraobserver and interobserver agreement values were relatively higher for NILT evaluation. The Az values increased at second evaluations for both caries detection methods. Conclusions: NILT examination has an appropriate sensitivity and diagnostic accuracy for detecting early interproximal caries lesions and can be considered as a method of choice for detecting caries without the use of ionizing radiation. [ABSTRACT FROM AUTHOR]

Background/purpose Detection of approximal caries may be difficult using conventional methods including visual inspection (VI) and radiography. The purpose of this in vitro research was to evaluate the efficiency of light-emitting diode (LED) and laser fluorescence (LF) devices, and radiographic and visual examination in approximal caries diagnosis. Materials and methods One hundred and fifty-six approximal regions were evaluated. All approximal regions were investigated using LED and LF tools after radiography and VI were performed. Histological evaluation of teeth was performed using stereomicroscopy. The area under the receiver operating characteristic curve and accuracy, specificity, sensitivity values calculated regarding approximal caries diagnose. Results The specificity of the bitewing examination was higher for both T1 and T2 thresholds (0.97 and 0.99, respectively), and the LF device showed better sensitivity at each threshold compared with the other devices used for caries diagnosis (0.94 at T1 and 0.79 at T2). The receiver operating characteristic curves presented that the LF device was more successful than the other techniques at T1 threshold and VI was better than the other caries detection methods at T2 threshold. The kappa values for interobserver agreements were 0.43 (LF pen), 0.33 (LED device), 0.55 (VI), and 0.75 (bitewing examination). Conclusion The ability of bitewing radiography to identify sound surfaces was better than that of the other methods. The LF device was the most sensitive tool for detecting approximal surfaces with caries, followed by the LED device. [ABSTRACT FROM AUTHOR]

Background. Investigators use questionnaire surveys to evaluate treatment philosophies in dental practices. The aim of this study was to evaluate the management strategies California dentists use for approximal and occlusal carious lesions. Methods. In May 2013, the authors e-mailed a questionnaire that addressed approximal and occlusal carious lesion management (detection and restorative threshold, preferred preparation type, and restorative materials) to 16,960 dentists in California. The authors performed a χ² statistical analysis to investigate the relationship between management strategies and respondent demographic characteristics. Results. The authors received responses from 1,922 (11.3%) dentists; 42.6% of the respondents would restore approximal lesions at the dentinoenamel junction, and 33.4% would wait until the lesion reached the outer one-third of dentin. The preferred preparation type was the traditional Class II preparation. Dentists who graduated more recently (20 years or less) were more likely to delay approximal restorations (P < .0001); 49.9% of the more recent graduates would wait to restore an occlusal lesion until the outer one-third of dentin was involved, and 42.6% would restore a lesion confined to enamel. Conclusions. There is wide variety among California dentists regarding their restorative treatment decisions, with most dentists restoring a tooth earlier than the literature would advise. More recent dental graduates were more likely to place their restorative threshold at deeper lesions for approximal carious lesions. Practical Implications. Clinical evidence shows that noncavitated carious lesions can be remineralized; therefore, early restorative treatment may no longer be necessary or appropriate. Noninvasive and minimally invasive measures should be taken into consideration. [ABSTRACT FROM AUTHOR]

Objectives: Detection of approximal caries lesions can be difficult due to their anatomical position. This study aimed to assess the ability of the quantitative light-induced fluorescence- digital (QLF-D) in detecting approximal caries, and to compare the performance with those of the International Caries Detection and Assessment System II (ICDAS II) and digital radiography (DR). Methods: Extracted permanent teeth (n = 100) were selected and mounted in pairs. The simulation pairs were assessed by one calibrated dentist using each detection method. After all the examinations, the teeth (n = 95) were sectioned and examined histologically as gold standard. The modalities were compared in terms of sensitivity, specificity, areas under receiver operating characteristic curves (AUROC) for enamel (D1) and dentine (D3) levels. The intra-examiner reliability was assessed for all modalities. Results: At D1 threshold, the ICDAS II presented the highest sensitivity (0.80) while the DR showed the highest specificity (0.89); however, the methods with the greatest AUC values at D1 threshold were DR and QLF-D (0.80 and 0.80 respectively). At D3 threshold, the methods with the highest sensitivity were ICDAS II and QLF-D (0.64 and 0.64 respectively) while the method with the lowest sensitivity was DR (0.50). However, with regard to the AUC values at D3 threshold, the QLF-D presented the highest value (0.76). All modalities showed to have excellent intra-examiner reliability. Conclusions: The newly developed QLF-D was not only able to detect proximal caries, but also showed to have comparable performance to the visual inspection and radiography in detecting proximal caries. Clinical significance: QLF-D has the potential to be a useful detection method for proximal caries. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the performance of a pen-type laser fluorescence device (DIAGNOdent 2190; LFpen, KaVo, Germany) and bitewing radiographs (BW) for approximal caries detection in permanent and primary teeth. Materials and Methods: A total of 246 anterior approximal surfaces (102 permanent and 144 primary) were selected. Contact points were simulated using sound teeth. Two examiners assessed all approximal surfaces using LFpen and BW. The teeth were histologically assessed for the reference standard. Optimal cut-off limits were calculated for LFpen for primary and permanent teeth. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (A²) were calculated for D¹ (enamel and dentin lesions) and D³ (dentin lesions) thresholds. The reproducibility was assessed by intraclass correlation coefficient (ICC) and Cohen's weighted kappa values. Results: For permanent teeth, the LFpen cut-off were 0-27 (sound), 28-33 (enamel caries) and >33 (dentin caries). For primary teeth, the LFpen cut-off were 0-7 (sound), 8-32 (enamel caries) and > 32 (dentin caries). The LFpen presented higher sensitivity values than BW for primary teeth (0.58 vs. 0.32 at D¹ and 0.80 vs. 0.47 at D³) and permanent teeth (0.80 vs. 0.57 at D¹ and 0.94 vs. 0.51 at D³). Specificity did not show a significant difference between the methods. Rank correlations with histology were 0.59 and 0.83 (LFpen) and 0.36 and 0.70 (BW) for primary and permanent teeth, respectively, considering all lesions. ICC values for LFpen were 0.71 (inter) and 0.86 (intra) for permanent teeth and 0.94 (inter) and 0.90/0.99 for primary teeth. Kappa values for BW were 0.69 (inter) and 0.68/0.90 (intra) for permanent teeth and 0.64 (inter) and 0.89/0.89 for primary teeth. Conclusion: LFpen presented better reproducibility for primary and permanent teeth and higher accuracy in detecting caries lesions at D¹ threshold than BW for permanent teeth. LFpen should be used as an adjunct method for approximal caries detection. [ABSTRACT FROM AUTHOR]

Diagnosing the necessity of cavity preparation in demineralized proximal areas has been considered as a challenge in restorative treatment planning. The purpose of this study was to investigate the clinical performance of a modified radiographic technique for the detection of proximal cavities. The sample consisted of 44 proximal surfaces in 38 dental students. The patients had radiolucent proximal lesions restricted to the inner half of enamel or the outer third of dentine in bitewing radiographs, and there was doubt regarding the presence or absence of cavities in the approximal areas. The suspected surfaces were then examined by secondary bitewing radiographs which were taken after pressing radiopaque material into the proximal areas. Finally, orthodontic elastic separators were placed in the contact areas to provide enough space for direct visual and tactile examination, thus detecting any proximal cavity (reference standard). The sensitivity, specificity and accuracy of the modified bitewing radiography were calculated against the reference standard. Overall, 7 surfaces presented caries cavities according to the reference standard. All proximal radiolucencies observed in the inner half of enamel and 46% of those extended to the outer third of dentine were not cavitated when evaluated by direct visual and tactile examination. The sensitivity, specificity and accuracy of bitewing radiography with opaque material for detecting proximal cavities (n = 7) were 86, 100 and 98%, respectively. The tested radiographic technique displayed good validity in this pilot study for detecting proximal cavities in posterior teethand should be further investigated. © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Bitewing examination is helpful for detecting hidden lesions in the approximal surface and is an essential aid for clinical diagnosis. Objective: This study aim to assess the prevalence of approximal carious lesions from radiograph and treatment given. Methods: A retrospective record review study was carried out on 239 clinical records of patients age 14 and above who attended in dental clinic of HUSM from January 2008 to December 20011. Readable bitewings of second molar to first premolar were assessed for the absence or presence and depth of caries. Caries prevalence, distribution of caries and treatment given were calculated by frequency (%). Results: A total of 4538 surfaces were examined. Lesions confined to the outer half of the enamel and inner half of enamel were found in 7.1% and 3.5% of surfaces respectively. Lesions in outer half of dentine were 2.8% and lesions beyond the outer part of the dentine were 3.8%. No treatment was given for most of the surfaces with radiolucency in the enamel. Topical fluoride was given in the 4% of outer and 8.8% of inner half of the enamel. While surface with caries extend into dentine (59.7%) and more than half of dentine (58.6%) were replaced with restoration. The more extensive treatment such as RCT and extraction were found in 22.7% of dentinal caries surface. Conclusion: Both enamel and dentine caries prevalence was low. Most enamel caries were not intervened. Preventive intervention was given more in enamel caries. Dentinal caries were restored according to the depth. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: To compare the performance of LFpen (DIAGNOdent pen) with two different wedge-shaped tips to conventional bitewing radiography (BW) for detecting proximal secondary caries at the cervical margin of amalgam restorations in vitro. Methods: Seventy-five molars with class II amalgam restorations were selected. Depending on the marginal filling extension, data was subdivided into a crown group (C), when the filling ended in enamel, and into a root group (R), when the filling ended beyond the cementum-enamel junction. Bayesian analysis including calculation of the area under the receiver operating curve (AUC) was performed. Furthermore, Spearman correlations between caries and cofactors, such as presence of plaque or stain, occlusal ditching, marginal gap size, filling overhangs, and shortfalls, were calculated. Additionally, for group R the correlation coefficient between LFpen measurements and lesion depth was calculated. Histology served as gold standard. Results: In group C both at the D1 and D3 levels, LFpen with two different tips showed a better performance than bitewing radiography (AUC at D1: 0.83/0.79 (LFpen) and 0.63 (BW); at D3: 0.66/0.66 (LFpen) and 0.53 (BW)). In group R, the respective AUC values were 0.53/0.56 (LF) and 0.59 (BW). A significant medium correlation was observed for occlusal ditching and proximal caries. Stain accumulation at the restoration margins especially in combination with filling overhangs interfered with LFpen readings, resulting in false positive measurements. Conclusions: Compared to BW, LFpen enhances the detection of secondary caries lesions at the cervical margin of amalgam restorations that do not extend below the cementum-enamel junction. [Copyright &y& Elsevier]

Copyright of Pesquisa Brasileira em Odontopediatria e Clinica Integrada is the property of Pesquisa Brasileira em Odontopediatria e Clinica Integrada Journal (Brazil) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim was to measure variations in threshold for operative treatment of approximal caries in permanent teeth and the use of restorative materials, compared with results from studies conducted in Norway in 1983 and 1995. In 2009, a precoded questionnaire was sent electronically to 3,654 dentists with E-mail addresses in the member register of the Norwegian Dental Association. The questions were related to caries, treatment strategies and choice of dental materials. Replies were obtained from 61% of the dentists after two reminders. Restorative treatment of approximal lesions confined to enamel, based on radiographic appearance, was proposed by 7% of the dentists, compared with 66% in 1983 and 18% in 1995. Younger dentists, significantly more often than older, would defer operative treatment of approximal lesions until the lesion was visible in dentine. While tunnel preparation most often was the preparation of choice in 1995 (47%), saucer-shaped preparation was most favoured in 2009 (69%). Tunnel preparation was only preferred by 4% of the dentists. Resin composite was the restorative material preferred by 95%, compared with 16% in 1995. The corresponding values for conventional glass ionomer cement (GIC) were 1 versus 22%, for resin-modified GIC 1 versus 7%, and for a combination of GIC and resin composite 2 versus 22%. Compomer was preferred by 1% of the respondents. The authors conclude that treatment concepts for approximal caries have changed considerably during the last 26 years. In 2009, only 7% of dentists reported that they would treat approximal caries operatively before the lesion reached dentine. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. Methods: One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. Results: Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites (D 0, n =40) showed significantly lower laser fluorescence measurements than carious sites (D 1–4, n =77) (Mann–Whitney test, P <0.025) suggesting a cut-off at 7 (sensitivity=0.68, specificity=0.7). Comparing measurements of D 0–2 (n =74) and D 3,4 (n =43), the results were also different by a statistically significant amount (P <0.025) and the cut-off calculated to be 16 (sensitivity=0.6, specificity=0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho=+0.47, P <0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho=+0.34, P =0.03) and a moderately strong correlation to the radiographic scoring (rho=+0.67, P <0.01). Conclusion: The device may be an adjunct tool in the approximal detection of caries along with established procedures. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: This in vitro study aimed at evaluating the ability of Laser Fluorescence device (LFpen) in quantifying approximal caries lesions in primary molars. Methods: Two examiners assessed 123 approximal surfaces of primary molars using the DIAGNOdent pen (LFpen). Surfaces were determined to be either sound with white-spot lesions or have small cavitations. After sectioning, lesion depth was determined through polarized light microscopy. The intra-/inter-examiner agreement was calculated using intraclass correlation coefficient (ICC) and Bland–Altman analyses. Furthermore, Spearman correlation coefficients (Rs) were calculated between LFpen readings and lesion depth. Results: Correlation between LFpen values and lesion depth was low for both examiners (Rs=0.36 and 0.51), especially when cavitated lesions were excluded from the analysis (Rs=0.22 and 0.40). For all surfaces, ICC revealed intra- and inter-examiner reproducibility values of 0.75 and 0.63, respectively, but when only non-cavitated surfaces were analyzed, these values decreased (0.41 and 0.33, respectively). Conclusions: LFpen readings present low correlation with approximal caries lesion depth and low reproducibility, especially in white-spot lesions. Therefore, the device could not be a suitable method for monitoring non-cavitated approximal caries lesion in primary molars. [Copyright &y& Elsevier]

Copyright of Swedish Dental Journal is the property of Swedish Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Swedish Dental Journal is the property of Swedish Dental Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: The aim of this study was to compare the diagnostic quality of a new wireless handheld unit (ADX4000; Dexcowin Co. Ltd, Korea) on conventional bitewings and its LCD screen for the detection of approximal caries in primary teeth. Methods: In total, 108 approximal surfaces of primary teeth were examined in vitro by 3 observers. Conventional films were viewed under subdued lighting conditions on a conventional view box. Digital 3.5 inch images were displayed on the built-in monitor of the ADX4000 and digital 17 inch images were viewed on a 17 inch monitor. The true caries diagnosis was based on histological assessment of the approximal surfaces after sectioning the primary teeth. Receiver operating characteristic (ROC) curve (Az) analysis was used to assess the diagnostic quality of imaging modalities. Results: The areas under the ROC curves ranged from 0.786 (digital 17 inch) to 0.813 (digital 3.5 inch). No statistically significant differences were found between the three modalities for detecting approximal caries. Conclusions: It was concluded that the diagnostic quality of conventional film and digital images, which were exposed and viewed by a new wireless handheld unit, was comparable. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the influence of the zero value subtraction on the performance of laser fluorescence (LFpen) for approximal caries detection. Three areas (cuspal, middle and cervical) of both mesial and distal buccal surfaces of 78 permanent molars were assessed using both wedge-shaped (WDG) and tapered wedge-shaped (TWDG) tips. With the addition of the average, one cut-off value for each area was obtained and the performance was assessed. The areas under the receiver operating characteristics (ROC) curve, specificity, sensitivity and accuracy with and without the zero value subtraction were calculated. The McNemar test revealed a statistically significant difference for specificity at thresholds D(1), D(2) and D(3) (WDG) and D(1) and D(2) (TWDG) when the zero value subtraction was not performed. Influence of the zero value subtraction on the LFpen performance was observed for approximal caries detection. However, when modified cut-off values were used, the zero value subtraction could be eliminated. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to investigate the diagnostic accuracy of conventional bitewing, periapical radiographs, unfiltered and filtered digital panoramic images for the assessment of approximal carious lesions in posterior teeth. Methods: 20 patients who required bitewing, periapical and panoramic radiographs participated in the study. The digital panoramic images were treated with the ''sharpen'', ''smooth'' and ''emboss'' filters. Three experienced observers evaluated the bitewing and periapical radiographs, and the unfiltered and filtered digital panoramic images for the presence or absence of approximal carious lesions according to a 5-point confidence scale. Intra- and interobserver reliability was analysed with the Cronbach alpha test and diagnostic accuracy was evaluated using receiver operating characteristic (ROC) analysis. Results: According to the results, the intra- and interobserver agreement levels were found to be almost perfect. The highest diagnostic accuracy was found for the bitewing, followed by the periapical and panoramic images. Compared with the unfiltered panoramic images, the filtered images had an almost equal or slightly higher diagnostic accuracy. The largest increase in diagnostic accuracy was observed for those images filtered with the emboss filter. Conclusions: The accuracy of unfiltered and filtered digital panoramic images is lower than conventional bitewing and periapical radiographs. The filtration of the digital panoramic images, especially the emboss filter, may have some value for the detection of approximal carious lesions. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of the scanning resolution of storage phosphor plate (SPP) radiographs on the detection of proximal caries lesions. Methods: 10 dentists evaluated 72 proximal surfaces of premolars with respect to caries from SPP radiographs scanned with theoretical spatial resolutions of: (1) the Digora FMX at 7.8 lp mm-1; (2) the Digora Optime at both 7.8 lp mm-1 and 12.5 lp mm-1; and (3) the Dürr VistaScan at 10 lp mm-1 and 20 lp mm-1, respectively. The lesions were validated by histological examination. Receiver operating characteristic (ROC) analysis was employed. Results: The Az value for the radiographs scanned with the Dürr VistaScan at 10 lp mm-1 is significantly lower than those for the other series of radiographs (P = 0.000). Conclusions: For SPP radiographs, an increased theoretical spatial resolution per se is not related to an improved detection of proximal caries. [ABSTRACT FROM AUTHOR]

The aim was to investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience (including initial caries lesions) at the age of 15 years (n = 568). Data were selected from examinations, interviews and questionnaires at 1 and 3 years and bitewing radiographs at 15 years. Four levels of cut-off points for the statistical analysis were used: DFa = 0, > 0, ≥4 and ≥8. In the final logistic regression analyses, mother’s self-estimation of her oral health care being less good remained statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa ≥4: (1) female gender, (2) plaque on maxillary incisors at 1 year, (3) mother’s self-estimation of her oral health care being less good and (4) father being less satisfied with his social situation. Two variables predicted DFa ≥8: (1) toothbrushing with fluoride toothpaste just once a day, and (2) father being less satisfied with his social situation. Furthermore, children who failed to attend the examination at 1 year of age had 6.95 ± 5.36 (mean ± SD) DFa at 15 years compared with 3.10 ± 3.85 for children who were examined at 1 year of age (p < 0.01). To conclude, factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study investigated the effect of compomer on initial interproximal caries development. One-hundred and sixty cylindrical, and 40 semispherical, bovine enamel samples (control) were prepared, polished, and sterilized. Sixty semicircular samples were prepared from each of the compomer Dyract eXtra and the fluoride-free composite Spectrum TPH. Samples were stored in water and fluoridated twice daily for 28 d. A baseline quantitative light fluorescence (QLF) image was made of each cylindrical sample. Twenty volunteers received intra-oral appliances with eight sample chambers. Each wing contained 1 control sample and either 3 Dyract eXtra or 3 Spectrum TPH samples in contact with the enamel surface of a cylindrical enamel sample. Appliances were worn for 24 h a day for 28 d except during toothbrushing (twice daily) and placement in 10% sucrose solution (five times daily). A final QLF image was made after 28 d. Caries development was analyzed as the lesion area × mean fluorescence loss (ΔQ % mm2) between these and the baseline images using QLFsubtract software. The median ΔQ was significantly lower in the Dyract eXtra group (−6.1% mm2) than in the Spectrum TPH (−13.9% mm2, P ≤ 0.001) or control (−11.4% mm2, P = 0.03) groups. Teeth in contact with the compomer developed less caries compared with controls. [ABSTRACT FROM AUTHOR]

The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospectively followed Swedish population (n = 568), with special reference to their caries experience at the age of 3 years. Only approximal surfaces were recorded, since all children in the Community of Jönköping have had fissure sealing performed on all caries-free permanent molars. At 15 years of age, the mean number of approximal tooth surfaces with initial caries lesions (Dia), manifest caries lesions and fillings (DmFa) and total caries experience and fillings (Di + mFa) – recorded on bitewing radiographs – was 2.78 , 0.45 and 3.23, respectively. One third of the adolescents had no approximal caries or fillings; the Dia constituted 86% of the Di + mFa. Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age (41 vs. 17%). Furthermore, children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries (37 vs. 17%). All these differences were statistically significant (p < 0.001). Additionally, early childhood caries experience (developed before 3 years of age) had a greater predictive value than late childhood caries experience (developed between 3 and 6 years of age) concerning approximal caries at 15 years of age. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aims were to determine caries prevalence in 9-year-olds belonging to a low-caries prevalence population and to assess how accurately some commonly used risk factors/risk markers (predictors) can identify additional approximal caries as judged from bitewing examination (BW). One calibrated dentist examined 117 consecutive 9-year-olds from the inner city of Stockholm. The predictors were the number of clinically detected dfs and DFS, visible plaque, salivary mutans streptococci, tooth brushing habits, consumption of sugary products, parents’ education, and (before BW) an overall clinical judgement by the examiner. Analyses of the data included sensitivity and specificity and a multiple logistic regression model. When BW was included, the mean DFS was 0.27 and the mean dfs 1.74. For approximal enamel and dentin lesions, the average gain from BW was 0.20 lesions for permanent first molars and 1.23 lesions for primary molars. Altogether, 48% of the children benefited from BW. The best predictors of additional approximal caries from BW were presence of caries (cavitation/dentin level) on occlusal surfaces of permanent first molars and the dentist’s judgement based on clinical findings, both with a combined sensitivity and specificity of 134%. The only statistically significant variables in a logistic regression model were the dentist’s judgement and the child’s statement about regular tooth brushing. It is concluded that a sizeable proportion of 9-year-olds, representing a low-caries prevalence population, benefited from BW. However, the ability to identify these children from the predictors was limited. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study was to test whether the status of the adjacent tooth surface has an influence on the signal of a new laser fluorescence (LF) device for the detection of approximal caries. Seventy-eight teeth were selected from a pool of extracted permanent human molars, frozen at −20°C until use. Before being measured the teeth were defrosted, cleaned, and any calculus removed. As a control, a defined approximal surface of each tooth was measured with the LF device holding the tip with the detecting- and the reverse-side on it, but without a neighboring tooth contacting the surface. The proximal site under examination was then placed adjacent to a tooth, which had deep dentinal caries, a composite restoration, a provisional ZnO-Eugenol restoration, or a ceramic restoration. The adjacent tooth with the ZnO-Eugenol restoration, the composite restoration, and the dentinal caries all demonstrated a statistically significant increase of LF readings on sound tooth surfaces. Teeth with enamel or dentinal caries were only slightly (and not statistically significantly) influenced by the different types of neighboring surfaces compared with the control LF readings. It can be concluded that caries detection of approximal tooth surfaces with the new LF system might be influenced by the condition of the adjacent tooth surface. [ABSTRACT FROM AUTHOR]

The laser device DIAGNOdent developed for the detection of occlusal caries has limited value on approximal surfaces. The aim of this study was to develop and to test a new laser fluorescence (LF) device for the detection of approximal caries. Light with a wavelength of 655 nm was transported to the approximal surface using two different sapphire fibre tips. Seventy-five teeth were selected from a pool of extracted permanent human molars, frozen at –20°C until use. Before being measured, they were defrosted, cleaned and calculus was removed with a scaler. The molars were set in blocks simulating the contact area of adults. Bitewing radiographs were obtained using Kodak Insight films. After two independent assessments with the new LF device, the teeth were histologically prepared, and assessed for caries extension. Using the laser, specificity values for D1 threshold (outer half of enamel), D2 threshold (inner half of enamel), D3 threshold (dentine) ranged between 0.81 and 0.93, sensitivity between 0.84 and 0.92 with no difference between the two tips. Bitewing radiography showed an inferior performance compared to LF (p < 0.05). Intraex aminer reproducibility was high (kappa >0.74). The new LF system might be a useful additional tool in detecting approximal caries. Because of its good reproducibility, it could be used to monitor caries regression or progression on approximal surfaces. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim was to evaluate a 3-year randomised controlled trial of school-based fluoride mouth rinsing (FMR) on approximal caries development in 13- to 16-year-olds with low to moderate caries risk. The adolescents used F toothpaste at home and underwent prophylactic treatment at yearly check-ups at public dental clinics. Out of 788 randomly selected 13-year-olds, 622 completed the trial, carried out in 1999–2003. Supervised by a dental nurse, the subjects rinsed with a 0.2% NaF solution at different intervals. Group 1 rinsed their teeth on the first three schooldays every semester; group 2 on the first three and the last three schooldays every semester; group 3 on three consecutive days once a month during semesters; group 4 once every fortnight during semesters, and group 5 (control) did not rinse. Radiographic recording of approximal caries was performed. FMR on the three first and the three last schooldays every semester (group 2) had a prevented fraction of 59%, with approximal enamel lesions as a diagnostic threshold. Corresponding figures for groups 1, 3 and 4 were 30, 47 and 41%, respectively. The control group differed statistically from groups 2–4 for new enamel and dentin lesions and fillings (p < 0.01). Enamel lesions constituted more than 90% of the new caries lesions. Caries progression was low for all groups and no significant differences were found between groups. The main conclusion from this randomised controlled trial is that school-based FMR, as a supplement to the daily use of F toothpaste, reduces caries incidence on approximal surfaces in adolescents with low to moderate caries risk. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We have in two earlier studies evaluated the effect of professional flossing with chlorhexidine (CHX) gel treatment, in 4- to 7-year-old preschool children and in 12- to 15-year-old teenagers. The mean caries reduction after 3 years was around 40% compared to placebo gel or no gel treatment. The aim of the present investigation was to follow up these two clinical studies. The preschool children were followed up to the age of 16 years and the teenager group to the age of 19. Of the total number of original children, 71 and 80% were available at the age of 16 and 19 years, respectively. At the 9-year follow-up, when the children were 16 years old, the former CHX group had still significantly lower mean DFS than the control group (p < 0.05). The differences in caries increment occurred between 7 and 12 years of age, whereas the number of new caries lesions during the next 4 years were almost the same in the three groups. At the 4-year follow-up, when the teenagers were 19 years old, DFS was 6.9 in the former CHX group compared to 10.4 in the control group (p < 0.05). The main conclusion of these two follow-up studies after 9 and 4 years, respectively, is that caries reductions obtained at the end of professional flossing with a 1% CHX gel were maintained. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. Two hundred and sixty-seven consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs (decayed, missing and filled surfaces) value (canines and molars), the number of occlusal dmfs, the frequency of intake of between-meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs value without bitewing examination was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33% at least one enamel lesion that were detected from bitewing examination only. The gain from adding bitewing examination to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist’s overall judgement with an average precision of 73%; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33% of the 5-year-olds, representing a low caries prevalence population, benefited from bitewing examination. The ability to identify these children from the predictors was, however, limited. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim was to evaluate the effect of two toothpicks and two dental flosses on demineralized enamel and dentine and on plaque composition, using an in situ model with simulated approximal spaces within dentures. Fifteen subjects with full dentures were recruited and 14 completed the study. It consisted of two crossover periods, the first comparing a birch toothpick with AmF and a birch toothpick with NaF, and the second comparing a dental floss with AmF + NaF and a dental floss without F. Between these four periods, there was a control period without any approximal cleaning. In small, rectangular sample holders, one enamel and one dentine specimen were embedded, forming a triangular, approximal-like space. Two sample holders were mounted in the premolar-molar region of the upper or lower dentures. The subjects used the toothpicks or dental flosses 3 times/day for 4 weeks. The results showed that all toothpicks and dental flosses inhibited further demineralization compared to the control period (p < 0.001). The dental flosses were somewhat more effective in this respect than the toothpicks, especially in dentine. There were relatively small numerical differences between AmF and NaF toothpicks, but in favour of NaF regarding mineral gain (p < 0.05). The fluoridated floss gave somewhat less lesion depth in dentine than the non-fluoridated floss (p < 0.01). Toothpicks and flosses resulted in lower counts of microorganisms in plaque compared to the control period (p < 0.001); the AmF toothpick gave a more pronounced reduction than the NaF toothpick (p < 0.001). Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Previous studies on the effect of the chlorhexidine and thymol-containing varnish (Cervitec®) have consistently shown a reduction in Streptococcus mutans, while the data on the caries-inhibiting effect are conflicting. Aim: To measure the effect of a chlorhexidine- and thymol-containing varnish (Cervitec) on approximal caries in a low caries population. Material: Eighty-five schoolchildren, 13 years of age, entered the study after being selected on the basis of bitewing radiographs. Children with at least one approximal lesion were included after informed consent. Methods: The study was carried out as a double-blind, randomized controlled trial according to a split-mouth design using Cervitec on one side and a placebo varnish on the other side. All approximal surfaces between molars and premolars were treated every 3rd month. After 2 years new bitewing radiographs were taken. A total of 73 children completed the 2-year study. Results: Neither the difference in number of new lesions between the Cervitec-treated and the placebo-treated side (d: -0.21; 95% CI: -0.57; 0.16) nor the mean difference in number of already existing lesions that progressed (d: -0.01; 95% CI: -0.33; 0.30) were statistically significant (paired t test; p > 0.05). Conclusion: The results of our study do not indicate an effect of Cervitec on initiation or progression of approximal caries in a population with a low DMFS. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the use of computer-assisted densitometric image analysis (CADIA) to detect incipient approximal carious lesions in vitro and to compare areas of demineralization and mechanically induced lesions by radiographic visual inspection.Methods. Thirty-six extracted non-carious human molars were demineralized in a defined approximal area of interest (AOI) using a gel system (pH 4.8) applied over 15 weeks. Standardized digital radiographs were taken before and after creation of caries-like lesions and grayscale values were measured within the AOI. For another group of eight teeth, artificial defects were mechanically induced by a diamond bur and densitometric analysis was performed. Statistical significance was tested using the Wilcoxon test and set at p≤0.05. In addition, radiographs were interpreted by visual examination by six experienced dentists. The sensitivity and specificity for both study groups were determined in comparison to a baseline group of untreated teeth. Polarized light microscopy and SEM analysis were used to evaluate changes in the subsurface mineralization pattern and surface micromorphology.Results. Densitometric comparison of images from identical regions in control teeth revealed no significant grayscale value differences within the AOI, whereas a significant decrease (p≤0.05) was observed in the demineralized group. Mechanically induced lesions also showed a significant densitometric decrease (p≤0.05). The sensitivity of visual inspection of radiographs of demineralized areas was 0%. In contrast, the sensitivity for the detection of a mechanical defect of 0.1 mm, which was the same subsurface extension as the histologically determined demineralization, increased to 52%. Specificity was 100% for all groups.Conclusions. CADIA is able to detect very small changes in mineralization of incipient carious approximal lesions in vitro. The findings presented in this investigation may improve the subtraction method used for diagnosis and monitoring of approximal caries, as well as prophylactic measures. [Copyright &y& Elsevier]