Search

Objective: This study investigated the accuracy of the Canary System (CS) to detect proximal caries lesions in vitro, and compared it with conventional methods: International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (BW)., Methods: Visible proximal surfaces of extracted human teeth were assessed by ICDAS-II before setting them in five manikin mouth models. Then contacting proximal surfaces in mouth models were assessed by BW and CS. Histological validation with polarized-light microscopy served as a gold standard. Pairwise comparisons were performed on area under the curve (AUC), sensitivity, and specificity of the three methods, and corrected using Bonferroni's method. Sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong's method., Results: The CS presented significantly higher sensitivity (0.933) than ICDAS-II (0.733, P = 0.01) and BW (0.267, P < 0.001), and ICDAS-II higher sensitivity than BW (P < 0.001). There were no significant differences between their specificity values: 0.825 (CS), 0.65 (ICDAS-II), and 0.875 (BW). The AUC of CS (0.862) was significantly higher than of ICDAS-II (0.681, P < 0.001) and BW (0.577, P < 0.001)., Conclusion: The CS demonstrated greater accuracy in detecting proximal lesions than ICDAS-II and BW, although without significantly higher specificity., (© 2015 Wiley Publishing Asia Pty Ltd.)

We evaluated the predictive and construct validity of a caries activity assessment system associated with the International Caries Detection and Assessment System (ICDAS) in primary teeth. A total of 469 children were reexamined: participants of a caries survey performed 2 yr before (follow-up rate of 73.4%). At baseline, children (12-59 mo old) were examined with the ICDAS and a caries activity assessment system. The predictive validity was assessed by evaluating the risk of active caries lesion progression to more severe conditions in the follow-up, compared with inactive lesions. We also assessed if children with a higher number of active caries lesions were more likely to develop new lesions (construct validity). Noncavitated active caries lesions at occlusal surfaces presented higher risk of progression than inactive ones. Children with a higher number of active lesions and with higher caries experience presented higher risk of developing new lesions. In conclusion, the caries activity system associated with the ICDAS presents predictive and construct validity in primary teeth in the assessment of occlusal caries lesions, but predictive validity was not observed in smooth surfaces., (© International & American Associations for Dental Research.)

Unlabelled: The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment., Trial Registration: ISRCTN65592532.

Objectives: This study aimed to evaluate the magnitude of the reduction in caries parameters after inclusion of dental caries activity assessment, in an epidemiological survey of preschool children, involving cavitated and noncavitated caries lesions., Methods: The survey was carried out in Santa Maria, Brazil, during the National Children's Vaccination Day, and 639 children aged between 12 months and 59 months were included. Fifteen examiners assessed the children based on the International Caries Detection and Assessment System (ICDAS) and additional lesion activity assessment criteria. The mean of decayed surfaces (d-s), the mean of decayed teeth (d-t), caries prevalence, and 95% confidence intervals were calculated, initially by classifying all lesions using the various thresholds defined by the ICDAS. Caries activity status was then evaluated, and inactive lesions were classified as sound in a secondary analysis; subsequently, the same caries parameters, at the same thresholds, were recalculated. The reduction in caries parameters and the number of children requiring assessment to change their classification from decayed to sound (number needed to be assessed) were also calculated., Results: The majority of lesions were classified as active, mainly at cavitated thresholds. When activity was considered, values of all caries parameters decreased. This decrease was more evident at noncavitated thresholds. The number of children requiring assessment to change their classification from decayed to sound was <20 considering all lesions, but this value increased to approximately 100 when we included only cavitated lesions., Conclusions: The inclusion of activity assessment in caries epidemiological surveys has little impact on the d-s, d-t and prevalence of dental caries considering both noncavitated and cavitated lesions., (© 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study was conducted to assess caries treatment thresholds among Japanese dentists and to identify characteristics associated with their decision to intervene surgically in proximal caries lesions within the enamel. Participants (n = 189) were shown radiographic images depicting interproximal caries and asked to indicate the lesion depth at which they would surgically intervene in both high- and low-caries-risk scenarios. Differences in treatment thresholds were then assessed via chi-square tests, and associations between the decision to intervene and dentist, practice, and patient characteristics were analyzed via logistic regression. The proportion of dentists who indicated surgical intervention into enamel was significantly higher in the high-caries-risk scenario (73.8%, N = 138) than in the low-caries-risk scenario (46.5%, N = 87) (p < 0.001). In multivariate analyses for a high-caries-risk scenario, gender of dentist, city population, type of practice, conducting caries-risk assessment, and administering diet counseling were significant factors associated with surgical enamel intervention. However, for a low-caries-risk scenario, city population, type of practice, and use of a dental explorer were the factors significantly associated with surgical enamel intervention. These findings demonstrate that restorative treatment thresholds for interproximal primary caries differ by caries risk. Most participants would restore lesions within the enamel for high-caries-risk individuals.

When the International Caries Detection and Assessment System (ICDAS-II) was introduced, a two-number coding system that identifies restorations/sealants with the first digit and scores the caries lesions with a second digit was suggested. The aim of this study was, first, to assess the intra- and interexaminer reproducibility of this method applied by predoctoral dental students and, second, to evaluate the influence of an additional theoretical training session on the reproducibility values. Twenty-four third-year dental students at Philipps University of Marburg, Germany, were trained in a theoretical session by an experienced examiner. The students were randomly divided into two groups to examine extracted teeth. The assessments were repeated after three weeks. Prior to the second examinations, one group received an additional theoretical training session. For the restoration code, mean kappa values for intra- and interexaminer reproducibility were between 0.28 and 0.82. For the caries code, mean kappa values for intra- and interexaminer reproducibility were between 0.34 and 0.72. The mean kappa values of the two groups did not differ significantly, either on the first digit or on the caries code (p>0.05).

Aim: To examine dental students' consistency in utilising the International Caries Detection and Assessment System (ICDAS) one and three months after training., Study Design: A prospective study., Methods: All clinical dental students (Year Two: BDS2; Year Three: BDS3; Year Four: BDS4) as part of their education in Paediatric Dentistry at Aberdeen Dental School (n = 56) received baseline training by two "gold-standard" examiners and were advised to complete the 90-minute ICDAS e-learning program. Study One: One month later, the occlusal surface of 40 extracted primary and permanent molar teeth were examined and assigned both a caries (0-6 scale) and restorative code (0-9 scale). Study Two: The same teeth were examined three months later., Statistics: Kappa statistics were used to determine inter- and intra-examiner reliability at baseline and after three months., Results: In total, 31 students (BDS2: n = 9; BDS3: n = 8; BDS4: n = 14) completed both examinations. The inter-examiner reliability kappa scores for restoration codes for Study One and Study Two were: BDS2: 0.47 and 0.38; BDS3: 0.61 and 0.52 and BDS4: 0.56 and 0.52. The caries scores for the two studies were: BDS2: 0.31 and 0.20; BDS3: 0.45 and 0.32 and BDS4: 0.35 and 0.34. The intra-examiner reliability range for restoration codes were: BDS2: 0.20 to 0.55; BDS3: 0.34 to 0.72 and BDS4: 0.28 to 0.80. The intra-examiner reliability range for caries codes were: BDS2: 0.35 to 0.62; BDS3: 0.22 to 0.53 and BDS4: 0.22 to 0.65., Conclusion: The consistency of ICDAS codes varied between students and also, between year groups. In general, consistency was greater for restoration codes.

Objectives: To (1) identify the methods that dentists in The Dental Practice-Based Research Network (DPBRN) use to diagnose dental caries; (2) quantify their frequency of use and (3) test the hypothesis that certain dentist and dental practice characteristics are significantly associated with their use., Methods: A questionnaire about methods used for caries diagnosis was sent to DPBRN dentists who reported doing some restorative dentistry; 522 dentists participated. Questions included the use of dental radiographs, the dental explorer, laser fluorescence, air-drying and fiber-optic devices and magnification as used when diagnosing primary, secondary/recurrent or non-specific caries lesions. Variations on the frequency of their use were tested using multivariate analysis and Bonferroni tests., Results: Overall, the dental explorer was the instrument most commonly used to detect primary occlusal caries and caries at the margins of existing restorations. In contrast, laser fluorescence was rarely used to help diagnose occlusal primary caries. For proximal caries, radiographs were used to help diagnose 75%–100% of lesions by 96% of the DPBRN dentists. Dentists who use radiographs most often to assess proximal surfaces of posterior teeth were significantly more likely to also report providing a higher percentage of patients with individualized caries prevention (p=.040) and seeing a higher percentage of pediatric patients (p=.001)., Conclusion: The use of specific diagnostic methods varied substantially. The dental explorer and radiographs are still the most commonly used diagnostic methods..

Objectives: The purpose of this study was: (a) to compare the visual caries classification system ICDAS II with conventional (CR) and digital radiography (DR) for diagnosis of non-cavitated caries on free proximal surfaces, (b) to examine the potential of micro-computed tomography (MCT) to substitute histological examination for the in vitro caries assessment., Methods: Both proximal surfaces of 20 teeth received classification separately by two examiners by means of the diagnostic modalities examined. The teeth were sectioned and assessed for depth of the lesion. The modalities were compared in terms of degree of inter-examiner agreement, sensitivity, specificity, accuracy, positive and negative predictive value and validity. Two diagnostic thresholds were applied: no caries versus all caries scores (D1), and no dentin caries versus dentin caries (D3)., Results: The weighted kappa values for inter-examiner reproducibility for all diagnostic modalities were 0.51-0.81. Visual examination (ICDAS II) reached significant higher sensitivity (0.92-0.96) and negative predictive value (0.9-1) than radiography. Likewise, the radiographic modalities presented significantly higher specificity (0.93-1) and positive predictive values (0.92-1) than the ICDAS II criteria. The overall accuracy performance of radiographic modalities was related to the diagnostic threshold. MCT did not agree with histological validation at each disease severity scale., Conclusions: The ICDAS II criteria are a promising tool for caries diagnosis on free proximal surfaces. DR and CR radiography present comparable performance. Furthermore, MCT is not capable of constituting a reliable alternative to histological examination for caries research., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objectives: The Icelandic Oral Health Survey aimed to obtain new national data on the oral health of Icelandic children and teenagers., Methods: A representative stratified random cluster sample of 2251 Icelandic children in first, seventh and 10th grade, aged approximately 6-, 12- and 15-years old was examined for caries prevalence using the ICDAS criteria. Bite-wing digital radiographs were obtained for the children in 7th and 10th grade., Results: D(3)MFT scores by visual examination of 6-, 12- and 15-year olds were 0.12, 1.43 and 2.78 respectively but when including radiographs, the D(3)MFT rose to 2.11 at 12 years and 4.25 at 15 years. The Significant Caries Index, SiC, by visual examination for 12 and 15 y was 3.7 and 6.7 respectively but was 4.7 for 12 y and 8.9 for 15 y with radiographs. In all age groups and at most disease levels, caries was active in the majority of the lesions (58-100%). The percentage of children with no visually detectable caries at D(3)/D(1) level was 93%/74% for 6 years, 48%/22% for 12 years and 35%/16% for 15 years. When radiographs were included the percentage reduced to 34%/15% for 12 years and 20%/6% for 15 years. Approximately 80% of 12- and 15-year-olds had at least one of their first molars sealed, with the mean number of sealed first molars being 2.2 among 12 y and 2.0 among 15 y., Conclusions: Caries levels were higher than expected in this national survey and further away from the goals of the National Health Plan for 2010 than anticipated. Caries distribution was skewed with more than half of the children having low caries scores but a wide distribution of caries experience was seen among the remaining population.

Data mining of digital dental records provides possibilities for analysing the variation between dentists when diagnosing caries. A total of 71,317 male and 82,302 female subjects visited the health centres in Vantaa and Kemi during the 'digital era' (1994-2005). As subjects were classified as 'new patients' at the first examination, all re-examinations of the same subjects thereafter by the same dentist produced 'old patients'. A mean number of decayed surfaces (DS) was counted as a function of the age of the subject during the follow-up. The significance of the difference between old and new patients was determined by the Mann-Whitney test for each age cohort at the cross sections, and for the whole follow-up. Caries was seen to affect new patients more than the old ones in both health centres after the age of 20 years. The mean DS values were the same, reaching about 1 for new and old patients at the age of 15 years. The mean DS had a peak for new patients in both health centres at the age of 25 years and another peak around 45-50 years in Kemi. With a few exceptions there was a significant difference between the DS values of new and old patients at most cross sections and for the whole follow-up time. Evidently dentists examine new patients more carefully than their old patients. After the age of 18 years patients may have changed their dentists because they have finished the free-of-charge treatment period.

Oratest, a caries activity test was performed on 48 school going children of Mangalore city to estimate efficacy of the test. High statistical significance was found when the means of control and test group were compared [gamma = 0.913]. The Oratest is found to be a simple chair side, less time consuming and inexpensive caries activity test.

The purpose of this research was to study the efficacy of three CAT's (Dentocult SM, Dentocult LB and Dentobuff Strip) in revealing caries condition and predicting caries progress, and provide a reference for application by comparing the three tests. Oral condition and results of the three CAT's of 82 children aged 3 to 4 were recorded and followed up. The examination was checked again two years later. The caries incidence, dft and CSI data from the two examinations were analyzed statistically. The results were that each Dentocult SM degree showed significant variances in incidence rate, as did the dft and CSI results in the second examination. The dft and CSI of both examinations exhibited a high degree of statistical significance. The same may be said of the Dentocult LB findings for the two years. No noticeable variances in caries incidence rate, dft and CSI from the Dentobuff Strip test were observed in both years' study, nor was there any statistical significance drawn from the findings, except for those of the second exam. No gender differences were observed in the distribution by degree with the three CATs The conclusion is that Dentocult SM is the best of the three tests for the diagnosis of the presence of caries and prognosis of its progress, Dentocult LB is second best whereas the Dentobuff Strip shows no detection capability. The findings serve as an application reference.

The aim of the paper is to answer the question whether the Dentocult SM tests could be used to study dental caries activity in the 20-25 age group. 66 students of the Faculty of Dentistry, Medical University of Lublin, were included in the study. In all cases dental state was assessed by using average numbers of DMF and DMFs Ds. In the microbiological examinations a ready-made medium from Dentocult SM set was used. The results revealed that the risk of dental caries in the population studied cannot be determined only on the basis of Streptococcus mutans values.

This study compared the ability of two sodium fluoride dentifrices, one containing 5,000 ppm fluoride (Prevident 5000 Plus) and the other 1,100 ppm fluoride (Winterfresh Gel), to reverse primary root caries lesions (PRCLs). A total of 201 subjects with at least one PRCL each entered the study and were randomly allocated to use one of the dentifrices. After 6 months, 186 subjects were included in statistical analyses. At baseline and after 3 and 6 months, the lesions were clinically assessed and their electrical resistance measured using an electrical caries monitor. After 3 months, 39 (38.2%) of the 102 subjects in the 5,000 ppm F- group and 9 (10.7%) of 84 subjects using the 1,100 ppm F- dentifrice, had one or more PRCLs which had hardened (p = 0.005). Between baseline and 3 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group had decreased by 0.06+/-0.55, whereas those in the 5,000 ppm F- group had increased by 0.40+/-0.64 (p<0.001). After 6 months, 58 (56.9%) of the subjects in the 5,000 ppm F- group and 24 (28.6%) in the 1,100 ppm F- group had one or more PRCLs that had become hard (p = 0.002). Between baseline and 6 months, the log10 mean +/- SD resistance values of lesions for subjects in the 1,100 ppm F- group decreased by 0.004+/-0.70, whereas in the 5,000 ppm F- group, they increased by 0.56+/-0.76 (p<0.001). After 3 and 6 months, the distance from the apical border of the root caries lesions to the gingival margin increased significantly in the 5,000 ppm F- group when compared with the 1,100 ppm F- group. The plaque index in the 5,000 ppm F- group was also significantly reduced when compared with the 1,100 ppm F- group. The colour of the lesions remained unchanged. It was concluded that the dentifrice containing 5,000 ppm F- was significantly better at remineralising PRCLs than the one containing 1,100 ppm F-.

Objective: The aim of this prospective study was to determine whether a child population with low overall caries frequency benefits when prevention is targeted to high-risk individuals., Methods: Data from clinical examinations and salivary tests were used to assess caries risk in 12-year-olds (n=1465). Children who were regarded as being at high risk of developing caries were randomized into two groups. Half (HRI group) were offered intensive prevention (counseling, F-varnish applications, F-lozenges, sealants, chlorhexidine), and the other half (HRB group) were provided the same basic prevention given to low-risk children (counseling, one F-varnish application/year). A random sample of the low-risk children (LRB) was followed up for the same 3-year period as the high-risk children. The number of children completing the study was 216 in the LRB group, 199 in the HRI group and 174 in the HRB group., Results: The mean (SD) 3-year DMFS increment was 2.0 (2.4), 4.4 (4.7) and 5.1 (5.0) in the LRB, HRI and HRB groups, respectively. Comparison between the LRB and HRB groups revealed that risk assessment was fairly successful in terms of mean DMFS increment. However, 63% of the children in the LRB group developed at least one new lesion (max. 12)., Conclusions: The negligible difference between the HRI and HRB groups implies that intensifying prevention produced practically no additional benefit. By offering all children only basic prevention, virtually the same preventive effect could have been obtained with substantially less effort and lower costs.

Intensified plaque acidogenicity in caries-prone subjects was reported many years ago, but emerging evidence has suggested that the relationship may not be as strong as once thought. We have now determined a range of acidogenicity variables in subjects having both caries prevalence and incidence data, and have included plaque mineral data in the analysis. pH measurements were made in 20 randomly selected subjects from a high-caries group (mean DMFS = 8. 95) and 20 from a caries-free group of Beijing children aged 12 years participating in a caries prediction study. Subgroups with a 12-month DMFS increment >/=2 or = 0 were also formed from the two groups, respectively. Measurements were made with an iridium oxide electrode inserted between teeth 13/14, 23/24, 34/35 and 44/45, before and every 5 min for 30 min after rinsing with 10% sucrose, and the 4 resulting 'Stephan curves' averaged using a plaque pH analysis program. Supragingival plaque was collected from buccal and lingual smooth surfaces of posterior and upper anterior teeth and its acid extract analysed for Ca, P and F. Caries-free subjects (based on past experience) had a significantly higher maximum plaque pH and pH value after 30 min (reflecting a faster return to resting pH), a lower minimum enamel dissolution capacity of plaque and recorded less time below pH 7.0 than did high-caries subjects. No other differences were significant, including those of the principal acidogenic parameters 'minimum pH attained after a sugar rinse', 'curve area below the critical pH of 5.5' and 'time below the critical pH'. Selection of the caries groups on the basis of both experience and incidence did not reveal significant differences in more parameters. Upper arch plaque was significantly more acidogenic than lower arch plaque, and there was a consistently strong association between upper and lower arch values in individuals. Ca, P and F in the subjects' plaque had little or no influence on the principal acidogenic parameters. Our failure to find a relationship between caries prevalence or activity and these principal acidogenicity parameters may be related to differences between fissure and smooth surface plaque, temporal variations in acidogenicity and/or to use of F toothpaste during the 1-year observation period. These results support the view that factors such as the frequency of acidogenic episodes may be more important in caries progression than the degree of acidogenicity during any one episode.

Current scoring systems for dental caries do not consider the dynamic nature of the disease. The aims of the present study were to describe a new set of clinical caries diagnostic criteria which differentiate between active and inactive caries lesions at both the cavitated and non-cavitated levels and to evaluate the reliability of this criteria system in a population with high caries experience. Ten diagnostic codes were defined: 0 = sound; 1 = active (intact); 2 = active (surface discontinuity); 3 = active (cavity); 4 = inactive (intact); 5 = inactive (surface discontinuity); 6 = inactive (cavity); 7 = filling; 8 = filling with active caries; 9 = filling with inactive caries. Distinction between active and inactive caries lesions was made on the basis of a combination of visual and tactile criteria. The inter- and intra-examiner reliability was assessed through repeated examinations of 50 children by 2 recorders over a period of 3 years. The percentage agreement of caries diagnoses varied between 94.2 and 96.2%. The kappa values ranged between 0.74 and 0.85 for intra-examiner examinations and between 0.78 and 0.80 for inter-examiner examinations; 81.6% of all misclassifications involved non-cavitated caries lesions. Disagreement between sound surfaces and non-cavitated active or non-cavitated inactive lesions (31.3 and 31.2%, respectively) was more common than disagreement between non-cavitated active and non-cavitated inactive lesions (10. 6%). The probability of reconfirming a sound, non-cavitated active or non-cavitated inactive caries lesion - given that the surface was diagnosed as either sound, non-cavitated active or non-cavitated inactive at the first examination - was 98.0, 68.7 and 72.5%, respectively. The results show that the use of a new set of clinical caries diagnostic criteria based on activity assessment can be performed with a high reliability, even when non-cavitated diagnoses are included in the criteria system.

Objectives: Recent epidemiological studies in the economically developing countries show that the prevalence and severity of dental caries has increased with industrialization and exposure of these populations to western diets. The aim of this study was to quantify the caries experience, and identify determinants associated with caries, in a population which has a higher socio-economic status (SES), and is the most westernized in India., Basic Research Design: The study site was Goa, a former Portuguese colony, which became part of India in 1961. Data came from a cross-sectional survey of 1,189 seventh grade children in private schools, consisting of a clinical dental examination and a self-administered questionnaire to their parents., Main Outcome Measures: The study used the cavitated/non-cavitated criteria to score for caries, the TF index for fluorosis, and the Silness and Loe index for plaque., Results: The mean age of the children was 12.2 years. The proportion of children caries-free in the permanent dentition was 22.2%. The mean DMFT and DMFS in the study group were 2.78 and 4.20, respectively. The decayed component accounted for over 87% of the DMFT, DMFS, dft, and dfs. Results of the crude, stratified, and multivariate regression analyses showed that poor oral hygiene, mother's highest level of education, use of fluoride toothpaste before the age of six years, and higher frequency of tooth brushing were risk indicators of caries prevalence and severity., Conclusion: The findings suggest that risk indicators of caries in this study population were similar to those in developed countries.

The aim of this study was to investigate the caries status and susceptibility of children in preschool age. Sixty one children ages between 3 to 5 years (mean age 4.38 +/- 0.71) participated in this study. Caries status was assessed according to WHO criteria, and caries susceptibility by using the Cariostat test. The mean df-t was found to be 2.28 +/- 0.71 (df-s 6.26 +/- 11.92) and 31 children were caries-free. Cariostat scores were 1.75, 2.00, 2.16 in the 3, 4, and 5 year age groups respectively. There were no significant differences in caries status or Cariostat scores between boys and girls. The df-t for the 5 year age group was significantly higher than that for the 3 year age groups (p < 0.05). The test found 77% of the children to have a high caries risk (Cariostat score > 2.0).

Levels of mutans streptococci in plaque adjacent to orthodontic brackets retained with a glass ionomer cement (GIC) (Ketac-Cem) and a resin-based composite (CR) (Concise) were investigated, using the split mouth technique in 11 patients who, before treatment, had more than 10(5) CFU of these microorganisms. After full-term orthodontic treatment (mean 9.5 months), the percentage of mutans streptococci of total CFU count in plaque was lower adjacent to GIC-retained brackets (mean 3.9) than adjacent to CR-retained brackets (6.7), but the difference was not statistically significant. Two subjects harbored S. sobrinus. These subjects were the only ones who developed incipient caries during the orthodontic treatment. Incipient lesion formation occurred only adjacent to CR-retained brackets. This suggests that in patients who have relatively high salivary levels of mutans streptococci before treatment and especially in those who harbor S. sobrinus, the use of GIC for bonding may prevent incipient caries formation during orthodontic treatment.

Objectives: The purpose of this work was to analyse longitudinally whether the placement of restorations on permanent molar teeth immediately after their eruption results in (a cohort with) higher filling increments in all individual teeth thereafter. The patient documents of 937 subjects born either in 1970-1971 or in 1980-1981 were analysed., Methods: The methods of survival analysis were employed. If any of the first permanent molar teeth had been restored in the course of tooth emergence, the person was assigned to the experimental group, and all the others were placed in the control group. Those in whom all the first permanent molar teeth had been restored at the time of emergence were compared with all the others., Results: Early restoration of any permanent molar indicated higher filling increments in all the other molar teeth. The differences between the groups with regard to the first and second molar teeth were statistically highly significant (e.g. D.17 for the girls: log-rank chi 2 = 32.8, p = 0.0001 and Wilcoxon chi 2 = 28.7, p = 0.0001). The differences were greater among the girls than among the boys. Early restoration of the first permanent molar teeth did not indicate high filling increments in the incisors, canines or the smooth surfaces of any tooth., Conclusion: Fissure caries and smooth surface caries are different entities. The present method can be of help as an additional tool to help the clinician identify "risk" patients, in that an early restoration in any first molar is a powerful indicator of a risk of restorations in the other first molar teeth and also the second molar teeth.

Acidogenesis at low pH appears to be an important bacterial cariogenic trait. However, most information in this regard pertains to only a few of the acidogenic dental plaque bacteria. Therefore, the 'final' pH in sugar broth was determined for a wide variety of oral bacteria. Their source was: (1) carious material from advanced root lesions (ARL), (2) plaque from sound root surfaces of root-caries-free subjects (SRS), (3) plaque from "white spot" coronal lesions and sound coronal surfaces of caries-active subjects, and (4) plaque from sound coronal surfaces of caries-free subjects. Strains from groups 1 and 2 (ARL, 389 strains; SRS, 358 strains) were previously identified (van Houte et al., 1994) to the genus/species level and belonged to the predominant cultivable flora (PCF). Strains from groups 3 and 4 also belonged to the PCF but were not identified. All strains were placed in one of 4 final pH categories: < 4.2, 4.2-4.4, 4.4-4.6, and > or = 4.6. The main findings were: (1) ARL samples contained many strains with a final pH < 4.2 (mean percentage of 25.7). They included all strains of Lactobacillus and mutans streptococci (MS), most Bifidobacterium strains and non-mutans streptococci (non-MS), and about 20% of the Actinomyces strains. By contrast, SRS samples contained far fewer strains with a final pH < 4.2 (mean percentage of 8.4) which were nearly all non-MS. (2) Organisms with a final pH < 4.4 constituted mean percentages of 41.5 and 32.1 for the ARL and SRS samples, respectively. (3) The final pH distribution of strains in samples from coronal surfaces showed a tendency relative to caries activity (group 3 vs. group 4) similar to that for groups 1 and 2. Our findings further support the concept that increased cariogenic conditions are associated with increased proportions of organisms capable of acidogenesis at a low pH and that this shift involves organisms other than the MS and lactobacilli.

The aim was to test the predictive ability of defined levels of dietary and oral hygiene habits and also mutans streptococci and lactobacilli in saliva, separately and in combinations, in 1 1/2-year-old children. The population consisted of 181 children, who were investigated with respect to the above factors together with general health, use of fluoride in tablets and/or toothpaste, gingival condition and caries prevalence. Initially, 99% of the subjects were caries-free as against 72% at the age of 3 years, with a mean of 0.8 ds. Using data for sensitivity and specificity the predictive values for positive (PV+) and negative (PV-) tests were calculated for different levels and combinations of variables. A dividing line between high and low caries risk that combined high sensitivity and high specificity could not be established for any variable or combination of variables. High sensitivity was noted with diet as the predictor, high specificity with oral hygiene or occurrence of mutans streptococci. Lactobacilli were excluded as they were found in only 6 children. A two-step computation with mutans streptococci as second predictor improved the ability to single out children with caries at the age of 3 years. Subgrouping and analyses of the material as regards use of fluoride did not influence the results. To sum up, prediction at the age of 1 1/2 years, in a population with a low caries prevalence, was not successful with the variables used in this study.

Several factors for caries prediction have been proved in a one-year follow-up study on 73 patients. The white-spot lesions have proved to be a good criteria for caries prediction in this population. These lesions could be combined with the microbiological tests Dentocult SM and Oricult N or with the determination of the buffer capacity (Dentobuff), which did not much improve the prediction.