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The aim was to analyse the pattern of caries rates in enamel and dentin of the mesial surface of the first permanent molar (mesial 16, 26,36,46; here called 6m) and the distal surface of the second primary molar (distal 55,65,75,85; here called 05d) from 6 to 12 years of age. The material consisted of retrospectively collected bite-wing radiographs of a cohort of 374 children aged 5-7 years at baseline and followed to 11-12 years of age. The following scoring system was used: score 0 = no visible radiolucency, 1-2 = radiolucency in the outer (1) or inner (2) half of the enamel up to the enamel-dentin border, 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Two transitions were used: state 0-2 = the time lapse from state 0 until the lesion had reached state 2, and state 2-4 = the time lapse from state 2 until the lesion had reached state 4 or 5. At the age of 9, the mean defs (decayed, extracted and filled surfaces) of 05d was 0.70 and the mean DFS of 6m was 0.19. The enamel caries rates (state 0-2) were 4.6 new lesions/100 tooth surface-years for 6m and 11.3 for 05d. The dentin caries rates (state 2-4) were 20.5 new lesions/100 tooth surface-years for 6m and 32.6 for 05d. In conclusion, the enamel caries rate for 05d was more than twice that for 6m. Both surfaces had relatively high dentin caries rates, indicating that for these surfaces between 6 and 12 years of age, the rate of progression into the dentin is generally relatively high once the lesion has reached the inner half of the enamel as judged radiographically. [ABSTRACT FROM AUTHOR]

Objective. To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. Results. Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. Conclusions. Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population. [ABSTRACT FROM AUTHOR]

The aim of this article is to summarize and interpret present knowledge and evidence on the effect of fissure sealing permanent first and second molars in children and adolescents with two commonly used materials: resin sealants and glass ionomer sealants. Also, to identify important gaps in our knowledge. The results show that the conclusions from systematic reviews differ in several aspects, and that important knowledge gaps still exist, such as the costs and benefits of sealing low- versus high-risk populations. The effect of sealing noncavitated caries lesions is uncertain and possible differences in effect between resin sealants and the high viscosity glass ionomers need to be investigated. [ABSTRACT FROM AUTHOR]

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists. [ABSTRACT FROM AUTHOR]

The aim was to analyse the pattern of caries rates in enamel and dentin of the mesial surface of the first permanent molar (mesial 16,26,36,46; here called 6m) and the distal surface of the second primary molar (distal 55,65,75,85; here called 05d) from 6 to 12 years of age. The material consisted of retrospectively collected bite-wing radiographs of a cohort of 374 children aged 5-7 years at baseline and followed to 11-12 years of age. The following scoring system was used: score 0 = no visible radiolucency, 1-2 = radiolucency in the outer (1) or inner (2) half of the enamel up to the enamel-dentin border, 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Two transitions were used: state 0-2 = the time lapse from state 0 until the lesion had reached state 2, and state 2-4 = the time lapse from state 2 until the lesion had reached state 4 or 5. At the age of 9, the mean defs (decayed, extracted and filled surfaces) of 05d was 0.70 and the mean DFS of 6m was 0.19. The enamel caries rates (state 0-2) were 4.6 new lesions/100 tooth surface-years for 6m and 11.3 for 05d. The dentin caries rates (state 2-4) were 20.5 new lesions/100 tooth surface-years for 6m and 32.6 for 05d. In conclusion, the enamel caries rate for 05d was more than twice that for 6m. Both surfaces had relatively high dentin caries rates, indicating that for these surfaces between 6 and 12 years of age, the rate of progression into the dentin is generally relatively high once the lesion has reached the inner half of the enamel as judged radiographically. [ABSTRACT FROM AUTHOR]

This study aimed at mapping the preparation techniques and restorative materials that Swedish dentists are using for primary approximal and occlusal carious lesions. It involved sending a pre-coded questionnaire to a random sample of 923 dentists, with eight items concerning approximal and occlusal restorative preparation techniques and dental materials. Responses were received from 651 (70.5%) dentists. To restore a primary approximal carious lesion in an adolescent with low caries activity and good oral hygiene, the tunnel preparation was chosen by 48% of the dentists, the saucer-shaped preparation by 32%, and the traditional Class II preparation by 20%. The most common preparation technique for restoring an occlusal carious lesion was removal of the carious part only, which was chosen by 74% of the dentists. For a lower second molar with a minor occlusal caries lesion combined with a suspected dentin lesion as judged radiographically, about half of the dentists chose to restore the carious part only and 27% would seal the rest of the fissure system in addition. For a similar lesion with no obvious radiolucency in the dentin, about 1/3 chose the 'no treatment' alternative, 1/3 fluoride treatment, and the rest fissure sealing or other techniques. Composite was used most often and amalgam least often for both approximal and occlusal carious lesions. [ABSTRACT FROM AUTHOR]

The aim was to assess the prevalence of pulp exposure after stepwise versus direct complex excavation of permanent posterior teeth with deep carious lesions. The material, representing 116 patients aged 6-16 yrs (&xsline; = 10.2 yrs), consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if direct complete excavation was performed. Teeth with clinical symptoms, other than transient pain shortly before treatment, were not accepted. The teeth were randomly selected for either treatment procedure. Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide, followed by sealing of the cavity with zinc-oxide eugenol cement. After a period of 8-24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide, zinc-oxide-eugenol (ZOE) and a restorative material. Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above. In case of pulp exposure, pulp treatment was performed. The pulp was exposed in 40 of the teeth treated by direct complete excavation. The corresponding figure for those treated by stepwise excavation was 17.5%. The difference was statistically significant. The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up (&xsline: = 43 months). [ABSTRACT FROM AUTHOR]

The aim was to assess the distribution and pattern of caries development longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A baseline cohort of 536 children was studied, using bite-wing radiographs, from 11 to 22 years of age. The results showed a slow but continuous increase in both enamel and dentin caries of approximal surfaces. At 21, 29% of all posterior approximal surfaces had enamel caries according to the radiographic diagnoses, 14% had dentin caries and another 5% were restored. At the age of 20 21, the skewed distribution of DMFS(appr) apparent at 12 and 15 had given way to a more uniform picture and the percentage of individuals with no decayed approximal surfaces (DMFS(appr) = 0) decreased from 71 at 12-13 to 28 at 20-21 years of age. The proportion of DFS(occl) in relation to all DFS decreased from 83% at 12 to 52% at 21. The occlusal, mesial and distal surfaces of the first molar accounted for 60% of all restored surfaces at 21. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries., Data: Studies on following methods were included: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, oral hygiene, dietary habits and sociodemographic variables. QUADAS-2 was used to assess risk of bias. Sensitivity, specificity, predictive values, and likelihood ratios (LR) were calculated. Quality of evidence based on ≥3 studies of a method was rated according to GRADE., Sources: PubMed, Cochrane Library, Web of Science and reference lists of included publications were searched up to January 2015., Study Selection: From 5776 identified articles, 18 were included. Assessment of study quality identified methodological limitations concerning study design, test technology and reporting. No study presented low risk of bias in all domains. Three or more studies were found only for previous caries experience and salivary mutans streptococci and quality of evidence for these methods was low. Evidence regarding other methods was lacking. For previous caries experience, sensitivity ranged between 0.21 and 0.94 and specificity between 0.20 and 1. Tests using salivary mutans streptococci resulted in low sensitivity and high specificity. For children with primary teeth at baseline, pooled LR for a positive test was 3 for previous caries experience and 4 for salivary mutans streptococci, given a threshold ≥10(5) CFU/ml., Conclusions: Evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design., Clinical Significance: Low validity for the analysed methods may lead to patients with increased risk not being identified, whereas some are falsely identified as being at risk. As caries risk assessment guides individualized decisions on interventions and intervals for patient recall, improved performance based on best evidence is greatly needed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries., Study Design: A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach., Results: Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis., Conclusions: There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.

Background: In accordance with European guidelines, mammography screening comprises independent readings by two breast radiologists (double reading). CAD (computer-aided detection) has been suggested to complement or replace one of the two readers (single reading + CAD).The aim of this systematic review is to address the following question: Is the reading of mammographic x-ray images by a single breast radiologist together with CAD at least as accurate as double reading?, Methods: The electronic literature search included the databases Pub Med, EMBASE and The Cochrane Library. Two independent reviewers assessed abstracts and full-text articles., Results: 1049 abstracts were identified, of which 996 were excluded with reference to inclusion and exclusion criteria; 53 full-text articles were assessed for eligibility. Finally, four articles were included in the qualitative analysis, and one in a GRADE synthesis., Conclusions: The scientific evidence is insufficient to determine whether the accuracy of single reading + CAD is at least equivalent to that obtained in standard practice, i.e. double reading where two breast radiologists independently read the mammographic images.

Objective: The aim of this retrospective cohort study was to assess the association between background factors and future endodontic treatment due to caries in young permanent teeth., Material and Methods: The material comprised all 19-year-olds born in 1979 in a city in Sweden who had experienced endodontic treatment due to caries in permanent teeth (n=105) and a control group with no endodontic treatment. From dental records, the following independent variables were derived from age 7 to age 19: immigrant background, caries prevalence (DMFT values) at age 10, occurrence of dental anxiety, and missed or cancelled appointments before endodontic treatment. The outcome variable was presence or absence of endodontic treatment due to caries. Bivariate analysis and a multiple logistic regression model were used to analyse the data., Results: In the bivariate analyses, all independent variables except cancelled appointments were statistically significantly associated with future endodontic treatment. Of these, immigrant background did not remain as a statistically significant factor in the multiple regression model. The highest odds ratios were 4.3 for >2 DMFT at age 10 and 4.1 for >20% missed appointments., Conclusion: In the present sample, with a relatively high proportion of individuals with an immigrant background, >2 DMFT at age 10, many missed appointments and dental anxiety were all risk indicators for future endodontic treatment due to caries up to age 19.

Objective: The aim was to study periapical status and the technical quality of root-filled teeth in Swedish adolescents and young adults in Malmö, Sweden., Material and Methods: The sample, collected from dental records in the Public Dental Service, consisted of notes and radiographs of all root-filled permanent teeth in all 19-year-olds born in 1979 (mean age at root filling=16.2 years). The sample for assessing periapical status and technical quality consisted of 124-153 teeth. The criterion for inclusion for assessing periapical status was a follow-up time of at least one year. Periapical status was assessed with the Periapical Index (PAI). Technical quality was analyzed from radiographs in two respects: sealing quality of the root canal and distance from the root filling to the radiographic apex. The radiographs were analyzed independently by two observers with inter-examiner kappa values of 0.82-0.85., Results: Apical periodontitis was found in 52% of the teeth and occurred significantly more often among molars than among anterior teeth. As judged radiographically, 51% of the teeth were inadequately sealed. In 38%, the distance to the apex was >2 mm and overfilling was registered in 14% of the teeth. Compared with anterior teeth, significantly more root fillings of molars had a distance to the apex of >2 mm. Technical quality was statistically significantly correlated with periapical status at follow-up., Conclusions: The technical quality and periapical status of root-filled teeth in adolescents and young adults were unsatisfactory in about half of the teeth.

Unlabelled: It is generally agreed that the decision to take bitewing radiographs for detecting caries should be based on the benefit to the individual patient in relation to the risks associated with low dose radiation exposure and the costs. There is incomplete knowledge about the effectiveness of various methods for selecting individuals who will benefit from bitewing examination. Available knowledge suggests, however, that our ability to identify correctly those who will benefit is limited. It may, therefore, be more effective to combine population- and individual-based selection criteria. For this purpose, four key ages and individual-based criteria between the key ages are suggested., Clinical Relevance: The purpose of the presented selection criteria are to improve the dental practioner's effectiveness in selecting patients who will benefit from bitewing examination, thereby reducing the number of arbitrary and 'just in case' radiographs and the radiation dose.