Caries of the pits and fissures of permanent teeth continues to be a problem for children. Newly erupted permanent molars are particularly at risk. Oral hygiene measures have been shown to be able to reduce the incidence of caries. The aim of this study was to compare the caries preventive effects of a professional tooth cleaning and oral health education programme (test) with a standard preventive programme (comparison), comprising selective fissure sealing and application of topical fluorides on newly erupted first permanent molars. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to test (4)or comparison (4) clinics. Schoolchildren, mean age 6.3 plus or minus 0.3 (s) yr with, sound, newly erupted first permanent molars were included in the study (n=404; 207 test; 197 control).Children were examined after twelve and twenty-four months by an examiner who was 'blind' to the test or control status of the children. After twelve months, 186 test and 163 control children were examined, and after twenty-four months, 179 test and 156 control children were examined. Three hundred and twenty children were examined in both years. After twenty-four months, 32 children in test and 31 children in control developed caries of the first permanent molars, the estimated risk ratio was 0.90 (95% CI 0.58, 1.41); and children in the test group had an average DFT score of 0.30 plus or minus 0.75 compared with 0.30 plus or minus 0.70 DFT in the control group (t-test, p=0.96). The results suggest that, after two years, there was no statistically significant difference between the caries preventive effects of a professional tooth cleaning and oral health education programme and a programme based on selective fissure sealing and application of topical fluorides.Baseline deciduous caries experience, presence of hypomineralised first ++ / permanent molars and frequency of toothbrushing were statistically significant factors in predicting molar caries. Using baseline deciduous caries experience as a screening criterion to predict permanent molar caries, sensitivity of 0.67 and specificity 0.61 were obtained at a cutpoint of 1 dmfs. Sensitivity and specificity values were maximised at 0.72 by using a combined baseline dmfs and hypomineralisation as screening criteria. Cost-effectiveness analysis indicated an incremental cost-effectiveness ratio of $40/child/year. The test programme was more costly and produced similar outcomes and does not warrant adoption on economic grounds.

While dental caries represents the major chronic disease of humans, visual and tactile inspection are the methods of choice in daily dental practice. Several optical technologies have been developed in recent years for the purpose of dental examination, including near-infrared light transillumination as a promising tool for the supplementation and partial replacement of radiography. In case of occlusal alterations, the incidence of surface discolorations impedes the visual assessment, whereas tactile inspection appears to yield little diagnostic information or might be detrimental. Optical coherence tomography (OCT) facilitates depth-resolved imaging with μm resolution, utilizing near-infrared light, and has already shown its potential for various dental applications. We have recently demonstrated that depolarization imaging utilizing the degree of polarization uniformity (DOPU) extends those abilities by the detection of early carious lesions, as it provides an unambiguous demineralization contrast. Here, we show that this approach also enables the assessment of occlusal enamel lesions in the presence of stains, and compare PS-OCT cross sections with polarized light microscopy (PLM) images of thin sections. For tooth samples with discoloration or demineralization, respectively, PS-OCT and PLM results are in good agreement.

Currently, many developing countries are experiencing rising prevalences of caries associated with changes in lifestyle and living conditions. Objectives: To describe the hygiene, eating habits, and oral health status of Nepalese children. Materials and Methods: A stratifiedsample of 231 children 5–7, 11–13, and 15–16 years of age (53% boys, 47% girls) who attended public high schools in the rural area of the Lalitpur District, Nepal was selected. The study was a field study combining a clinical examination (plaque, gingivitis, calculus, and caries) and a questionnaire. The questions concerned sanitary conditions, health support, personal hygiene, tooth cleaning, and eating habits. Results: During the school day, half of the children ate nothing at all. General personal hygiene was associated with tooth-cleaning frequency.Four out of five children in the entire sample cleaned their teeth once/day or more, using their own toothbrush. The use of fluoride toothpaste was rare.More frequent tooth cleaning and lower plaque indices were seen among girls and older children. More plaque was found on the occlusal surfaces of erupting permanent molars than on fully occluded permanent molars. Most children had a low prevalence of manifest caries in the primary and the permanent dentitions. However, every fifth 5–7-yr-old had manifest caries in three or more primary teeth. The occlusal surfaces of molars accounted for almost all registered caries in both dentitions. Conclusion: Although the prevalence of manifest caries was low, the low level of preventive activities may cause an increase in the prevalence of caries, as in other developing countries. The presumed risk scenario needs to be met by comprehensive and systematic health promotion and preventive measures. / Sammanfattning: I många utvecklingsländer sker förändringar av livsstil och levnadsförhållanden med samtidig ökad förekomst av karies. Mål: Att beskriva hygien, matvanor och munhälsa hos nepalesiska barn. Material och Metod: Ett stratifierat urval av 231 barn, som i åldrarna 5-7, 11-13 och 15-16 år (53% pojkar, 47% flickor), elever i statliga grundskolor på landsbygden, Lalitpur distriktet Nepal, användes. Studien utformades som en fältstudie med klinisk undersökning (plack, gingivit, tandsten och karies) kombinerad med en enkätstudie. Frågorna rörde sanitära förhållanden, hälsostöd från hemmet, personlig hygien, tandrengörings- och matvanor. Resultat: Under skoldagen åt hälften av barnen ingenting alls. Allmän personlig hygien var associerad med tandrengörings frekvens. Av alla barn, som användande sin egen tandborste, borstade fyra av fem, en gång om dagen eller mer. Äldre barn och flickor rengjorde tänderna oftare och hade ett lägre plackindex. Mer plack fanns på erupterande molarers occlusalytor jämfört med molarer i full ocklusion. De flesta barnen hade en låg frekvens manifest karies i primära och permanenta bettet. Dock hade en femtedel av 5-7 åringarna tre eller fler manifesta kariesangrepp i primära bettet. Ocklusal karies på molarerna utgjorde nästan all registrerad karies i båda dentitionerna. Slutsats: Låg frekvens av manifest karies, men en låg grad av förebyggande aktiviteter, kan medföra en ökad kariesfrekvens liknande den i andra utvecklingsländer. Den förmodande risken måste bemötas med behovsinriktade och systematiska hälsobefrämjande och preventiva åtgärder. / <p>ISBN 91-7997-151-2</p>

Indiana University-Purdue University Indianapolis (IUPUI) Indiana University School of Dentistry Master Degree Thesis. / Detection of caries at an early stage is unequivocally essential for early preventive intervention. Longitudinal assessment of caries lesions, especially under the opaque preventive sealant, would be of utmost importance to the dental community. OBJECTIVES: The aim of this two-part in-vitro study is to evaluate the performance of multiple detection methods: The International Caries Detection and Assessment System (ICDAS); two quantitative light-induced fluorescence systems QLF; Inspektor™ Pro and QLF-D Biluminator™2 (Inspektor Research Systems B.V.; Amsterdam, The Netherlands); and photothermal radiometry and modulated luminescence (PTR/LUM) of The Canary System® (Quantum Dental Technologies; Toronto, Canada). All these are to be evaluated on their detection of caries on posterior human permanent teeth for 1) of primary occlusal lesions, and 2) under the sealant of primary occlusal lesions. METHODS: One hundred and twenty (N = 120) human posterior permanent teeth, selected in compliance with IU-IRB “Institutional Review Board” standards, with non-cavitated occlusal lesions ICDAS (scores 0 to 4) were divided into two equal groups. The second group (N = 60) received an opaque resin dental sealant (Delton® Light-Curing Pit and Fissure Sealant Opaque, Dentsply, York, PA). All lesions were assessed with each detection method twice in a random order except for ICDAS, which was not used following the placement of the sealant. Histological validation was used to compare methods in regard to sensitivity, specificity, % correct, and the area under receiver- operating characteristic curve (AUC). Intra-examiner repeatability and inter-examiner agreement were measured using intraclass correlation coefficient (ICC). RESULTS: 1) Of primary occlusal lesions, sensitivity, specificity, and AUC values were respectively: 0.82, 0.86 and 0.87 (ICDAS); 0.89, 0.60 and 0.90 (Inspektor Pro); 0.96, 0.57 and 0.94 (QLF-D Biluminator 2); and 0.85, 0.43 and 0.79 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.81 to 0.87: 0.72 (ICDAS); 0.49 to 0.97: 0.73 (Inspektor Pro); 0.96 to 0.99: 0.96 (QLF-D Biluminator 2); and 0.33 to 0.63: 0.48 (The Canary System). 2) Of primary occlusal lesions under the opaque dental sealants, sensitivity, specificity, and AUC values were respectively: 0.99, 0.03 and 0.67 (Inspektor Pro); 1.00, 0.00 and 0.70 (QLF-D Biluminator 2); and 0.54, 0.50 and 0.58 (The Canary System). Intra-examiner repeatability and inter-examiner agreement were respectively: 0.24 to 0.37: 0.29 (Inspektor Pro); 0.80 to 0.84: 0.74 (QLF-D Biluminator 2); and 0.22 to 0.47: 0.01 (The Canary System). CONCLUSION: Limited to these in-vitro conditions, 1) ICDAS remains the method of choice for detection of early caries lesion due to its adequately high accuracy and repeatability. QLF systems demonstrate potential in longitudinal monitoring due to an almost perfect repeatability of QLF-D Biluminator 2. The Canary System performance and repeatability were not acceptable as a valid method of early caries detection. 2) None of the methods demonstrated acceptable ability in detecting of occlusal caries under the opaque sealant. However, QLF-D Biluminator 2, with limitation to these in-vitro conditions and Delton opaque sealant, demonstrated a fair accuracy AUC (0.70) in detecting of caries under sealants at an experimental threshold of 12.5% ΔF.