This laboratory study of 100 occlusal surfaces investigated the reproducibility and accuracy of a visual ranked caries scoring system, an electronic caries scoring system (ECM) using a continuous conductance scale, and a radiographic ranked caries scoring system. Histological examination of the teeth served as a gold standard to validate the ability of each system to assess lesion depth and predict softened, demineralized dentine. After training, 3 examiners carried out each scoring system on two separate occasions. Kappa values for visual, ECM and radiographic ranked scoring systems showed good inter- and intra-examiner reproducibility levels and acceptable limits of agreement for ECM readings. When scoring systems were tabulated against histological scores there was a high correlation between the visual and ECM methods and lesion depth in both enamel and dentine, but radiographic examination could not detect enamel caries. When compared to the histological scoring, the Spearman correlation coefficients for the visual scoring ranged between 0.87 and 0.93, for the ECM between 0.80 and 0.85 and for the radiographic scoring system between 0.76 and 0.78. No tooth scored as visually sound had histological evidence of dentine caries. Soft dentine corresponded to demineralization involving the middle third of the dentine or more which was related to visual cavity formation or an ECM reading above 9 (score 3 or 4). The radiograph was an excellent predictor of soft dentine. In conclusion, the new visual system appears promising, but takes time to learn. The reproducibility and accuracy for the ECM is acceptable while radiographs miss early occlusal lesions.

The aims of the present study were to investigate the ability of 3 experienced clinicians to detect occlusal carious lesions, assess their depth, diagnose their activity and define a logical management for each lesion. The material consisted of 35 third molars scheduled for extraction or surgical removal making it possible to validate the accuracy of the clinical recordings histologically. Examinations were carried out at baseline and after 4 months in order to monitor lesion progression. At the first visit a radiograph was taken; the number of filled surfaces was counted and the oral hygiene assessed generally and by disclosing occlusal plaque of the tooth under examination. After cleaning the occlusal surface caries was recorded in a selected investigation site using a visual ranked caries scoring system, as well as an electrical conductance recording (ECM). Apart from counting fillings and taking new radiographs the same procedure was performed at the second visit, which then was followed by extraction of the tooth. After sectioning the tooth lesion depth was recorded, and lesion activity, based on acid production, was assessed using methyl red dye. Lesion activity was also judged by means of polarized light microscopic examinations of the sections. Results showed strong relationships between the visual, ECM and radiographic assessments and both lesion depth and lesion activity. In contrast, all other parameters were poorly related to lesion activity. Changes in visual assessments and in conductance readings from first to second examination were poorly associated with lesion activity. In conclusion, clinicians are able to detect lesions, predict activity and severity and define a logical management of occlusal caries on the basis of a single examination.

Objectives This article presents a review of published literature examining fibre-based endodontic post systems. Data sources A MEDLINE search was carried out for any articles in dental journals pertaining to fibre-based post systems. Wherever possible articles cited were obtained from the journals and where this was not possible abstracts were obtained. Where no abstract was available the article was not considered for evaluation. Data extraction Articles were reviewed by a single observer and subject to meeting inclusion criteria were included in the review. Fifty-nine articles were considered suitable for inclusion. Data synthesis Articles were divided into categories and a subjective description of the articles was made. Conclusions Review indicated that (1) most published literature on fibre-based posts took the form of laboratory analyses; (2) evidence for carbon-fibre posts far exceeds that for quartz-fibre posts; (3) laboratory evidence was contradictory and could not be used to inform practice reliably; (4) few clinical studies have been carried out though these have suggested fibre based posts may be clinically appropriate for restoration of the endodontically treated tooth; and (5) controlled prospective clinical trials evaluating fibre-based posts should be undertaken to inform use for clinical practice.

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The aim of this in vitro study was to assess the validity and reproducibility of the ICDAS II (International Caries Detection and Assessment System) criteria in primary teeth. Three trained examiners independently examined 112 extracted primary molars, ranging from clinically sound to cavitated, set up in groups of 4 to mimic their anatomical positions. The most advanced caries on the occlusal and approximal surfaces was recorded. Subsequently the teeth were serially sectioned and histological validation was undertaken using the Downer and Ekstrand-Ricketts-Kidd (ERK) scoring systems. For occlusal surfaces at the D₁/ERK₁ threshold, the mean specificity was 90.0%, with a sensitivity of 75.4%. For approximal surfaces, the specificity and sensitivity were 85.4 and 66.4%, respectively. For occlusal surfaces at ICDAS code ≥3 (ERK₃ threshold), the mean specificity and sensitivity were 87.0 and 78.1%, respectively. For approximal surfaces, the equivalent values were 90.6 and 75.3%. At the D₃ threshold for occlusal surfaces, the mean specificity and sensitivity were 92.8 and 63.1%, and for approximal surfaces 94.2 and 58.3%, respectively. Mean intraexaminer reproducibility (Cohen’s kappa) ranged from 0.78 to 0.81 at the ICDAS code ≥1 cut-off and at the ICDAS code ≥3 cut-off from 0.74 to 0.76. Interexaminer reproducibility was lower, ranging from 0.68 to 0.70 at the ICDAS code ≥1 cut-off and from 0.66 to 0.73 at the ICDAS code ≥3 cut-off. In conclusion, the validity and reproducibility of the ICDAS II criteria were acceptable when applied to primary molar teeth.

Sealants are a successful tool in caries prevention, but their role in preventive strategies after the caries decline has to be discussed. A survey of paediatric departments across Europe revealed that indications for pit and fissure sealants vary considerably, both nationally and internationally. Evidence for effectiveness of sealants in controlling caries in posterior teeth implies that sealants should be an integrated part of management of pit and fissure caries. Still, the indication for occlusal sealants seems to be shifting from primary prevention to a therapeutic decision for caries management of lesions in enamel and the outer part of the dentine. Sealants are also an interesting concept for caries management in approximal surfaces. Clinical trials suggest that novel techniques of sealing or infiltrating approximal lesions show promise. However, approximal sealing techniques are as complex to apply and time-consuming as approximal fillings. The article proposes guidelines for teaching on the use of sealants.

This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems – the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity assessment (ICDAS-LAA) – were compared using 763 primary molars of 139 children aged 3–12 years. The examinations were performed by 2 calibrated examiners. A subsample (n = 50) was collected after extraction and histology with 0.1% red methyl dye was performed to validate lesion depth and activity. The reproducibility of the indices was calculated (kappa test) and ROC analysis was performed to assess their validity and related parameters were compared using McNemar’s test. The association between the indices and with the histological examination was evaluated using Spearman’s correlation coefficient (r_s). Visual criteria showed excellent reproducibility both regarding severity (NY: 0.94; ICDAS-II: 0.91) and activity (NY: 0.90; LAA: 0.91). The NY and LAA showed good association in caries activity assessment (r_s = 0.88; 95% CI = 0.86–0.89; p < 0.001). Nevertheless, considering only cavitated lesions, this association was not significant (p > 0.05). Concerning the severity, both indices presented similar validity parameters. At D2 threshold, the sensitivity was higher for NY (NY = 0.87; ICDAS = 0.61, p < 0.05). Regarding activity status, NY showed higher specificities and accuracies. In conclusion, NY and ICDAS-II criteria are comparable and present good reproducibility and validity to detect caries lesions and estimate their severities, but the LAA seems to overestimate the caries activity assessment of cavitated lesions compared to NY.

Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large enough and demineralised enough to be detected radiographically. The detection rate of such lesions will depend upon the prevalence of caries in the population and the frequency with which bitewing radiographic examinations are performed. Whether 'hidden caries' is a distinct clinical entity, reflecting a particular anatomical fissure topography or a different bacterial aetiology, is unknown. It is possible that an improved visual examination, with careful cleaning and drying of teeth, may improve occlusal caries detection to the point where 'hidden caries' no longer exists. However, this possibility has yet to be tested clinically and until it is, practising dentists would be wise to examine bitewing radiographs carefully for occlusal demineralisation. The authors would treat such hidden lesions by removing soft caries and placing sealant restorations.