Little is known about the long–term effects of fluoride–releasing materials on carious dentine in vivo. The aim was to investigate the 2–year influence of a resin–modified glass ionomer cement (RM–GIC) and amalgam on the bacteriological counts of carious dentine that remained under class I restorations. To enable a split–mouth design, 33 molar pairs in 33 patients (mean age 15.1 years, SD 1.4) were selected, based on clinically and radiographically diagnosed occlusal dentine caries. The enamel of the carious molars was removed, and the carious dentine was sampled under aseptic conditions just beneath the dentinoenamel junction. The molars were alternately restored with RM–GIC or amalgam without further removal of carious dentine. The samples were processed for microbiological determination of total viable counts (TVC), mutans streptococci (MS), and lactobacilli (LB). The molar pairs of 25 patients were reevaluated after 2 years using the same clinical techniques and were permanently restored after complete caries removal. Both materials showed a substantial decrease in numbers of TVC and LB of the carious dentine after the 2–year period. Compared to amalgam, the decrease in the numbers of LB was significantly more pronounced for RM–GIC. No microorganisms were detected in only 11 molars (6 RM–GIC and 5 amalgam) after the 2–year period. Based on this study, we suggest that complete removal of carious dentine is still the best conservative treatment, irrespective of the restorative material used.

SUV can be used to predict resectability; however, SUV is not an independent factor that can be used to assess survival in patients with esophageal cancer.

Since the literature is very limited standard implementation of FDG-PET/CT into the tumour delineation process for radiation treatment seems unjustified and needs further clinical validation first.

The occlusal bite-wing radiograph evaluations of 13114-year-old and of 12317-and 20-year-old Dutch persons were compared with the clinically collected observations. The clinical observations and the bite-wing radiographs were collected as part of a longitudinal epidemiological survey conducted in 1987 and 1990. Comparison of the evaluations of the first and second molar teeth showed significantly more radiolucencies in all three age groups than expected clinically. Of the clinically judged ‘sound’ surfaces, 26% in the 14-, 37.5% in the 17- and 50% in the 20-year-old group showed a radiolucency on the bite-wing radiograph. In the 14-, 17- and 20-year-old age group a radiolucency was noticed on the bite-wing radiograph in 32,44 and 58% of the sealed teeth, respectively. The radiolucencies below the occlusal enamel of sealed teeth were most likely due to the problems in diagnosing occlusal dentine lesions correctly with the clinical diagnostic methods. Therefore not only approximal but also occlusal bite-wing radiograph judgement before sealant application seems to be advisable now. Because of the numbers of clinically undetected lesions it may be advisable to reconsider the criteria for occlusal diagnosis in epidemiological surveys and to judge not only the approximal but also the occlusal surfaces in epidemiological surveys when bite-wing radiographs are available.

Due to the changed treatment approach of proximal caries and the amalgam controversy, clinicians are in search for new materials. The aim of the present study was to compare amalgam with an adhesive material in deciduous molars in a clinical, split–mouth design study. At baseline 30 polyacid modified composite (Dyract^®) and 30 amalgam (Tytin^®) restorations were placed in primary molars, of which 24 and 17 could be evaluated after 24 and 36 months, respectively. Modified USPHS criteria were used for clinical evaluation every 6 months. Annual bite–wing radiographs were taken for evaluation of recurrent caries and cervical gap formation. In the present study, for Dyract as well as for Tytin restorations, low rates of recurrent caries were found, while Dyract restorations showed a better marginal adaptation and surface texture compared to Tytin restorations. In the Dyract group more radiolucencies were found at baseline. In both groups no patient complaint or pain was reported related to the radiolucencies. After 3 years the colour of Dyract was not comparable to the original. For Dyract no excessive wear was noticed compared to enamel. During the study one Dyract (recurrent caries: 18 months) and two Tytin (pulpal aetiology: 6 months, recurrent caries: 36 months) restorations had to be replaced. Even though the restorations were placed in caries risk children, at the 36 months’ evaluation of this clinical study, the results indicate that Dyract can be an alternative for Tytin in the primary dentition.

It has been suggested that the diagnosis of occlusal dentine carious lesions has become more difficult due to the influence of fluoride on the character of pit and fissure surfaces. The issue pertains to the occurrence of hidden caries exemplified by occlusal surfaces judged as clinically sound but showing a radiolucency on the bite-wing radiograph. The aim of this study was to investigate the influence of water fluoridation on the occurrence of hidden caries in clinically sound occlusal surfaces in young people. The data of 515 persons (15 years of age) collected in 1968/1969 as part of the Dutch longitudinal epidemiological Tiel/ Culemborg study were used. The participants in Tiel (F) were exposed to artificially fluoridated drinking water (F^- concentration 1.1 ppm F) from birth until the end of the data collection. The participants in Culemborg (NF) were not exposed to extra fluoride (F^- concentration 0.1 ppm F). In 1994 the status of occlusal surfaces of the first and second molars, as read from bite-wings made in 1968/1969, were judged by 2 investigators (Cohen’s Kappa intra- and inter-examiner agreement 0.90, 0.83 and 0.85, respectively). The original clinical data of 270 inhabitants of Tiel (F) and 245 of Culemborg (NF) were compared with the radiographic judgements. The children examined in Tiel (F) had a mean of 2.54 clinically sound occlusal surfaces in first and second molars (including surfaces with an enamel demineralization only) of which bite-wing radiographs detected 0.43 surfaces (16.9%) with a radiolucency into dentine. In Culemborg (NF) the children had a mean 0.65 clinically sound judged surfaces of which 0.16 (24.6%) showed a radiolucency on the bite-wing films. The results of the investigation show a proportional reduction of surfaces with hidden caries among clinically sound surfaces in the fluoridated area compared to the control.

The aim of this study was to study the characteristics and to explore risk factors within a group of Dutch children breast-fed on demand over a prolonged period, whose mothers attended the meetings of La Leche League. Ninety-six children, 55 boys and 41 girls (mean age 28.8 months, SD 8.8), were examined. Most of the parents belong to a higher socio-economic working class. The examination included a questionnaire and dietary sheet, combined with the caries status of the child. On average the children were breast-feed for 21.5 months (SD 9.8). The mean age at which the parents started brushing the children’s teeth was 11.7 months (SD 5.1). Fluoridated toothpaste (250 ppm fluoride) was used by 70% of the children. The children were divided into three groups according to their caries pattern: 1 caries-free; 2 caries, and 3 nursing caries. Dentine caries was found in 14 (14.5%) of the children, of which 9 (9.3%) met the criteria of nursing caries. The mean dmfs of all children examined was 1.2 (SD 4.8). Up to 18 months of age the breast was given significantly more frequently during the night and up to 24 months during the day time, to the children of the nursing caries group compared to the children in the other two groups. The children still being breast-fed at the time of investigation more frequently slept in their parents’ bed. The children of the nursing-caries group used fluoridated dentifrices less often. The majority of children of the caries and nursing-caries groups did not receive fluoride from other sources. The results of the present study demonstrate that prolonged demand breast-feeding does not lead to a higher caries prevalence although comparison between the groups demonstrates that frequent breast-feeding and low additional fluoride use should be considered as contributing factors in the process of nursing caries.

Restorative dentistry is based on the assumption that bacterial infection of demineralized dentine should prompt operative intervention. One of the concepts of practical dentistry is to create a favourable environment for caries arrest with minimal operative intervention. The progress of remaining primary caries is key to any discussion of this concept. This discussion is important for the atraumatic restorative treatment (ART) approach, since the removal of all carious dentine is sometimes difficult using hand instruments only. In this paper the results of possible measures to guard against the effects of residual carious and its consequences are reviewed, in order to obtain an impression of the justification for (in)complete excavation of occlusal dentinal caries. Three types of measure are considered: isolating the caries process from the oral environment, excavating the carious dentine, and using a cariostatic filling material. Each of these measures contributes to the arrest of the caries process. However, none of these measures can arrest this process by itself. A combination of all three seems necessary. It is concluded that although residual caries does not seem to be the criterion for rerestoration, one has to strive for as complete caries removal as possible. If this cannot be fulfilled the sealing capacities of the filling material seem to be more important than its cariostatic properties.