Dental caries, otherwise known as tooth decay, is one of the most prevalent chronic diseases of people worldwide; individuals are susceptible to this disease throughout their lifetime. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors including teeth and saliva. The disease develops in both the crowns and roots of teeth, and it can arise in early childhood as an aggressive tooth decay that affects the primary teeth of infants and toddlers. Risk for caries includes physical, biological, environmental, behavioural, and lifestyle-related factors such as high numbers of cariogenic bacteria, inadequate salivary flow, insufficient fluoride exposure, poor oral hygiene, inappropriate methods of feeding infants, and poverty. The approach to primary prevention should be based on common risk factors. Secondary prevention and treatment should focus on management of the caries process over time for individual patients, with a minimally invasive, tissue-preserving approach.

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The diagnosis of occlusal caries at non–cavitated sites remains problematic, especially since clinical visual detection has limited sensitivity. Electrical methods of detection show considerable promise, but specificity is reduced. The aims of this in vitro study were: (1) to assess the validity of a new laser fluorescence device – the DIAGNOdent – (and compare the values with those of a fixed–frequency electrical device); (2) to determine the optimum cut–off points of the new device for different stages of the caries process, and (3) to assess the reproducibility of the new laser device. For validity and determination of optimum cut–off points, 105 extracted teeth with macroscopically intact occlusal surfaces were measured by a single examiner, using both the laser fluorescence device (on both moist and dried teeth) and an Electronic Caries Monitor. The teeth were subsequently examined histologically to determine the specificity, sensitivity and likelihood ratio at the D₂ (caries extending through more than half of the enamel thickness) and D₃ (caries involving dentin) levels. The values obtained for the laser device ranged from 0.72 to 0.87 (specificity), 0.76 to 0.87 (sensitivity) and 3.0 to 5.6 (likelihood ratio). Those for the ECM ranged from 0.64 to 0.78 (specificity), 0.87 to 0.92 (sensitivity) and 2.4 to 4.1 (likelihood ratio). To determine intra– and interexaminer reproducibility of the DIAGNOdent, 11 dentists recorded two different measurements at the same site on a separate set of 83 extracted molar teeth, and these were compared using Cohen’s kappa (at D₂ and D₃ levels) and Spearman’s correlation coefficient. The average intra–examiner kappa scores were 0.88 (D₂) and 0.90 (D₃), with a Spearman correlation of 0.97. For interexaminer reproducibility, the average kappa values were 0.65 (D₂) and 0.73 (D₃), with a Spearman correlation of 0.84. It is concluded that for occlusal caries (1) the new laser device has a higher diagnostic validity than the ECM, and (2) in vitro, measurements using the device are highly reproducible. Thus, the laser device could be a valuable tool for the longitudinal monitoring of caries and for assessing the outcome of preventive interventions.

Northern Ireland. In contrast to previous surveys, Scotland did not participate meaning that UK wide comparisons are not possible. The first paper in this series 1 describes in more detail the sampling and analytic methods. This paper, the second in the series, summarises the main findings of the 2009 Adult Dental Health Survey (ADHS) with respect to the state of teeth and periodontal tissues and how these impact on the quality of life of people. It is based on data from both the questionnaire and the clinical examination. For the dental examination, teeth were examined and data recorded at tooth surface level for caries and restoration status. Periodontal examination was undertaken at two sites on each tooth and data were also recorded for plaque, tooth wear and occlusal contacts. The questionnaire included information on oral-health-related quality of life, by focusing on the impact of oral conditions on the daily life of participants. We employed two indicators (OHIP-14 2 and

At general dental practices in Scotland 211 children between the ages of 5 and 15 years were examined by 1 observer. A comparison of the status of 1,468 permanent and 756 primary posterior approximal surfaces was made on the basis of their appearance on posterior bite-wing radiographs and the findings of a direct in vivo visual examination, made after temporary tooth separation had been achieved over 1 week using elastomeric separation. For permanent tooth surfaces, 0% of radiolucencies in the outer half of enamel, 10.5% in the inner half of enamel, 40.9% extending to the outer half of dentine, and 100% extending to the inner half of the dentine were found clinically to be cavitated. The analogous results for primary teeth were that 2.0, 2.9, 28.3, and 95.5%, respectively, of radiolucencies appeared to be cavitated. Although further research with larger numbers of permanent teeth is indicated, these results may contribute to a re-evaluation of the optimal threshold for restorative intervention at approximal sites. Greater numbers of approximal radiolucencies and carious lesions (p < 0.001) were found in those surfaces which initially had a normal anatomical contact when compared to those which did not.

Following the consideration of several recent systematic and other reviews, there is a growing professional and scientific consensus that caries measurement methodology in caries clinical trials (CCT) should be updated to reflect progress made elsewhere in cariology. In this paper, therefore, "modern" means accepted in contemporary dental research and dental practice on the basis of sound research evidence--not necessarily new or requiring the use of new technology. Caries measurement should be seen in the context of the objectives of modern clinical caries management and the continuum of disease states, ranging from sub-surface carious changes through to more advanced lesions. Measurement concepts can be applied to at least three levels: the tooth surface, the individual, or the group/population. All are relevant to CCTs. Modern clinical caries management can be seen as comprised of seven discrete but linked steps (Steps 2, 3, and 4 are directly concerned with measurement.): (1) 'Caries detection' represents a yes/no decision as to whether caries is present; (2) lesion measurement assesses defined stages of the caries process, taking into account the histopatholgical morphology and appearance of different sizes and types of lesion and the diagnostic threshold(s) being used; (3) lesion monitoring by repeated measures at a series of examinations is used when lesions are less advanced than the stage judged to require operative intervention (A comparison of serial measurements permits the efficacy of preventive care aiming either to arrest or to reverse the lesion to be assessed.); (4) caries activity measures would be very valuable, but are relatively poorly developed and tested at present; (5) diagnosis, prognosis, and clinical decision-making are the important human processes in which all the information obtained from steps 1 to 4 is synthesised; (6) interventions/treatments, both preventive and operative, are now routinely used for caries management; and (7) outcome of caries control/management assesses caries management by examining evidence on the long-term outcomes. A challenge for the future is to define a range of optimal caries measurement methods--in use or in development in recent trials, in clinical practice, and/or in caries epidemiology--that will best contribute to more efficient, modern caries clinical trials.

This study investigated the impact of employing differing diagnostic thresholds on clinical caries data in studies of groups with low caries prevalence. Data from clinical examinations of 287 Hong Kong dental students were analyzed by means of the CARIES microcomputer software package. This software allows for re-calculation of raw data according to three different diagnostic thresholds (D3, D2, and D1). When "enamel" and "initial" lesions (as defined by WHO criteria) were included in the calculation of DMFT, its value increased from 3.0 (D3) to 5.9 (D1), while the percentage of individuals considered "caries-free" decreased from 28.2% to 7.0%. Little change was found in the magnitude of the intra-examiner reproducibility, when calculated at each threshold, for a random 10% of the subjects. It was unfortunately not possible to calculate inter-examiner reproducibility in this study. The use of criteria which might be misinterpreted as being similar, but which use differing effective diagnostic thresholds, can dramatically influence the reported level of dental caries. In view of these findings, it may be necessary for the question of diagnostic thresholds to be re-examined and to receive greater emphasis in future studies.

Background: Biomedical research constantly produces new findings but these are not routinely translated into health care practice. One way to address this problem is to develop effective interventions to translate research findings into practice. Currently a range of empirical interventions are available and systematic reviews of these have demonstrated that there is no single best intervention. This evidence base is difficult to use in routine settings because it cannot identify which intervention is most likely to be effective (or cost effective) in a particular situation. We need to establish a scientific rationale for interventions. As clinical practice is a form of human behaviour, theories of human behaviour that have proved useful in other similar settings may provide a basis for developing a scientific rationale for the choice of interventions to translate research findings into clinical practice.