Caries Process on Occlusal Surfaces: Evolving Evidence and Understanding

Abstract

Management of the caries process on occlusal surfaces of permanent molars has proven a major challenge. The onset of caries on these surfaces takes place soon after their eruption, and the permanent first molars, followed by the second molars, remain the sites in the dentition which show the highest caries prevalence. This paper is structured in the form of questions and answers in which traditional concepts of caries susceptibility of occlusal surfaces are appraised and confronted with the current evidence. Then, research studies examining the role of biological determinants on the development and arrest of occlusal caries in young permanent teeth are discussed. Finally, the contribution of these studies in terms of developing the available scientific evidence and our understanding of the caries process on occlusal surfaces is analyzed. The current evidence does not support the concept that the early onset and high prevalence of occlusal caries in young permanent teeth are due to a particularly low inherent resistance of the occlusal surface or due to the presence of inaccessible fissure-like structures on these surfaces. Evidence is provided to show that the most influential biological determinants of the development and arrest of occlusal caries are thick plaque accumulation on the groove-fossa system and the stage of tooth eruption limiting mechanical oral function. Consequently, active occlusal lesions are significantly more prevalent in erupting than in fully erupted teeth. The major contribution of this review is to provide updated knowledge about the biological principles determining the development and arrest of caries on occlusal surfaces of erupting teeth.

Seal or Varnish? A randomised controlled trial to determine the relative cost and effectiveness of pit and fissure sealant and fluoride varnish in preventing dental decay

“…Management of occlusal caries on permanent molars has proven to be a great challenge to the dental profession. 7 Occlusal caries accounts for the majority of affected tooth surfaces in adolescents and adults. [8][9][10][11] It is, therefore, apparent that preventing dental caries on the occlusal surfaces of FPMs is a key objective in preventative dental care.…”

Occlusal Caries: Biological Approach for Its Diagnosis and Management

“…Risk factors are part of the causal chain [Beck, 1998]. According to this definition, occlusal biofilm is a risk factor for the occurrence of occlusal caries [Carvalho, 2014]. However, the question of interest is how accurately can we identify individuals or tooth surfaces/sites at risk by assessing risk factors?…”

“…The tooth types with the highest caries experience are first molars followed by second molars. Concerning the groups of teeth, molars are often and premolars are seldom attacked by dental caries [Carvalho et al, 2001;Van Nieuwenhuysen et al, 2002;Batchelor and Sheiham, 2004;Carvalho, 2014]. A recent Danish study has shown that half of the caries experience in 18-year-olds is located occlusally, although the occlusal surfaces constitute less than 15% of all surfaces in the dentition [Nørrisgaard et al, 2016].…”

Caries Detection With Laser Fluorescence Devices. Limitations of Their Use

“…Most commonly, occlusal caries occur more often in premolars and fi rst molars. 3,4 The diffi culty of prompt clinical diagnosis in occlusal areas is due to the anatomical features of these surfaces as well as the use of topical fl uoride products. Fluoride can prevent the collapse of the superfi cial enamel layer and infl uence the remineralization process.…”