Dentin caries activity in early occlusal lesions selected to receive operative treatment

Abstract

Background Members of the practice-based research network Practitioners Engaged in Applied Research and Learning (PEARL) Network investigated the dentin caries activity in early occlusal lesions and its relationship to patient age, preoperative tooth sensitivity and radio-graphic appearance, as well as its influence on preparation depth and volume. Methods PEARL Network practitioner-investigators (P-Is) (n = 45), general dentists who were trained but whose methods were not calibrated, conducted a study regarding postoperative hypersensitivity in resin-based composite restorations. The P-Is enrolled as study participants 613 patients with occlusal carious lesions that, in the P-Is’ clinical judgment, required restoration. The P-Is used baseline radiographs to assess the depth and extent of the lesions. Data for 671 restorations included baseline sensitivity; ranking of dentin caries activity on the opening of the enamel; radiographic visibility (n = 652); and measurements of preparation depth, width and length. Results P-Is found rapidly progressing dentin caries in 38.5 percent (258 of 671) of lesions and slowly progressing (and potentially inactive dentin) caries in the remainder of the lesions. Rapidly progressing caries was not related to the participant’s age or participant-reported preoperative hypersensitivity but was related to the lesion depth as seen radiographically (P < .001) and depth (P < .001) and volume (P < .001) of the preparation. Molars had slightly higher but not statistically significant levels of caries activity. Conclusion Rapidly progressing dentin caries, while present in only 38.5 percent of lesions, was related to the lesion’s radiographic appearance but not to the participant’s age or the study tooth’s pre-operative sensitivity. Clinical Implications On the basis of the low level of rapidly progressing dentin caries in this study population and the fact that slowly progressing caries can be inactive or remineralizing, the authors advise sealing versus operative treatment of early or shallow occlusal lesions.

Effectiveness of a resin-modified glass ionomer liner in reducing hypersensitivity in posterior restorations

“…18 The P-Is ranked DCA as active (or rapidly progressing) (score of 1 or 2) in 52 percent of these lesions; this finding is in line with the majority’s being ranked as having active caries. The caries risk classification of these patients generally was low (44 percent) to moderate (39 percent).…”

“…The PEARL Network executive management team trained P-Is through use of videos, animated slide presentations and online quizzes in the identification of lesions, caries classification, 15,16 measurement of hypersensitivity to air and cold, SB evaluation, 17 DCA ranking 18 and measurement of preparation dimensions and depth, 2 as well as in treatment procedures. Study participants at baseline and at each recall appointment rated their hypersensitivity to air and cold stimuli by using the Numeric Pain Assessment Scale (NPAS) 19 and completed questionnaires about stimuli that cause hypersensitivity and how the condition affects their QoL.…”

“…Study participants at baseline and at each recall appointment rated their hypersensitivity to air and cold stimuli by using the Numeric Pain Assessment Scale (NPAS) 19 and completed questionnaires about stimuli that cause hypersensitivity and how the condition affects their QoL. 18 In addition, participants were asked about their pain medication usage. P-Is in this study were limited to those who had engaged in at least one PEARL Network study, so they were experienced in administering participant surveys regarding hypersensitivity and QoL.…”

“…The P-I initiated cavity preparations and ranked DCA according to a visual-tactile scale 18 (Table 2). He or she then completed the preparation.…”

Treatments for hypersensitive noncarious cervical lesions

“…In our previous work 46,50 we defined AH as values of 3 or higher on the 0- to 10-point NPAS, and this was the basis for our having included in this study participants who had clinically measured AH. Figure 5 (page 503) indicates the numbers of patients in each group who had AH after treatment.…”