Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions

Abstract

Background A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency, but where caries is suspected due to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). Our objective was to quantify the characteristics of SOCLs and their relationship to lesion depth/activity after surgically opening these lesions. Methods Ninety-three dentists participated. When consented patients presented with a SOCL, information was recorded about the tooth, lesion, treatment(s) done and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted chi-square test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster. Results 1593 SOCLs were analyzed. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other color. A majority (69%) of SOCLs had a rough surface when examined with an explorer. Over 1/3 of the SOCLs (39%) were treated surgically. Of the surgically treated SOCLs (n=585), 61% had dentinal caries. There were statistically significant associations between lesion depth and color (p=0.03), luster (p=0.04) and roughness (p=0.01). 52% of patients were classified as being at elevated caries risk. There were no significant associations between lesion depth and patient risk (p=0.07). Conclusion Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions, and result in high rates of false positives. Practical implications Given that 39% of opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention.

Recruitment strategies and retention rates for five National Dental PBRN studies

“…When recruiting/ enrolling on a national scale, it can be challenging to stop enrollment at a specific date, especially when simultaneously wanting to maintain optimal relationships with practitioners who have devoted significant effort to a specific study. Three studies were excluded: (1) Suspicious Occlusal Caries study because patients were not followed [24]; (2) Anterior Open bite study because only patients whose treatment was considered ended or completed, viz., open-bite closed, were requested to return in 18 months [25]; and (3) Risk for Oral Cancer study because only patients with a positive high-risk human papillomavirus test (N = 11) result were requested to come in for a 6-month visit [26]. Two out of the five studies described below required in-person FU visits.…”

Evaluation of fluoride varnish treatment of postorthodontic white spot lesions by visual inspection and laser fluorescence—A randomized controlled study

“…The presence of a WSL is conventionally well detected by visual inspection, (Gimenez et al, 2015) but with a limited ability to assess the degree of demineralization and the de‐ and remineralization dynamics (Makhija et al, 2017). Laser fluorescence (LF) detecting devices have been used as an additional diagnostic method to monitor the dynamics of WSL de‐ and remineralization in a bacteria inhabited environment, as was shown in vitro and in situ by Spiguel et al (2009) and in vivo by Ferreira et al (2008).…”