Abstract
Over the last decade, there has been growing interest in diagnosing non-cavitated lesions in epidemiological studies involving large numbers of preschool children, schoolchildren and young adults. In this context, assessment of lesions characteristics indicating whether or not there is ongoing mineral loss is also considered relevant. The reasoning sustained by these studies is that diagnosis of the caries process limited to the cavitated level is no longer in accordance with current state-of-the-art knowledge in cariology. This paper highlights one topic of the lecture entitled "Caries Process: Evolving Evidence and Understanding," presented at the 18th Congress of the Brazilian Association for Oral Health Promotion (Associação Brasileira de Odontologia de Promoção de Saúde - ABOPREV) in April 2013. In the framework of epidemiological studies, the interest in diagnosing active and inactive non-cavitated lesions was elucidated. However, relevant questions associated with the diagnosis of non-cavitated lesions that might raise concerns among researchers and health administrators were not addressed. The present paper aims to bring these questions into discussion. The contribution of this discussion in terms of developing the understanding of caries decline is analyzed by using data from a caries trends study of Brazilian preschool children residing in the Federal District of Brazil as an example. The inclusion of active and inactive non-cavitated lesions in the diagnosis of the caries process allowed us to demonstrate that, in Brazilian 1- to 5-year-old children, caries prevalence decreased significantly from 1996 to 2006, simultaneously with a reduction in the rate of caries progression.
Highlights
Over the last decade, there has been growing interest in diagnosing non-cavitated lesions in epidemiological studies involving large numbers of preschool and school-age children.[1,2,3,4,5,6,7] In this context, the assessment of lesion characteristics indicating whether or not there is ongoing mineral loss is considered relevant
The reasoning sustained by these studies is that diagnosis of the caries process limited to the cavitated level is no longer in accordance with current state-of-the-art knowledge in cariology
Diagnosing non-cavitated lesions in epidemiological studies: practical and scientific considerations lored to the aim of the epidemiological study, since arguments can be made both ways.[8]
Summary
There has been growing interest in diagnosing non-cavitated lesions in epidemiological studies involving large numbers of preschool and school-age children.[1,2,3,4,5,6,7] In this context, the assessment of lesion characteristics indicating whether or not there is ongoing mineral loss is considered relevant. Thorough clinical examination may be performed under field conditions, including the diagnosis of non-cavitated lesions, by having calibrated dentists assess caries activity and severity at the non-cavitated level, by having participants lie down on tables and having their teeth professionally brushed, flossed and dried with gauze bandage and by working with portable lights. Our data showed significant differences in caries prevalence and severity when non-cavitated lesions were considered in the individual’s caries experience.[13] In this context, it is worth mentioning that in our studies very few children presented inactive non-cavitated lesions only. These cases were included in the group of participants classified as caries-free. The observed caries decline was related to both active and inactive non-cavitated lesions
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