Dentistry Research Articles

Exploring the oral health status of children living with hypoxic ischemic encephalopathy (HIE): A caregiver described self-report.

Hypoxic Ischemic Encephalopathy (HIE) is a birth complication due to loss of oxygen flow, resulting in a wide range of physical and cognitive differences often requiring support from multidisciplinary healthcare teams. Despite this population's increased need, little is known about their oral health status and the role of the dentist as a member of the care team. A 32-item oral health questionnaire was shared to 8700 members within the patient advocacy non-profit, Hope for HIE's, Facebook group. The survey assessed caregiver-reported oral health status and facilitators and barriers to receiving dental care. Two hundred sixty-two individuals responded to the survey. The majority were white (90%, 177/196) parents of children with HIE (99%, 259/262) that lived in the U.S. (76%, 148/195) and cared for children under 3 (42%, 106/251). 36% (85/236) reported cavity experience, 81% (180/223) reported visiting the dentist for a dental check-up, however, 58% (147/255) considered the dentist to be a member of their child's care team. Children diagnosed with HIE likely experience similar oral health status as their peers, however, qualitative developmental work is necessary to assess facilitators and barriers to receiving dental care, and how to integrate the dentist into the care team.

Oral Health of Children and Adolescents with Diabetes Mellitus

Aim: To examine the oral health of children and adolescents with and without diabetes mellitus. Background: Diabetes mellitus is the most common metabolic disease in childhood and demonstrates an increasing incidence. Many children live with gingivitis as a precursor to periodontitis. If left untreated, it can cause the development of periodontitis. The links between periodontitis and diabetes mellitus are known but have been little studied in the age group of children and adolescents. Materials and Methods: Clinical examination and collection of sulcus fluid from participants aged 5 to 21 years was performed. The following data were collected: demographic variables, caries prevalence, DMF-T, VPI, PUFA, salivary flow rate, HbA1c, PSI, and the concentration of IL-1β, IL-6, MMP-8, and TNF-α. Results: Patients with diabetes mellitus showed a significantly lower salivary flow rate with higher concentrations of MMP-8 and IL-1β. The data indicate that at this age, regular visits to the dentist are of great importance for the promotion of oral health in children and adolescents regardless of diabetes and that patients with diabetes mellitus in particular benefit from prevention, as they belong to the periodontitis risk group. Conclusions: Patients with low salivary flow rates and increased inflammatory mediators are high-risk patients for whom dental preventive measures play a major role.

Plasma Rich in Growth Factors Compared to Xenogenic Bone Graft in Treatment of Periodontal Intra-Osseous Defects—A Prospective, Comparative Clinical Study

Background: Periodontal intra-bony defects are challenging conditions in dental practice, often requiring regenerative approaches for successful treatment. This clinical study aimed to compare the effectiveness of plasma rich in growth factors (PRGF) versus xenogenic bone graft (BXG) in addressing intra-bony defects. Methods: Forty patients aged between 30 and 50 years presenting with generalized periodontitis were included. The study assessed various parameters, including relative attachment level (RAL); probing pocket depth (PPD); gingival marginal level (GML); intra-bony defect depth (IBDD) at baseline, 3, and 6 months; and level of pain, post-operative bleeding, and swelling, as patient-reported outcomes during the first seven days post operation. Results: The results revealed that both PRGF and BXG treatments led to significant reductions in IBDD over the 6-month study period. PRGF demonstrated significant advantages in GML enhancement and post-operative pain management during the initial post-treatment days. However, BXG showed a significantly greater reduction in IBDD compared to PRGF. Post-operative bleeding and swelling levels were comparable between the two treatments. Conclusions: These findings underscore the efficacy of both PRGF and BXG in periodontal regeneration, with treatment decisions guided by patient-specific factors and clinical goals.

Knowledge, Attitude, and Practice of General Dentists Towards Tele-dentistry

Background: Considering the growing importance of tele-dentistry and its potential to enhance the delivery of dental services, this study aimed to assess the knowledge, attitude, and practice (KAP) of private dental offices towards this technology. Methods: This analytical cross-sectional study included 50 general dentists practicing in Semnan city, selected based on entry criteria through the enumeration method. Participants completed a demographic questionnaire (including gender and years since graduation) and a 15-item researcher-made questionnaire designed to assess their KAP towards tele-dentistry. Results: Among the participants, 54% (27 participants) were female, and 46% (23 participants) were male, with an average age of 30.2 ± 6.48 years. The mean number of years since graduation was 7.74 ± 5.13 years. The mean and standard deviation of KAP scores were 5.96 ± 1.07 (knowledge), 34.32 ± 3.41 (attitude), and 1.44 ± 0.50 (practice), respectively. Men scored significantly higher in knowledge compared to women (7.26 ± 0.91 vs. 6.70 ± 1.14; P = 0.037). There was a significant inverse correlation between knowledge scores and years since graduation (r = -0.292; P = 0.032). Additionally, 52% (26 participants) reported having used tele-dentistry, while 96% (48 participants) expressed an intention to use it in the future. Conclusions: The findings suggest that knowledge regarding tele-dentistry was notably higher among men and those with fewer years since graduation. Health policies should prioritize training programs to enhance general dentists' knowledge and practice of tele-dentistry, supporting its effective implementation in dental care.

How to ensure an appropriate oral health workforce? Modelling future scenarios for the Netherlands

BackgroundCurrent methods for oral health workforce planning lack responsiveness to dynamic needs, hampering efficiency, equity and sustainability. Effective workforce planning is vital for resilient health care systems and achieving universal health coverage. Given this context, we developed and operationalised a needs-adaptive oral health workforce planning model and explored the potential of various future scenarios.MethodsUsing publicly available data, including the Special Eurobarometer 330 Oral Health Survey, we applied the model in a hypothetical context focusing on the Dutch population’s dental needs from 2022 to 2050. We compared current and future provider supply and requirement and examined, in addition to a base case scenario, several alternative scenarios. These included epidemiological transition scenarios with different oral health morbidity trajectories, skill-mix scenarios with independent oral hygienists conducting check-ups and multiple dental student intake and training duration (5 instead of 6 years) scenarios.ResultsBased on the aforementioned historical data, our model projects that provider requirement will exceed supply for the planning period. If the percentage of people having all natural teeth increases by 10% or 20% in 2032, 34 or 68 additional full-time equivalent (FTE) dentists will be required, respectively, compared to the base case scenario. In the skill-mix scenario, the model indicates that prioritising oral hygienists for check-ups and shifting dentists’ focus to primarily complex care could address population needs more efficiently. Among the student intake and training duration scenarios, increasing intake to 375 and, to a lesser extent, reducing training to 5 years is projected to most effectively close the provider gap.ConclusionsThe study underscores the importance of understanding oral health morbidity trajectories for effective capacity planning. Due to limited dental epidemiological data, projections carry substantial uncertainty. Currently, demand for FTE dentists seems to exceed supply, though this may vary with epidemiological changes. Skill-mix strategies could offer efficiency gains by redistributing tasks, while adjustments in dental intake and training duration could also help address the requirement-supply gap. Resolving dentistry workforce challenges requires a multifaceted approach, including strengthening oral epidemiology projections, addressing the root causes of dental health issues and prioritising harmonious dental public health and general practice prevention measures.

Traumatic Dental Injuries in Children and Adolescents from a Major Dental Clinic in Bosnia and Herzegovina: A 5-Year Retrospective Study

The aim of this study was to investigate the epidemiology of dental trauma in a public dental clinic in Banja Luka, Bosnia and Herzegovina, from 2019 to 2024. Methods: This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. Results: The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7–9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. Conclusions: It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time.

Perspectives of general dental practitioners on restoring endodontically treated molars: a UK-based vignette study.

Aims To assess and compare how UK general dental practitioners (GDPs) restore endodontically treated molars and what tooth-related factors they consider relevant to their management.Method An online cross-sectional vignette survey was sent out to UK dentists via email and the use of social media platforms. Three clinical cases were designed.Results In total, 394 participants completed the survey. GDPs showed a preference towards restoring the endodontically treated molars with indirect restorations, such as crowns and onlays. Material selection varied, with a notable inclination towards gold and lithium disilicate. This was influenced by factors such as the number of remaining tooth walls, thickness of walls and the presence of parafunction.Conclusion Clinicians generally agreed on whether to place a direct or indirect restoration but there was greater disagreement when deciding on the type of restoration and material. Further evidence and education are required to help UK dentists decide more objectively whether to place an onlay or a crown, what material to select and what prognostic factors are most pertinent to the case.

Antibiotics Knowledge and Prescription Patterns Among Dental Practitioners in Croatia, Bosnia and Herzegovina, and Serbia: A Comparative E-Survey with a Focus on Medically Healthy and Compromised Patients

Background: The non-specific prescription of antibiotics, especially in dentistry, contributes to the global problem of antimicrobial resistance and highlights the need for education on the proper use and serious consequences of overprescribing these drugs. The main objective of this study is to assess and evaluate antibiotic knowledge and prescribing patterns in dental practice in Croatia, Bosnia and Herzegovina, and Serbia, focusing on understanding the rationale for prescribing, adherence to evidence-based guidelines, and dentists’ awareness of antibiotic resistance. Methods: A total of 795 dentists participated in this electronic cross-sectional survey (Croatia N = 336, Bosnia and Herzegovina N = 176, and Serbia N = 283). The study utilized a self-structured questionnaire to collect data on various aspects of antibiotic use, including knowledge, prescribing practices, awareness of guidelines, and demographic and professional information about dentists. Data analysis included the Mann–Whitney test, the Kruskal–Wallis test with post hoc analysis, and chi-square tests, with statistical significance set at p < 0.05. Results: The overall score for the participants’ knowledge of antibiotics was 6.40 ± 1.40 out of a maximum of eight points, which indicates a generally good level of knowledge among dentists. Factors such as gender, specialty, and practice location significantly influenced the level of knowledge (p < 0.05). However, actual prescribing practice was a cause for concern. Only 66.1% of Croatian dentists felt they had received adequate training during their studies, and even fewer in Serbia (48.4%) and Bosnia (46.6%). It is noteworthy that 9.7% of dentists in Bosnia and Herzegovina prescribe antibiotics at the request of patients, while 22.3% of Croatian and 25.4% of Serbian dentists do so. Many dentists prescribe no or only one antibiotic per week. In addition, 50.9% of Croatian dentists reported adverse effects related to the use of antibiotics, while only 31.3% of Bosnian and 33.6% of Serbian dentists reported similar experiences. Conclusions: While the study results indicate that dentists in the region generally possess good knowledge of antibiotic use, there are significant discrepancies between this knowledge and actual prescribing practices. This highlights the need for enhanced educational programs and awareness initiatives focused on proper antibiotic guidelines to improve prescribing behaviors.

The influence of maternal long term health conditions including multimorbidity on child oral health: A scoping review and evidence gap map protocol

Objective This scoping review will map the extent and type of evidence in relation to the association between maternal long term health conditions (LTCs), including multimorbidity, and child oral health. Introduction Newer theories are emerging that detail the many factors that can influence child oral health at child, family and community levels. More recently, the association between maternal general health and child oral health has been explored, with preliminary evidence suggesting a link between shared environmental factors and diet/substance use during pregnancy causing childhood caries. Inclusion criteria All published studies that describe the relationship between maternal LTCs (including multimorbidity) and child oral health. There will be no limitation on the date of publication due to the limited number of studies available from the initial search of PubMed. The review will exclude case studies, abstracts, and grey literature. Literature must be in English language. Methods The following databases will be searched; CINAHL, Cochrane Library, Maternity and Infant Care, Medline via PubMed, Scopus, Web of Science. The search will include sources in English only and will be undertaken between April and July 2024. Studies to be included will be of any type of study design that describe a relationship between maternal long term health conditions, including maternal long term oral health conditions, and child oral health. Data extraction will be undertaken using tabulation of results by at least two independent reviewers. Narrative analysis of the evidence will be undertaken, and results will be presented in a narrative and tabular manner due to the heterogenous and limited evidence base found in the test search. This review has been registered prospectively on Open Science Framework, (https://doi.org/10.17605/OSF.IO/ECSWJ). The review will also inform an Evidence Gap Map (EGM) to illustrate the current evidence base regarding maternal health factors that influence child oral health.

Blue Zone Loma Linda: Assessing the Relationship Between Lifestyle and Oral Health.

Objectives: Assess the relationship between lifestyle and oral health-related quality-of-life (OHRQoL) of residents in a blue zone, Loma Linda. Methods: A cross-sectional study was conducted using a questionnaire including demographics, lifestyle, and Oral Health Impact Profile (OHIP-14). Lifestyle cumulative scores ranged from 8-32, lower scores indicating greater conformity to Power 9® lifestyle, characterized by observing Sabbath, time with friends, volunteering, exercising, eating lots of plants, eating meat in moderation, drinking a lot of water, snacking on nuts, and eating an early dinner. OHIP-14 assessed OHRQoL, with scores from 0-56. Negative binomial regression was used, with significance of alpha = 0.05. Results: A total of 350 surveys were collected. Cumulative lifestyle showed a mean of 13.9. Spending time with friends was the most adhered to activity (96%) while the least followed was having early dinners (71.2%). Asians (Mean = 14.2) had significantly higher lifestyle scores than Whites (Mean = 13.7). The mean OHIP-14 was 7.01. Whites had lower OHIP-14 scores than Asians, indicating better OHRQoL. Race, nut consumption and exercise were significant predictors for increased OHRQoL (P < 0.05, in all instances). Conclusions: Loma Linda residents adhere well to the Power 9® lifestyle. There are significant predictors such as nut consumption and exercise for increased OHRQoL.

Should dental practices take control of smoking cessation?

Should dental practices take control of smoking cessation?

Perception of facial esthetics and cephalometric correlations in Class II patients: a comparison between two-phase and one-phase treatments

An effective orthodontic treatment should not only aim for satisfactory occlusal outcomes but also consider its impact on facial esthetics. The study aims to evaluate and compare the perception of profile esthetics of skeletal Class II patients treated with two orthodontic modalities: (1) Two-phase approach involving functional appliances followed by fixed appliances with premolar extractions, or (2) One-phase approach using fixed appliances with premolar extractions. Additionally, the study aims to evaluate the correlation between the perceived esthetics and the corresponding cephalometric measurements. The study included 40 skeletal Class II adolescents who underwent either two-phase (n = 20, mean age = 12.38 ± 1.18) or one-phase (n = 20, mean age = 12.53 ± 0.79) orthodontic treatments. Eighty profile silhouettes (pre- and post-treatment) were assessed by 64 raters, including 23 orthodontists, 21 general dental practitioners, and 20 laypersons. The raters used a visual analog scale (VAS) to access profiles, upper and lower lips, and chin esthetics. At pre-treatment, all three groups of raters gave significantly lower scores to the profile silhouettes of the two-phase group compared to the one-phase group (P < 0.01); however, after treatment, they rated the two-phase group significantly higher (P ≤ 0.001). The two-phase group exhibited greater improvements in profile and upper and lower lip esthetics as perceived by all raters (P ≤ 0.001). Furthermore, cephalometric results revealed greater reductions in SNA, ANB, Wits appraisal, and G’-Sn-Pog’ in the two-phase group compared to the one-phase group (P < 0.05). Five cephalometric parameters (SNB, SNPog, overjet, overbite, and UL-SnPog’) demonstrated significant correlations with VAS scores given by orthodontists (P < 0.05). In conclusion, the two-phase group showed greater subjective and objective improvements in facial esthetics than the one-phase group. Additionally, the anteroposterior mandibular position and upper lip protrusion may be the primary cephalometric parameters correlated with subjective facial profile perceptions.

The Hippo pathway in oral diseases and treatments: A review.

This review aims to provide a recent update on the Hippo pathway in oral diseases. The Hippo pathway plays a crucial role in organ development, tissue regeneration, wound healing, maintaining epithelial homeostasis, and modulating the immune system. Globally, billions of people suffer from various oral diseases, posing significant public health risks and resulting in substantial economic losses. This article reviews the recent advancements in the research on the Hippo signaling pathway and its effectors in various conditions related to oral health. The implications of Hippo signaling in various dental fields, including endodontics, orthodontics, periodontology, oral implantology, oral and maxillofacial surgery, and oncology are discussed. It provides readers with an overview of the regulatory role of the Hippo pathway in the development of various oral diseases and the potential for exploiting this pathway for developing targeted therapeutics.

An 'explosion in the mouth': The oral health experiences of autistic children.

In England, one in four children have tooth decay by the age of 5 years. Tooth decay affects many autistic children. Communication differences, sensory sensitivities and preferred routines can make dental care difficult. Daily toothbrushing, healthy eating and drinking, and attending the dentist may be challenging for autistic children. We do not know much about how autistic children feel about looking after their teeth. Learning from them directly is important to understand their needs and make sure their voices are heard. We interviewed 10 autistic children aged between 7 and 13 years to discover how they care for their teeth, what helped and what did not. We talked about toothbrushing, healthy eating and drinking and visiting the dentist. To support our conversations, we used Talking Mats® - a tool that can help with communication. Autistic children described a wide range of sensory issues related to looking after their teeth. This finding shows how important it is to tailor care to each child's needs. Children wanted to be included in conversations about their teeth at home and at the dentist. This was felt to make a big difference in building trust and making them feel comfortable and supported. Overall, we found Talking Mats® can be used in dental research to engage with autistic children. By understanding children's views, we can better help professionals and parents to support their dental needs. Our research showed that every child's experience is unique, so dental support must be tailored and inclusive to meet children's needs.

Consistency between inter-institutional panels using a three-level Angoff-standard setting in licensure tests of foreign-trained dentists in Sweden: A cohort study.

Licensure exams play a crucial role in ensuring the competence of individuals entering a profession, thereby safeguarding the public and maintaining the quality and integrity of the profession. In Sweden, dentists educated outside the European Union seeking to practise dentistry must undergoa re-certification process. The re-certification process includes a theoretical examination where pass marks are set using a three-level Angoff method. This study aimed to determine the consistency of the Angoff ratings using independent panels at two Swedish universities. Two cohorts of panellists were included in the study: one reference and one external. The reference panel was responsible for rating the upcoming theoretical examinations in the proficiency test, which were used to set the pass mark. The external panel, recruited from a dental school at a university in another region in Sweden, provided ratings after the examinations. Three examinations during 2019-2020 were included in this study (267 items in total). There was a strong correlation (ρ ≥ 0.70, p < .001) between the ratings of the two independent panels, with no significant differences in item ratings across the full exams, dental disciplines, and professional qualifications analysed. This suggests that the three-level Angoff method reliably produces similar standards for assessing the competence of the minimally qualified dentist across different institutions. The expectations of the minimally qualified but still acceptable dentist were comparable between the two independent panels across the three theoretical examinations explored. The alignment between the panels indicates valid, reliable standards across institutions, despite the independent syllabi of the two study programmes. However, while there is an alignment, differences in ratings remain. Consequently, involving multiple institutions in future standard-setting processes could help ensure that the standards reflect a broader range of educational practices, supporting the credibility of licensure examinations.

The Anthropological Process of Identifying Missing Persons as a Teaching Method for Increasing Awareness in Legal and Forensic Dentistry in the Republic of Cyprus

Forensic Odontology is a critical field within forensic science, with significant importance in legal contexts and the identification of victims in mass disasters or cases of abuse. This article focuses on the efforts made by the European University Cyprus (EUC) School of Dentistry to raise awareness among dental students regarding legal and forensic dentistry practices. Through voluntary visits to the Anthropological Laboratory of the Committee on Missing Persons (CMP) in Cyprus, students gain firsthand experience and insights into anthropological analysis for identifying missing individuals. These visits provide students with practical application opportunities, emphasizing record-keeping practices, oral tissue morphology analysis, and unique aspects of restorative work during identification processes. Feedback from participating students highlights the value of experiential learning in increasing awareness about forensic odontology’s importance and relevance in real-world scenarios. The initiatives undertaken by the EUC School of Dentistry contribute to enhancing legal and forensic dentistry awareness among future dental professionals in Cyprus.

The pattern of antibiotics prescription for endodontic infections in Malaysia: Cross sectional survey study.

This study aimed to assess the antibiotic prescribing pattern for endodontic infections among general dental practitioners (GDPs) and endodontic specialists in Malaysia. A 22-questions survey on demographic and general information on antibiotic prescribing patterns for endodontic infection was delivered to the email addresses of general dentists and specialists via the Dental Practitifoner Information Management System database. Collected data were analysed using multivariate logistic regression tests at the significance level of 0.05. A total of 372 responses were collected. 94% of respondents were GDPs, and 6% endodontists. Clinical experience and frequency of endodontic treatment performance were the significant factors in prescribing antibiotics (p < 0.05). The common reasons for antibiotic prescription were to control the spread of infection and fever (88%). Endodontists have better knowledge of antibiotic prescription than GDPs. The majority of GDPs had inappropriately prescribed antibiotics. Improving the knowledge of GDPs in Malaysia regarding antibiotics-indications in endodontics is mandatory.

Examination of oral health quality of life and patient satisfaction in removable denture wearers with OHIP-14 scale and visual analog scale: a cross-sectional study

BackgroundOral Health-Related Quality of Life (OHRQoL) is a term that encompasses conditions such as oral health status, living conditions, and function. OHQoL can change with the varying health conditions of the same individual. Many patients cannot afford implants or have anatomical limitations and therefore use traditional removable dentures. There are comparatively few studies investigating OHRQoL and denture satisfaction that include the patients’ sociodemographic data, denture satisfaction and related questions.AimThis study aimed to investigate OHRQoL and patients’ satisfaction with three types of dentures: upper and lower complete dentures, upper and lower partial dentures, and upper complete lower partial dentures.MethodsThe study was conducted between January 2022 and June 2023, with 150 patients using removable dentures. Patients’ age, gender, education level, place of residence, smoking status, reasons for tooth loss and visiting the clinic, type of denture and the duration of denture use were recorded. Oral Health Impact Profile (OHIP-14) and patient satisfaction with dentures as measured on a Visual Analog Scale (VAS) were used to assess patients’ satisfactions with OHRQoL and dentures respectively. Descriptive statistics, the Shapiro-Wilk normality test, the Mann-Whitney non‐parametric test and the Kruskal-Wallis test were used.ResultsStatistically significant differences were found between gender, prosthetic type, usage duration and OHIP and VAS scores (p < 0.05). Women’s OHIP scores were higher than men’s, patients using complete dentures had higher scores than those using partial dentures in both jaws, those using dentures for less than 1 year had higher scores than those that had used them for more than 1 year. The analysis revealed no statistically significant differences in OHIP and VAS scores based on age, education level, and place of residence (p > 0.05).ConclusionsPatients may find it easier to adapt to removable partial dentures compared to complete dentures. Therefore, in prosthetic planning, dentists should prioritize preserving existing teeth. Regardless of the type of prosthesis, patients adapt to their prostheses over time, leading to increased satisfaction with prolonged use. Since individuals do not have a habit of visiting the dentist when there is no known problem, dentists should encourage patients to attend regular dental check-ups.

Impact of Gram-negative bacteria on oral health

Impact of Gram-negative bacteria on oral health

Dentists’ Treatment Decisions Concerning Restorations in Adult Patients in North Norway: A Cross-Sectional Tromsø 7 Study

Plain Language SummaryA randomized population of adults over 40 years, selected among the citizens of Tromsø County in North Norway, were examined by dentists, resulting in a study group of 3,653. Clinical examinations were executed, clinical photos and X-rays taken of each patient in a dental clinic. This is part of the Tromsø 7 study. A specially designed data programme was developed, and 17 trained dentists were able to assess the clinical state of restorations. All the dentists were working as clinical teachers in dental schools. The purpose was to decide what kind of treatment they thought best for unacceptable restorations. Should they be replaced or repaired if revision was needed. Only 3.3% of all examined teeth were proposed for restoration revision, which seemed to be rather low. Among the suggested revisions, approx. 25% were recommended for repair, while 75% was assigned for replacement. Tooth-coloured material, i.e., composite, was recommended in almost 75% of the cases. Different kinds of crowns counted for 25%. A considerable difference in the number of treatment suggestions was noted among the dentists. Statistical analyses demonstrated that 16% of the difference in suggestions for restoration re-treatment depended on different dentist opinions. Secondary caries and restoration fracture were found to be the most used indications for re-treatment. Need for restoration revision seems low in North Norway. However, there is a tendency towards larger and more indirect restorations. The diagnosis of secondary caries is still a matter of uncertainty.