Interproximal Caries Research Articles

In vitro study into the influence of X-ray beam angulation on the detection of artificial caries defects on bitewing radiographs.

Little is known about the influence of errors in angulation of the X-ray beam on the correct diagnosis of interproximal caries defects from bitewing radiographs. In this study radiographs were made of 10 artificial lesions resembling initial interproximal caries defects in mandibular teeth at different projection angles within a range of +/- 15 degrees in horizontal and in vertical direction and presented in a random order to 25 dentists. The result show that the best angle for lesion detection was site-specific with about a 7 degrees tolerance range. On the average, best detection performance was achieved with horizontal angulation perpendicular to the tooth surfaces, and vertical angulation with a positive or negative tilt of 12-15 degrees relative to the perpendicular. Deviations from the best horizontal angle resulted mainly in loss of sensitivity, while vertical misangulations caused mainly a drop of the specificity. The classification of lesions with an actual depth less than halfway into the enamel is influenced to a larger extent than that of deeper lesions.

Dutch dentists' decisions to take bitewing radiographs.

A postal questionnaire was sent to a 10% (n = 444) national random sample of Dutch dental practitioners. The response was 77% (n = 344). The practitioners prescribed bitewings on average for 57% of "new" 25-yr-old patients. Five significant (P less than 0.05) variables explained 24% of the variation in bitewing prescribing for these "new" patients. These were, in declining level of importance: the initial dental condition of the patient, the proportion of restorative treatment decisions based solely on radiographs, the level of urbanization of the practice location, the technical level of the practice equipment and the importance attached by dentists to the diagnostic use of dental floss for interproximal caries diagnosis. The low power of the regression model in explaining variation in the decision to take bitewings indicates an idiosyncratic use of bitewing radiographs for caries diagnosis. A weak tendency to adopt different diagnostic sets of procedures was demonstrated.

Selecting the optimal threshold for the radiographic diagnosis of interproximal caries

The declining prevalence of dental caries and changes in understanding about the progressive nature of this disease have led to recommendations that new diagnostic criteria be adopted. Selecting the optimum diagnostic threshold requires consideration of the probability of disease, distribution of true and false diagnoses at different test thresholds, and estimates of the consequences of treatment based on these diagnoses. Data from the Veterans Administration Dental Longitudinal Study were used to determine the distribution of true and false diagnoses at progressively more stringent diagnostic thresholds. Estimates of the consequences of treatment provided on the basis of true and false diagnoses were obtained from a randomly selected group of clinicians. The data were combined in a decision analysis to determine the "expected value" of operative treatment at each threshold under varying assumptions about the prevalence of disease, rate of disease progression, and value of treatment. No single diagnostic threshold consistently maximized the benefits of treatment. While patients with a high caries prevalence who experience infrequent recalls would benefit from a diagnostic threshold that includes early lesions, patients with a low caries prevalence who follow good recall schedules should benefit from a more conservative diagnostic threshold.

A clinical comparison of xeroradiography and film radiography for the detection of proximal caries

Xeroradiographs and conventional film radiographs (D- and E-speed) were compared in a clinical study with the use of 1 complete-mouth radiographs for (1) the presence of interproximal caries and (2) the determination of the depth of interproximal caries with the use of 200 tooth surfaces. In addition, an analysis of correct classification rates making a comparison of the same techniques was conducted. The results with the use of ROC analysis indicated that when a comparison was made of xeroradiography and D- and E-speed film, all techniques were equally useful. A broad range of observer ROC area values was found, indicating that diagnostic performance varies greatly with observer. The results of the diagnostic decisions made on carious surfaces versus noncarious surfaces indicated that all techniques tested were similar: 90% correct for noncarious surfaces and 77% correct for carious surfaces.

Changing patterns of dental caries in Ethiopian adolescents who immigrated to Israel.

The aim of this investigation was to explore changes in caries prevalence and gingival health in adolescents who immigrated from Ethiopia to Israel, experiencing an abrupt cultural transition. Fifty adolescents, aged 15-17, born in Ethiopia, and 196 adolescents born in Israel were examined. All were pupils of a boarding school, sharing the same living conditions and eating schedules. The results showed a nearly sixfold difference in caries prevalence between the Ethiopian and the Israeli group (1.5/9.6). No differences could be seen clinically between the Ethiopians who immigrated more than 1 yr ago and those who arrived within the last year. Radiographically, a significant difference was found between the two Ethiopian subgroups. Those who arrived more than 1 yr ago had nearly three times more initial caries. Total interproximal caries scores for the Israeli group, Ethiopians who arrived more than 1 yr ago, and newly arrived Ethiopians were 6.9, 5.7 and 2.1 respectively. Oral hygiene was poorer in the Ethiopian group than in the Israeli group; little difference was found in gingival health. Change in dietary habits, more meals per day and more frequent consumption of fermentable carbohydrates, could have been the cause of the change in caries rate.

Intraoral or Panoramic Radiography?

When panoramic radiographs are used to replace full-mouth radiographic series for the pediatric patient, certain advantages and disadvantages of this technique should be understood. The panoramic exposure offers ease of operation, shorter working time, and greater coverage than does the intraoral full-mouth series. However, certain shortcomings are noted. Rotations of maxillary premolars appear where there are none, and confusion exists in the anterior region about rotated teeth. Supernumerary teeth are frequently missed on the panoramic film in the anterior region. Because of this it is wise to supplement the panoramic image with anterior periapical films. Posterior bitewing films are a necessary supplement to the panoramic examination and with them interproximal caries, periapical lesions, and other details not visualized on the panoramic film are noted. It is imperative that the dentist understand confusing panoramic images that result from motion, superimposed structures, and apparent rotations, so that missed diagnoses do not occur.

The Application of Blue Polymer Curing Lights for Diagnostic Transillumination

or several years, ultraviolet light has been used to activate the polymerization of composite restorative materials. Re­ cently, resin systems have been devel­ oped that are polymerized by visible light in the blue region of the spectrum. Sev­ eral commercial visible curing lights are available to the dentist for this purpose with fiber optics and right angle probes. Another application of these visible curing lights is as an aid in oral diagnosis. More specifically, these lights have a po­ tential application for use in transillumi­ nation. Fiber-optic transillumination (FOTI) has been used with white light for the detection of caries and calculus, and the examination of existing restora­ tions.1'8 The results of previous studies comparing radiography and trans­ illumination in the detection of caries have been conflicting. A consensus emerged that caries detection with trans­ illumination is routinely successful with only anterior teeth.1'7 However, tech­ niques requiring skill and practice have been developed for detecting interproximal caries between posterior teeth by

Statistical contrast enhancement of subtraction images for radiographic caries diagnosis

The effects of the nonlinear contrast-enhancement technique are examined in terms of diagnostic performance obtainable from subtracted dental radiographs for a variety of simulated exposures. Conventional bitewing radiographs of patients known to be free of caries were digitized by means of a computer interfaced with a conventional television camera. The resulting images were duplicated and stored in the computer. Radiolucencies similar in appearance to interproximal caries were simulated analytically in one set of the images. Reference images were superimposed spatially and subtracted from their counterparts containing the induced interproximal lesions after simulating the effects of quantum limited exposure on both sets. This was done for each separate image element independently by replacing original gray levels in each image with levels determined by a Poisson random deviate. The resulting difference images were contrast enhanced by a method which first smooths out local variations in gray level and then reassigns gray-level values in a way determined by the observed second-order spatial statistics. To aid in localization, these images were then again subtracted from the original noise-degraded pictures without lesions, rendering images similar to conventional radiographs but contrast enhanced. Observer performance by means of these enhanced images was compared with that produced from unenhanced lesion-containing controls. The results suggest that enhancement increases the certainty with which diagnosis can be made and, further, that diagnostic accuracy can be improved in severely degraded images which simulate the effects of reduced levels of exposure.

フッ化ジアンミン銀塗布による乳臼歯隣接面齲蝕の抑制に関する研究 3.フッ化ジアンミン銀の片側塗布による臨床試験

フッ化ジアンミン銀塗布による乳臼歯隣接面齲蝕の抑制に関する研究 3.フッ化ジアンミン銀の片側塗布による臨床試験

Studies on Topical Application of Ag(NH3)2F for the Control of Interproximal Caries in Human Primary Molars

Studies on Topical Application of Ag(NH3)2F for the Control of Interproximal Caries in Human Primary Molars

Clinical and radiographic study of dens invaginatus

After a determination of the frequency of dens invaginatus by means of radiographic observations, various problems of its identification are discussed. The 188 teeth showing a distinct loop-shaped invagination apically on the radiograph were studied for the presence or absence of caries and periapical lesions. It was demonstrated that periapical lesions caused by caries are mostly due to interproximal caries and that the frequency of periapical lesions caused by caries in the dens invaginatus area was less than previously reported. Comments are made on the dens invaginatus cases having periapical lesions without caries and the parameters for future studies.

Proximal contacts in posterior teeth and factors influencing interproximal caries

A tooth may be touching its neighbors at the proximal surface but this alone is not sufficient to provide protection to the interdental tissues and prevent the initiation of caries. A well-contoured, properly positioned, firm proximal contact may protect the gingival tissues and tend to clean the adjoining surfaces, thereby preventing the occurrence of caries. Faulty proximal contacts in the natural teeth or in restorations may lead to gingival disease and caries. There are instances where identical types of proximal contacts exist in different mouths or in the same mouth at different regions showing the presence of caries in one area and the absence of caries in another, suggesting that other factors may also play a part in the occurrence of caries. Unfortunately scant literature is available on the subject and hence it was decided to investigate the dimensions of the proximal contacts in posterior teeth and the factors which may influence the occurrence of interproximal caries. This knowledge may be useful for educating patients and in duplicating a correct contact relationship in restorations to maintain the integrity of dental arches, health of the supporting structures, and permanence of the restoration,

Absorbed Radiation from Panoramic Plus Bitewing Exposures vs Full-Mouth Periapical Plus Bitewing Exposures

Although it demonstrates great potential in the detection of pathoses and anomalies, panoramic radiography inadequately defines interproximal caries. The addition of bitewings to a panoramic radiographic survey permits a more complete examination of the patient. In this study, the amount of radiation a patient received from a standard intraoral survey (14 films plus two bitewings) was compared with that received from a panoramic exposure supplemented by two bitewings. More radiation was received with the intraoral survey at all 23 sites tested. The means for the panoramic survey and bitewings were statistically smaller (<i>P</i>&spilt;0.001) at all locations except over the mastoids and the eyelids (where the probability was <i>P</i>&spilt;0.05). The results showed that patients received 82% less radiation with the panoramic survey than with the periapical type.

A Cohort Study on Interdental Space and Interproximal Caries in Deciduous Teeth, by Neighboring Age

This study was made to investigate the connection between interdental space and interproximal caries in the deciduous teeth by means of “neighboring age” as defined by the author. The materials were the same infants and children of 0, 1, and 2 years of age in 1965 in Kameoka City, Kyoto, on which the “Studies on Epidemiological Patterns of Caries Attack in Deciduous Teeth” had been made by means of cohort survey by the author.Interdental spaces were examined at the semiannual oral examinations by inserting a wire (diameter: 0.5mm) between two contiguous teeth and noting “Space” where the wire passed and “Contact” where it did not.Neighboring age: Considering that the neighboring relationship is formed between two tooth surfaces by the eruption of a tooth next to an existing tooth, the neighboring age was counted from this point and by half years. Furthermore, because the neighboring relationship may change as time elapses, the calculation was made only with the tooth surfaces which remained spaced or in contact according to the basis shown in Table 1. The numbers of the “contact” and “space” tooth surfaces were as shown in Table 2.Table 3 shows the caries indexes of the “Contact” group and the “Space” group: that is, caries incidence rate of tooth surfaces during a half year (Mx), number of tooth surfaces newly attacked by caries per initial healthy 1, 000 surfaces during a half year (Cx), and cumulative number of carious tooth surfaces per initial healthy 1, 000 tooth surfaces (ΣCx).The polygonal lines of Cx are shown in Fig. 1, and the trend-lines of Cx, ΣCx, and e-kx line of the proximal surfaces of Contact and Space groups obtained from Table 3 are as shown in Fig. 2.Table 4 shows the angle formed by the e-kx line and the 1-line, and the neighboring age at which the Cx trend-line reached the summit, and ΣC2.5.The trend-lines of ΣCx of proximal surfaces of the opposing tooth in the case of the spaced condition is seen in Fig. 3, while Fig. 4 shows the ΣCx trend-lines of caries in the opposing proximal surfaces in the contact condition. Of these the trend lines of almost simultaneously erupted pairs of teeth, such as A-B, C-D, A-B, and C-D are almost identical. On the other hand, in the case of D-E and D-E, if one of the pair, that is, D or D, eru- pts about a year before the other, there would be affected cases before any neighboring relationship comes to exist, and D, therefore, shows higher rates than E at 0 year of neighboring age. At 3 years of neighboring age, however, the rates of the two become roughly equivalent. The relation of D and E observed by post-eruptive tooth age in the previous paper exhibited an opposite situation. By either method of counting it is impossible to observe the situation of two teeth that have different eruption times like D-E under the same condition. It was presumed, however, that if they were placed under the same condition the proximal surfaces between D and E would show the same pattern.Table 5 shows the comparison of Mx between the Contact group and the Space group. It may be of use in the assessment of the effectiveness of floss silk in the prevention of caries.

The Association of Streptococcus Mutans with Early Carious Lesions in Human Teeth

Plaque samples from interproximal surfaces were obtained on floss from 164 young men. The sample site was between the upper first molar and second premolar on the right side, with the criterion that clinical caries was absent. Radiographs were taken. A total of 83 lesions were found on radiographs and Streptococcus mutans was positive (+ +) in 72% of the associated cultures. In 81 participants no lesions were found and S mutans was not present in 46% of the cultures (− −). The hybrid situation of lesions in the absence of positive cultures (+ −, 28%) could be explained by experimental error, lesion arrestment, sampling error, or presence of some other cariogenic bacteria. The hybrid situation of no lesions and positive cultures (− +, 54%) could be explained by the presence of very early caries activity or the presence of some noncariogenic strain S mutans. However, a strong positive correlation occurred between early detectable lesions and S mutans; this leads to the conclusion that the bacterium is associated with interproximal caries.

Artificial interproximal grooving of the teeth in American Indians.

AbstractArtificial grooves about 2 mm in width have been observed on the cervical region of teeth of American Indian populations which come from widespread localities and which extend through considerable time depth. The grooves appear to have been made ante‐mortem and to show a close relationship with interproximal caries and peridontal bone resorption. It is conjectured that the grooves represent efforts of a therapeutic or, at least, palliative nature.

Panoramic roentgenograms compared with conventional intraoral roentgenograms

T heoretically, panoramic x-ray films present more information through greater area coverage than do conventional intraoral x-ray films. Because of their lack of detail, however, panoramic roentgenograms have been considered by previous investigators to be diagnostically inferior to intraoral roentgenograms.*-3 Those investigators concluded that the panoramic films are better suited for mass screening surveys, for the detection of gross pathoses, and for identification purposes rather than for the detection of carious lesions.4 In previous studies, the panoramic films were compared to intraoral surveys which included bitewing films. If posterior interproximal caries is detected primarily in posterior bitewing films, it might be possible, by including these bitewing films with the panoramic film, to make a diagnostic survey comparable to the intraoral survey with bitewing films. If the resultant diagnoses by the two methods are the same or nearly the same, then the panoramic method could be preferred on the basis of greater area coverage, less radiation exposure to the patient and dentist,5 and time saved in producing a complete dental x-ray survey.3* 4 The primary purpose of this study was to compare the diagnostic interpretations made from a panoramict roentgenogram with the addition of two posterior bitewing films to the diagnostic interpretations made from an intraoral survey of fourteen periapical and two posterior bitewing films. A secondary purpose was to establish any difference in production time between the panoramic and the intraoral x-ray survey techniques. -This investigation was supported by the United States Army Medical Research and Devcllopment Command, Department of the Army, under Research Contract DA-49-193-MD2561. *‘Associate Professor, Coordinator of Research. *“Clinical Instructor. fPanorex XRM Model Pan 2, X-ray Manufacturing Corporation of America, Inc., Great Neck, N.Y.

Some considerations of preventive and interceptive orthodontics

A REALISTI c approach to prevention and interception of malocclusion requires an understanding of the basic concepts of etiology. It has been known for some time that heredity plays a vital role; however, sometimes this role is viewed out of proportion and there is a failure to heed the local and environmental factors which come into play. Any consideration of the genetic potential of the dental-facie-skeletal pattern must recognize that this genetic potential runs the gamut of bizarre and incalculable environmental hazards. In many instances the environmental factors are restrictive and prevent the genetic potential from ever being fully reached. On the other hand, without adequate environmental support the genetic potential also fails to reach its full limit. An example of this may be seen in cases of aglossia where lack of tongue function incompletely augments the full development of the dentition. Genetic factors, then, can do no more than govern the norm of reaction of the dentition to its environment. Conversely, it might be said that the environment alters the expression of the genetic factors. We must not consider heredity and environment as necessarily competing or antagonistic forces, but rather as being interwoven, each modifying the other, and their interaction determining the state of occlusion. The developing dental occlusion is dependent upon: 1. Growth of the supporting bone. 2. Size and shape of the developing teeth. 3. Directional development and eruption of these teeth. 4. Interaction and balance of forces operative upon the teeth and the alveolar processes. Whereas the first two areas have a high correlation with genetic factors, the latter two are intimately related to a vast complex of interacting local factors. These may relate to the presence of interferences such as supernumerary teeth, cysts, or over-retained and ankylosed teeth. Traumatic injury to deciduous teeth commonly deflects permanent erupting successors. Other factors are missing teeth, premature loss of teeth (with drifting), interproximal caries, improper fillings, peculiar shape and size of contacting teeth and the presence of a frenum. Operative also is the possible imbalance of the supporting musculature, hyperhypotonic oral muscles, thick or heavy buccinator muscles, short or hypertonic upper lips, or numerous variations in tongue size and shape, and peculiarities

Some physicochemical factors in relation to the causation of interproximal caries.

Some physicochemical factors in relation to the causation of interproximal caries.