Radiographic pattern of underlying dentin lesions (ICDAS 4) in permanent teeth.

OBJECTIVE: To assess the radiographic pattern of underlying dentine shadows (UDS) in the occlusal surfaces of permanent teeth. METHODS: A total of 282 permanent posterior teeth pertaining to 91 individuals, 142 UDS and 140 non-cavitated enamel lesions (NCEL), were included for comparison. UDS was defined as shadows of discolored dentin visible through the enamel surface which may or may not show signs of localized enamel breakdown, classified as code 4 by the International Caries Detection and Assessment System group. Data collection included the application of a questionnaire, clinical examination, and bilateral bitewing radiographs. The risk for presenting radiolucency was estimated using logistic regression model with generalized estimating equations. RESULTS: Approximately 79% of UDS exhibited no radiolucency. The proportion of teeth exhibiting a radiolucency restricted to the enamel-dentin junction was 20.4% for UDS and 3.6% for NCEL (p < 0.001, chi-square test). UDS had a sixfold increased risk for exhibiting radiolucency compared with NCEL (OR = 5.78, 95% CI = 2.73-12.22, p < 0.001). Despite this finding, it is important to highlight that virtually all cases were located at the enamel-dentin junction, and only one tooth in each category of clinical status exhibited radiolucency at the outer one half of dentin. No tooth exhibited radiolucency reaching the deep dentin. CONCLUSION: The present study showed that UDS presented radiolucency in very few cases. The vast majority of lesions showed no radiolucency. CLINICAL RELEVANCE: Our findings suggest that only a small proportion of UDS would demand restorative treatment.

Long-term follow-up of inactive occlusal caries lesions: 4-5-year results.

OBJECTIVE: To assess the clinical behavior of inactive caries lesion on the occlusal sites of permanent molars over 4-5 years and to estimate the risk for progression of caries-inactive sites compared with sound ones. METHODS: Clinical examinations were conducted at baseline (n = 258) and after 4-5 years and included the recording of dental plaque and dental caries at the occlusal surfaces and the eruption stage of each permanent molar. RESULTS: One hudred ninety-three schoolchildren were followed (response rate of 74.8%), totalizing 1152 teeth. Of the children, 30.6% (n = 59) presented at least one molar containing an active lesion, filling, or that had been extracted; according to the activity criterion, inactive lesions presented around a twofold increased risk for caries progression than sound surfaces (OR = 2.34 95%CI = 1.51-3.62). Thirteen percent (n = 25) of the children presented at least one molar progressing to dentine cavity, filling, or extraction; according to the severity criterion, inactive caries lesions presented a significantly higher risk for progression when compared with sound surfaces (OR = 2.69, 95% CI = 1.50-4.83). CONCLUSION: The vast majority of lesions (85-90%) identified as inactive enamel caries at baseline did not progress over 4-5 years. Despite this fact, it was possible to detect an increased risk for caries progression in caries-inactive occlusal sites compared with the sound ones. CLINICAL RELEVANCE: Considering the low progression rates, inactive caries lesions do not need a specific caries-controlling treatment and should be monitored longitudinally in the same manner as sound surfaces.