Ex vivo evaluation of antibiotic sensitivity in samples from endodontic infections.

Objective: To develop an in vitro model for real-time monitoring of endodontic biofilm growth and evaluate the ex vivo effect of antibiotics on biofilm growth. Material and Methods: Root canal samples were taken from 40 patients and inoculated into 96-well plates in a system that measures biofilm growth through electrical impedance. Biofilm bacterial composition at the genus and species level was analyzed by Illumina sequencing. ANCOM-BC corrected data were used to compare bacterial composition after antibiotic treatment through compositional analysis, and to compare microbiological with clinical data. Results: The stationary phase was reached at 8 hours. The biofilm formed had a similar bacterial composition to the inoculum, and Enterococcus faecalis was virtually absent from the samples. The bacterial composition and the effect of antibiotics were sample-dependent. Metronidazole was the antibiotic that most inhibited biofilm formation and azithromycin the one that inhibited it in the highest percentage of cases. The antibiotic effect could not be related to the biofilm original bacterial composition. Conclusions: The impedance system allowed real-time monitoring of endodontic biofilm formation, and we propose it as a model for ex vivo evaluation of the whole biofilm susceptibility to antimicrobials, as opposed to evaluating antibiotic sensitivity of specific bacterial isolates.

Adaptación marginal de tres cementos biocerámicos / Marginal adaptation of three bioceramic-based sealers

Objetivo. Evaluar la interfase entre tres cementos biocerámicos y la pared del conducto radicular, comparándolos con un cemento de resina. Material y Métodos: Se seleccionaron 80 dientes unirradiculares, los cuales se dividieron en 4 grupos de acuerdo al cemento de obturación: 1 (MTA FillApex), 2 (EndoSequence BC Sealer), 3 (Bio Root) y 4 (AHPlus). Los dientes se decoronaron dejando una longitud estándar de 15 mm; se instrumentaron con el sistema Mtwo hasta la lima 35/.04. Se irrigó con hipoclorito al 5’25%, EDTA al 17% y se finalizó la irrigación con solución salina. La obturación se realizó con gutapercha 35/.04 y técnica de cono único. Las muestras fueron cortadas a 3, 5 y 8 mm del ápice y se observaron con un estereomicroscopio. Obtenidas las imágenes, se midió el perímetro del conducto en el que hubo adaptación del cemento (expresado como porcentaje respecto a la longitud total del perímetro del conducto) a tres niveles: apical, medio y coronal. Los resultados se analizaron mediante el test de Kruskal Wallis, con una significación de p < 0,05. Resultados: El grupo 1 presentó significativamente peor adaptación a las paredes dentinarias que el resto de cementos estudia-dos en todos los tercios (apical, 63,71%; medio, 69,53%; coronal, 50,82%). Aunque no se encontraron diferencias significativas, el tercio que mejor adaptación presentó fue el apical. Conclusiones: MTA Fillapex, globalmente, se comportó significativamente peor que los otros cementos evaluados. No existen diferencias significativas entre la adaptación a las paredes dentinarias del BioRoot y el Endosequence y el AHPlus

Objective: To evaluate the interface between three bioceramic-based sealers and the root canal wall, comparing them with a resin-based sealer. Material and Methods: 80 single-rooted teeth were selected and divided into 4 groups according to the sealer: 1 (MTA FIllapex), 2 (EndoSequence BC Sealer), 3 (Bio Root) y 4 (AHPlus). Crowns were sectioned at 15mm from the apex; all the roots were instrumented with Mtwo system until 35/.04 file. Canals were irrigated with 5’25% sodium hypochlorite, 17% EDTA and a final rinse with saline solution. The roots were obturated with 35/.04 gutta-percha and single-cone technique. The samples were sectioned at 3, 5 and 8 mm from the apex and were observed with a stereo microscope. The images taken were analyzed; the root canal perimeter where there was adaptation was measure (expressed as a percentage regarding to the root canal total perimeter) at three levels: apical, middle and coronal. The results were analyzed statistically by the Kruskal Wallis test with a p<0,05 significance level. Results: Group 1 presented significantly worst adaptation to the canal walls than the other studied sealers (apical, 63,71%; middle, 69,53%; coronal, 50,82%). The third with the worst adaptation was the apical, even though there were no statistical differences. Conclusions: MTA Fillapex, overall, behaved worse than the other sealers studied. There was no statistical difference between AH Plus, BioRoot and EndoSequence on the canal wall adaptation

In vitro evaluation of microleakage in Class II composite restorations: High-viscosity bulk-fill vs conventional composites.

This study compared marginal microleakage of Class II cavities restored with bulk-fill resin (Filtek™ Bulk Fill) and conventional composite resin (Filtek™ Supreme XTE). Two standardized Class II cavities were prepared in forty extracted human molars. The gingival margin was located above the cemento-enamel junction for twenty molars (groups 1 and 2) and apically for the other twenty (groups 3 and 4) (n=20). The occlusomesial cavity was filled with bulk-fill resin by insertion in bulk (groups 1 and 3) and the occlusodistal cavity was restored with conventional composite using incremental technique (groups 2 and 4). The teeth were thermocycled (500 cycles 5-55°C), stained and observed under light microscope. The microleakage was significantly lower in gingival margins located in enamel compared with dentin margins (p<0.01). There was no statistically significant difference between groups 1 and 2 (p=0.86) and groups 3 and 4 (p=0.26). Bulk-Fill resins presents gingival microleakage similar to conventional composites.

MI paste plus and PreviDent fluoride varnish appear no more effective than normal home care for improving the appearance of white spot lesions.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, Starrett JL, Greenlee GM, Drangsholt RJ, Matunas JC. Am J Orthod Dentofacial Orthop 2013;143:31-41. REVIEWER: Carmen Llena-Puy PURPOSE/QUESTION: The authors' aim was to compare the effectiveness of MI Paste Plus and PreviDent fluoride varnish (22,600 ppm of fluoride) with a standard oral hygiene regimen with toothpaste (1100 ppm of fluoride; Colgate Oral Pharmaceuticals)--control group--in improving the appearance of white spot lesions (WSLs) after orthodontic treatment during 8 weeks of follow-up SOURCE OF FUNDING: National Institute of Dental and Craniofacial Research TYPE OF STUDY/DESIGN: Randomized controlled trial LEVEL OF EVIDENCE: Level 1: Good-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE: Not applicable.

[Relationship between tobacco smoke and dental caries in school children at the Valencian Country]. / El humo del tabaco y su asociación con la caries dental en niños y niñas de 10 a 15 años atendidos en la unidad de odontología del departamento 9 de la Comunidad Valenciana.

BACKGROUND: Recently, it has focused the role of exposure to environmental tobacco smoke in the etiology of dental caries, so we plan to evaluate the association between environmental tobacco smoke inhalation and caries experience in 10-15-years-old children. METHODS: A transversal descriptive study was designed. Carried out in the Primary Dentistry Unit. 9th Health Department. Valencian Country (Spain). 380 children random sample was selected (following the inclusion criteria). Each participant was clinically explored, then answered a self-administered opinion test about contact with tobacco smoke. MEASUREMENTS: DMF-T and df-t indexes and their components, plaque and gingival indexes, contact with tobacco smoke frequency (at home or not), own opinion about tobacco effects and present or future tobacco consumption. RESULTS: Children living with smokers at home showed a decayed teeth average of 1,9 ± 2,34, while those not living with smokers had 1,03 ± 1,46 ( p<0,001). df and DMF average indexes for children exposed and not exposed to tobacco smoke were 0,27 ± 0,78 (df)and 1,62 ± 2,21 (DMF) and 0,10 ± 0,47 (df) and 0,92 ± 1,40 (DMF) respectively (p=0,039 y p<0,001). CONCLUSIONS: In our study conditions, coexistence with environmental tobacco smoke is associated with a higher caries prevalence in both deciduous and permanent dentitions in 10-15-years-old children.

El humo del tabaco y su asociacióncon la caries dental en niños y niñas de 10 a 15 años atendidos en la unidad de odontología del departamento 9 de la Comunidad Valenciana / Relationship between tobacco smoke and dental caries in school children at the Valencian country

Fundamentos: Recientemente se ha destacado el papel dela exposición al humo del tabaco ambiental en la etiología de la caries dental. El objetivo del trabajo es valorar la asociaciónentre la inhalación del humo del tabaco ambiental y la experiencia de caries en niños de entre 10 y 15 años. Métodos: Estudio descriptivo transversal, realizado en la Unidad de Odontología de Atención Primaria del Departamento 9 de Salud de la Comunidad Valenciana. Se seleccionó una muestra aleatoria de 380 niños. Se realizó una exploración clínica a cada uno y se les entregó un cuestionario de opinión y contacto con el humo del tabaco para cumplimentar de formaautoadministrada. Se determinó: índice CAOD, índice cod, índice de placa y gingival, frecuencia de contacto con el humodel tabaco en el domicilio y fuera del domicilio, opinión sobre los efectos del tabaco, consumo de tabaco actual o futuro. Resultados: Los niños que convivían con personas fumadoras en el domicilio presentaban una media de dientes afectados por caries de 1,90 ± 2,34 frente a los que no convivían en los queera de 1,03± 1,46 (p< 0,001). Los índice cod y CAO D medios fueron respectivamente de 0,27 ±0,78 y 1,62± 2,21 para los queconvivían con personas fumadoras frente a 0,10±0,47 y 0,92 ±1,40 para los que no (p=0,039 y p<0,001). Conclusiones: En las condiciones de nuestro estudio la convivencia de niños de entre 10 y 15 años en ambientes con humo de tabaco se encuentra asociada con mayor prevalencia decaries, tanto en la dentición temporal como en la permanente(AU)

Background: Recently, it has focused the role of exposureto environmental tobacco smoke in the etiology of dental caries, so we plan to evaluate the association between environmentaltobacco smoke inhalation and caries experience in 10-15-yearsold children. Methods: A transversal descriptive study was designed.Carried out in the Primary Dentistry Unit. 9th Health Department. Valencian Country (Spain). 380 children random samplewas selected (following the inclusion criteria). Each participant was clinically explored, then answered a self-administered opinion test about contact with tobacco smoke. Measurements: DMF-T and df-t indexes and their components, plaque and gingival indexes, contact with tobacco smoke frequency (at home or not), own opinion about tobacco effects and present or futuretobacco consumption. Results: Children living with smokers at home showed a decayed teeth average of 1,9 ± 2,34, while those not living withsmokers had 1,03± 1,46 ( p< 0,001). df and DMF average indexes for children exposed and not exposed to tobacco smokewere 0,27 ±0,78 (df)and 1,62± 2,21 (DMF) and 0,10 ±0,47 (df) and 0,92 ±1,40 (DMF) respectively (p=0,039 y p<0,001). Conclusions: In our study conditions, coexistence with environmental tobacco smoke is associated with a higher cariesprevalence in both deciduous and permanent dentitions in 1015- years-old children(AU)

Periodontal status and treatment needs among spanish military personnel

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Introduction: Problems arising from poor gingival and periodontal health in military personnel account for around 10% of the emergencies of oral origin during deployments and manoeuvres. Consequently, it is important to ascertain the prior oral health situation among Spanish military personnel.Objective: To assess the periodontal health status and treatment needs of a population of Spanish Army personnelat the General Almirante Base at Marines, in the province of Valencia, and calculate the time required to cover the treatment needs of this population.Materials and methods: Observational cross-sectional study of periodontal health status in a representative sample of the population in question. The community periodontal index (CPI) was used in accordance with WHO criteria. The sample comprised 387 subjects, selected by systematically sampling those attending the sick bay at the base for different reasons. The examinations were carried out by a single examiner; the intra-observer Kappa index was 0.83. Data collection began in December 2003 and ended in July 2004.Results: All sextants were healthy in 7,2% of the sample. The most prevalent condition was the presence of calculus, especially in the younger population. 7.8% had 4-5 mm periodontal pockets and 2.3% had pockets of 6 mm or more, all in the over-25 age group. The women below 25 years of age were significantly more healthy than the men. The healthy sextants mean was 2.38, without differences by rank. Privates presented a significantly higher mean figure for sextants with bleeding, while officers and non-commissioned officers presented a higher average number of sextants with pockets. Practically every subject needed oral hygiene instructions and scaling and root planing but only 2.3%, all over 25 years old, required complex treatments. The estimated treatment time need is 1 hour per person per year (AU)

Evidence concerning the medical management of caries.

Caries is an infectious, chronic and cumulative disease. It seriously affects quality of life and creates considerable expense for individuals and communities. The disease can be managed by acting on biofilm formation and maturation, by modifying the kinetics of apatite solution or with a combination of the two processes. This can be achieved by mechanical and chemical control of plaque, appropriate use of fluorides, controlling diet and salivary flow, when possible. Many of these factors depend on the patient's co-operation. Decisions concerning treatment are influenced by two questions: the scientific evidence for the different alternatives available and each patient's individual caries risk. The use of different fluoride regimes, depending on the individual risk, remains the most scientifically proven method for avoiding the appearance of new lesions and curbing the speed at which existing ones progress. Chemical control of plaque using chlorhexidine is indicated for patients at high microbiological risk; it is more effective at controlling caries when used in combination with fluorides. Fissure sealing is an effective means of controlling occlusal caries of the molars when the patient's caries risk and the eruptive age of the tooth are taken into account.

Evidence concerning the medical management of caries

Caries is an infectious, chronic and cumulative disease. It seriously affects quality of life and creates considerable expense for individuals and communities.The disease can be managed by acting on biofilm formation and maturation, by modifying the kinetics of apatitesolution or with a combination of the two processes. This can be achieved by mechanical and chemical control ofplaque, appropriate use of fluorides, controlling diet and salivary flow, when possible. Many of these factors depend on the patient’s co-operation.Decisions concerning treatment are influenced by two questions: the scientific evidence for the different alternatives available and each patient’s individual caries risk.The use of different fluoride regimes, depending on the individual risk, remains the most scientifically proven method for avoiding the appearance of new lesions and curbing the speed at which existing ones progress. Chemical control of plaque using chlorhexidine is indicated for patients at high microbiological risk; it is more effective at controlling caries when used in combination with fluorides. Fissure sealing is an effective means of controlling occlusal caries ofthe molars when the patient’s caries risk and the eruptive age of the tooth are taken into account (AU)

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Emergencias orales en los militares españoles desplegados en Bosnia Herzegovina. Incidencias durante 9 semanas (2000-2001) / Oral emergencies in the Spanish military unfolded in Bosnia Herzegovina. Incidences during 9 weeks (2000-2001)

se presenta la incidencia y distribución de las causas de emergencias dentales en los militares españoles desplegados en Bosnia-Herzegovina (BiH). Definimos emergencia oral como las circunstancias que hacen que el soldado se ausente de su servicio o de su tiempo libre por una causa oral. Se trata de un estudio descriptivo longitudinal. El número de soldados españoles desplegados en BiH en la última semana del año 2000 y las primeras 8 semanas del año 2001 fue de 1063, y fueron tratados en el 2º escalón de Mostar-Aeropuerto, primer nivel de asistencia odontológica. En esos momentos en las exploraciones previas al despliegue no se clasificaba al contingente por su estado de salud oral. La tasa de incidencia fue de 304 asistencias/ 1000 personas/ año. Estas se distribuyeron de la siguiente forma: 39,3% por caries y restauraciones defectuosas, pulpitis y patología periapical 16,1%, gingivitis y periodontitis 16,1%, pericoronaritis 5,36%, complicaciones de exodoncias 1,79%, traumatismos 1,79%, fracturas dentales (sin trauma) 3,57%, lesiones de las mucosas 1,79%, dolor oro facial/ síntomas ATM 3,57%, causas protésicas 3,57%, hiper oclusión, trauma oclusal 5,36%. De estas emergencias el 57% podrían haberse evitado con un diagnostico y tratamiento oportuno previo. Por ello las estrategias de prevención son la clave, para poder en un futuro desplegar en situación de aptitud dental

This study reports about dental emergency rates and cause distribution of Spanish military troops deployed in Bosnia Herzegovina (BiH). Oral emergency is defined as those circumstances that force soldiers away from their duties or free time due to oral problems. This is a descriptive longitudinal analysis of incidences. The number of Spanish soldiers deployed in BiH in the last weeks of 2000 and the first 8 weeks of the 2001 were 1063. The soldiers received oral care at the 2nd echelon posted in Mostar-Airport, the first level of dental assistance. At the time, and before deployment, the military personnel were examined but not classified according to their oral health status. The incidence rate was of 304 attendances per 1000 military personnel per year. The distribution was as follows: 39.3% presented defective restorations or caries, pulpitis and periapical pathology 16.1%, gingivitis and periodontitis 16.1%, pericoronaritis 5.36%, post extraction related complications 1.79%, traumatisms 1.79%, fractured teeth (without trauma) 3.57%, oral pathology 1.79%, oro-facial pain / TMJ symptoms 3.57%, prosthodontics 3.57%, hyper occlusion and occlusal trauma 5.36%. From these emergencies it was concluded that 57% could have been prevented with proper previous diagnosis and treatment. For this reason prevention strategies are the key to deploying a dentally fit unit in the future

Emergencias orales en los militares españoles desplegados en Bosnia Herzegovina: Incidencias durante 9 semanas (2000-2001) / Oral emergencies in the Spanish military unfolded in Bosnia Herzegovina. Incidences during 9 weeks (2000-2001)

Se presenta la incidencia y distribución de las causas de emergencias dentales en los militares españoles desplegados en Bosnia-Herzegovina (BiH). Definimos emergencia oral como las circunstancias que hacen que el soldado se ausente de su servicio o de su tiempo libre por una causa oral. Se trata de un estudio descriptivo longitudinal. El número de soldados españoles desplegados en BiH en la última semana del año 2000 y las primeras 8 semanas del año 2001 fue de 1063, y fueron tratados en el 2º escalón de Mostar-Aeropuerto, primer nivel de asistencia odontológica. En esos momentos en las exploraciones previas al despliegue no se clasificaba al contingente por su estado de salud oral. La tasa de incidencia fue de 304 asistencias/ 1000 personas/ año. Estas se distribuyeron de la siguiente forma: 39,3% por caries y restauraciones defectuosas, pulpitis y patología periapical 16,1%, gingivitis y periodontitis 16,1%, pericoronaritis 5,36%, complicaciones de exodoncias 1,79%, traumatismos 1,79%, fracturas dentales (sin trauma) 3,57%, lesiones de las mucosas 1,79%, dolor oro facial/ síntomas ATM 3,57%, causas protésicas 3,57%, hiper oclusión, trauma oclusal 5,36%. De estas emergencias el 57% podrían haberse evitado con un diagnostico y tratamiento oportuno previo. Por ello las estrategias de prevención son la clave, para poder en un futuro desplegar en situación de aptitud dental (AU)

This study reports about dental emergency rates and cause distribution of Spanish military troops deployed in Bosnia Herzegovina (BiH). Oral emergency is defined as those circumstances that force soldiers away from their duties or free time due to oral problems. This is a descriptive longitudinal analysis of incidences. The number of Spanish soldiers deployed in BiH in the last weeks of 2000 and the first 8 weeks of the 2001 were 1063. The soldiers received oral care at the 2nd echelon posted in Mostar-Airport, the first level of dental assistance. At the time, and before deployment, the military personnel were examined but not classified according to their oral health status. The incidence rate was of 304 attendances per 1000 military personnel per year. The distribution was as follows: 39.3% presented defective restorations or caries, pulpitis and periapical pathology 16.1%, gingivitis and periodontitis 16.1%, pericoronaritis 5.36%, post extraction related complications 1.79%, traumatisms 1.79%, fractured teeth (without trauma) 3.57%, oral pathology 1.79%, oro-facial pain / TMJ symptoms 3.57%, prosthodontics 3.57%, hyper occlusion and occlusal trauma 5.36%. From these emergencies it was concluded that 57% could have been prevented with proper previous diagnosis and treatment. For this reason prevention strategies are the key to deploying a dentally fit unit in the future (AU)

The rôle of saliva in maintaining oral health and as an aid to diagnosis.

Saliva is a complex secretion. 93% by volume is secreted by the major salivary glands and the remaining 7% by the minor glands. 99% of saliva is water and the other 1% is composed of organic and inorganic molecules. While the quantity of saliva is important, so is its quality. The components of saliva, its functions in maintaining oral health and the main factors that cause alterations in salivary secretion will be reviewed, the importance of saliva in caries development and bacterial plaque formation will be discussed and its role as an aid to diagnosing certain pathologies will be examined. Variations in salivary flow can be affected, reversibly or irreversibly, by numerous physiological and pathological factors. Saliva plays an essential role in maintaining the integrity of the oral structures, in personal relationships, in the digestion and in controlling oral infection. The part that saliva plays in protecting teeth from caries can be summarised under four aspects: diluting and eliminating sugars and other substances, buffer capacity, balancing demineralisation/remineralisation and antimicrobial action. Saliva is a promising option for diagnosing certain disorders and monitoring the evolution of certain pathologies or the dosage of medicines or drugs. Its advantages as a diagnostic tool include its being easy to obtain and the positive correlation between many parameters in serum and saliva.

La saliva en el mantenimiento de la salud oral y como ayuda en el diagnóstico de algunas patologías / The role of saliva in maintaining oral health and as an aid to diagnosis

La saliva es una secreción compleja proveniente de las glándulas salivales mayores en el 93% de su volumen y menores en el 7% restante. El 99% de la saliva es agua mientras que el 1% restante está constituido por moléculas orgánicas e inorgánicas. Si bien la cantidad de saliva es importante, también lo es la calidad de la misma. Se revisará los componentes de la saliva y sus funciones en el mantenimiento de la salud oral los principales factores causales que alteran la secreción salival, se comentará la importancia de la saliva en el desarrollo de la enfermedad de caries y en la formación de la placa bacteriana, y se analizará su papel como material de ayuda para el diagnóstico de algunas patologías.Las variaciones en el flujo salival pueden verse afectadas por múltiples factores fisiológicos y patológicos, de forma reversible o irreversible. Juega un papel fundamental en el mantenimiento de la integridad de las estructuras bucales, en la vida de relación, en la digestión y en el control de infecciones orales. El papel de la saliva en la protección frente a la caries podemos concretarlo en cuatro aspectos, dilución y eliminación de los azúcares y otros componentes, capacidad tampón, equilibrio entre la desmineralización / remineralización y acción antimicrobiana.La saliva como alternativa para el diagnóstico, de algunas enfermedades, como elemento para monitorizar la evolución de determinadas patologías o la dosificación de medicamentos o drogas proporciona una vía prometedora. La accesibilidaden su obtención y la correlación positiva entre múltiples parámetros en el suero y en la saliva son algunas de las ventajas que ofrece como instrumento diagnóstico

Saliva is a complex secretion. 93% by volume is secreted by the major salivary glands and the remaining 7% by the minor glands. 99% of saliva is water and the other 1% is composed of organic and inorganic molecules. While the quantity of saliva is important, so is its quality. The components of saliva, its functions in maintaining oral health and the main factors that cause alterations in salivarysecretion will be reviewed, the importance of saliva in caries development and bacterial plaque formation will be discussed and its rôle as an aid to diagnosing certain pathologies will be examined.Variations in salivary flow can be affected, reversibly or irreversibly, by numerous physiological and pathological factors.Saliva plays an essential rôle in maintaining the integrity of the oral structures, in personal relationships, in the digestion and in controlling oral infection. The part that saliva plays in protecting teeth from caries can be summarised under four aspects: diluting and eliminating sugars and other substances, buffer capacity, balancing demineralisation / remineralisation and antimicrobial action.Saliva is a promising option for diagnosing certain disorders and monitoring the evolution of certain pathologies or the dosage of medicines or drugs. Its advantages as a diagnostic tool include its being easy to obtain and the positive correlation between many parameters in serum and saliva

A clinical and radiographic comparison of caries diagnosed in approximal surfaces of posterior teeth in a low-risk population of 14-year-old children.

INTRODUCTION: The prevalence of caries, and its preferential location, has changed in recent years. The percentage reduction in caries has been lower in pits and fissures than in other locations, making it necessary to use more sensitive diagnostic procedures than visual inspection for approximal lesions. OBJECTIVES: The objective of this study was to compare the amount of overlooked proximal caries by bitewing X-rays versus clinical in patients who were completing a public oral health program at the age of 14 years. METHODS: 162 children aged 14 years were clinically examined by a dentist as part of the systematic six-monthly dental check-ups of the children. The survey was carried out on dried teeth using a light, plane mouth mirror and blunt probe. All molar and premolar surfaces were examined in order to determine the presence of caries or restorations. In addition, two bitewing radiographs of each patient were obtained using a Klauser plastic parallelizer. RESULTS: Caries lesions were diagnosed better by the X-rays than clinically (delta X-ray = 0.61), whereas clinical examination was better at diagnosing the presence of fillings (delta X-ray = -0.03). Clinical examination diagnosed all occlusal caries but underestimated the interproximal lesions by 86.84%. CONCLUSIONS: In the context of public oral health programs, the authors consider it necessary to obtain two bitewing X-rays of the children's teeth before discharging them, as otherwise they could be told that they are healthy whereas, in fact, they present interproximal caries that could be treated by remineralization or restorative methods.