Ingegerd Mejàre

Caries-preventive effect of fluoride toothpaste: a systematic review

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non‐supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow‐up and caries increment in the permanent (ΔDMFS/T) or primary (Δdmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A–C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non‐supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long‐term studies in age groups other than children and adolescents are still lacking.

Caries-preventive effect of fissure sealants: a systematic review

The objectives of this study were to evaluate systematically the evidence of the caries‐preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi‐randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow‐up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin‐based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin‐based sealants on permanent 1st molars was 33% (relative risk=0.67; CI=0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin‐based materials has a caries‐preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

Caries incidence and lesion progression from adolescence to young adulthood : a prospective 15-year cohort study in Sweden.

The objectives were (1) to assess caries development, including the incidence and rate of lesion progression, in a Swedish cohort from adolescence to young adulthood and (2) to compare the caries incidence rates in adolescents with those of young adults. The original material consisted of 536 children aged 11–13 years at baseline. This cohort had been followed through annual bitewing radiographs to 21–22 years of age. In 1998–1999, 250 of these individuals were re-examined at the age of 26–27, and the new caries data were added to the original data. The results showed that fewer new enamel lesions developed on approximal surfaces during young adulthood than during adolescence; the caries incidence rates for enamel lesions decreased from 4.3 in the age group 12–15 years to 2.7 new caries lesions/100 surface-years in the age group 20–27 years. The same applied to the rate of lesion progression, where the corresponding values from the enamel-dentin border to the outer dentin were 32.5 for the youngest and 10.9 new lesions/100 surface-years for the oldest age group. The caries incidence of outer dentin lesions on approximal surfaces was low but increased from 0.2 in the age group 12–15 years to 0.9 new outer dentin lesions/100 surface-years in the age group 20–27 years. The incidence rates varied considerably between different tooth surfaces. Also for occlusal surfaces, fewer new dentin lesions developed during young adulthood than during adolescence; the incidence was 2.0 new dentin lesions/100 surface-years in the youngest age group and 0.7 during young adulthood. At the age of 13, the proportion of DFS of occlusal surfaces predominated over DFS of approximal surfaces but at the age of 26–27 the proportions of occlusal and approximal DFS were almost equal.

Incidence and Progression of Approximal Caries from 11 to 22 Years of Age in Sweden: A Prospective Radiographic Study

Using annual bite–wing radiographs, the incidence and progression of approximal caries (4d–7m) were assessed longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A closed cohort of 536 children initially was followed from 11 to 22 years of age. The scoring system was: 0 = no visible radiolucency; 1–2 = radiolucency in the enamel up to the enamel–dentin border; 3 = radiolucency with a broken enamel–dentin border but with no obvious progression in the dentin; 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Caries rates were estimated as the number of new lesions/100 tooth surface–years, and the Kaplan–Meier estimate was used to calculate the cumulative survival time of each approximal surface. Three events were used: the transitions from states 0 to 2, 2 to 4 and 3 to 4. The results showed a considerable variation between the surfaces in both caries rates and survival time. For all surfaces combined, the median caries rate from state 0 to 2 was 3.9 new lesions/100 tooth surface–years; from state 2 to 4, the rate was 5.4, and from state 3 to 4 it was 20.3. Of the sound surfaces (state 0), 75% survived 6.3 years without reaching state 2. Given state 2, 75% survived 4.8 years without reaching the outer half of the dentin (state 4), while given a lesion at the enamel–dentin border (state 3), 75% survived 1.3 years without doing the same. The median survival time of lesions from state 3 to 4 was 3.1 years. The group with DMFSappr>1 at the age of 11–12 years had a risk of new approximal enamel lesions (state 0–2) that was 2.5 times greater than that of the group with DMFSappr = 0–1.

Caries Development from 11 to 22 Years of Age: A Prospective Radiographic StudyPrevalence and Distribution

The aim was to assess the distribution and pattern of caries development longitudinally in teenagers and adolescents whose treatment had been based on remineralizing rather than restorative strategies. A baseline cohort of 536 children was studied, using bite-wing radiographs, from 11 to 22 years of age. The results showed a slow but continuous increase in both enamel and dentin caries of approximal surfaces. At 21, 29% of all posterior approximal surfaces had enamel caries according to the radiographic diagnoses, 14% had dentin caries and another 5% were restored. At the age of 20–21, the skewed distribution of DMFSappr apparent at 12 and 15 had given way to a more uniform picture and the percentage of individuals with no decayed approximal surfaces (DMFSappr = 0) decreased from 71 at 12–13 to 28 at 20–21 years of age. The proportion of DFSoccl in relation to all DFS decreased from 83% at 12 to 52% at 21. The occlusal, mesial and distal surfaces of the first molar accounted for 60% of all restored surfaces at 21.

Caries risk assessment. A systematic review

Abstract Objective. To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. Results. Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accuracy in schoolchildren/adolescents. The period of highest risk for caries incidence in permanent teeth was the first few years after tooth eruption. In general, the quality of evidence was limited. Conclusions. Multivariate models and baseline caries prevalence performed better in pre-school children than in schoolchildren/adolescents. Baseline caries prevalence was the most accurate single predictor in all age groups. The heterogeneity of populations, models, outcome criteria, measures and reporting hampered the synthesis of results. There is a great need to standardize study design, outcome measures and reporting of data in studies on caries risk assessment. The accuracy of prediction models should be validated in at least one independent population.

Bacteria beneath composite restorations—a culturing and histobacteriological study

The occurrence, viability and identification of the microbial flora under composite fillings using an anaerobic technique were studied. Class V cavities were prepared on clinically healthy buccal surfaces of 7 contralateral pairs of premolars in children 11--15 years of age. After preparation, rubber dam was applied and one cavity in each pair of teeth was washed with water blasted dry with air and filled with Adaptic. The other cavity was washed with a cavity cleaner (Tubulicid) and a cavity liner (Tubulitec) was applicated prior to filling with Adaptic. The teeth were extracted after 4--6 weeks. Under anerobic conditions the tooth crown was split. From one half samples were taken from the pulpal wall under the filling and cultured on blood agar and in broth medium. The other half was examined with histobacteriological technique. No growth occurred in cultures from lined cavities but in 6 of the 7 unlined cavities. Full agreement was observed between the findings from the culturing and histobacteriological examinations concerning presence or absence of microorganisms at the pulpal wall in all 14 teeth. The flora was mixed. Gram-positive bacteria, mainly Streptococcus and Actinomyces, dominated over gram-negative bacteria including Veillonella, Fusobacterium, Campylobacter and Selenomonas. The composition of the flora was more similar to that observed in dental plaque than that found in carious dentin or in saliva in other studies.

Economic evaluation of dental caries prevention: a systematic review.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well‐conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health‐economic effect of the studied caries‐prevention methods.

Caries rates for the mesial surface of the first permanent molar and the distal surface of the second primary molar from 6 to 12 years of age in Sweden.

The aim was to analyse the pattern of caries rates in enamel and dentin of the mesial surface of the first permanent molar (mesial 16,26,36,46; here called 6m) and the distal surface of the second primary molar (distal 55,65,75,85; here called 05d) from 6 to 12 years of age. The material consisted of retrospectively collected bite–wing radiographs of a cohort of 374 children aged 5–7 years at baseline and followed to 11–12 years of age. The following scoring system was used: score 0 = no visible radiolucency, 1–2 = radiolucency in the outer (1) or inner (2) half of the enamel up to the enamel–dentin border, 4 = radiolucency with obvious spread in the outer half of the dentin, and 5 = radiolucency in the inner half of the dentin. Two transitions were used: state 0–2 = the time lapse from state 0 until the lesion had reached state 2, and state 2–4 = the time lapse from state 2 until the lesion had reached state 4 or 5. At the age of 9, the mean defs (decayed, extracted and filled surfaces) of 05d was 0.70 and the mean DFS of 6m was 0.19. The enamel caries rates (state 0–2) were 4.6 new lesions/100 tooth surface–years for 6m and 11.3 for 05d. The dentin caries rates (state 2–4) were 20.5 new lesions/100 tooth surface–years for 6m and 32.6 for 05d. In conclusion, the enamel caries rate for 05d was more than twice that for 6m. Both surfaces had relatively high dentin caries rates, indicating that for these surfaces between 6 and 12 years of age, the rate of progression into the dentin is generally relatively high once the lesion has reached the inner half of the enamel as judged radiographically.

Influence of Approximal Caries in Primary Molars on Caries Rate for the Mesial Surface of the First Permanent Molar in Swedish Children from 6 to 12 Years of Age

The objective was to assess the influence on the caries rate for the mesial surface of the first permanent molar (6m) of the caries status of the distal surface of the second primary molar (05d) in children from 6 to 12 years of age. The study design was retrospective and included 374 children with an average of 5 sets of bite–wing radiographs. The mean age of the children was 6.7 years when the first bite–wing radiographs were taken and 11.5 years at the time of the latest radiographs included in the study. The approximal surfaces were classified according to a scoring system: 0 = no visible radiolucency, 1= radiolucency in the outer half of the enamel, 2 = radiolucency in the inner half up to the enamel–dentin border, 3 = radiolucency with a broken enamel–dentin border but with no obvious involvement of the dentin, 4 = radiolucency with obvious spread in the outer half of the dentin, and score 5 = radiolucency in the inner half of the dentin. The influence of the status of 05d on the caries rate for 6m (state ≧2) was assessed by using a model for dependence between the two neighbouring surfaces. Presence or absence of approximal caries in the distal surface of the first primary molars (04d) and/or the mesial surface of the second primary molars (05m) at the time of eruption of 6m was also related to the caries rate for 6m. The caries rate for 6m was 15 times higher if 05d had developed enamel/enamel–dentin border caries (state 2 or 3) compared to a radiographically sound 05d (state 0 or 1). No significant increase in the caries rate for 6m was found when 05d had deeper unrestored dentin caries than when 05d had superficial caries (state 2 or 3). Furthermore, for preventing caries in 6m, no benefit could be found from restoring an 05d with dentin caries with amalgam as opposed to leaving the carious lesion unrestored until exfoliation. The caries rates for 6m and 05d were 3.4 and 2.7 times higher, respectively, in the presence of dentin caries/restoration in 04d/05m compared to absence of dentin caries in these molar surfaces at the time of eruption of 6m. In conclusion, the caries rate for 6m depended on the status of 05d and increased 15 times if 05d had enamel/enamel–dentin border caries compared to a sound 05d. Deeper unrestored or restored dentin lesions in 05d did not result in a higher caries rate for 6m compared with more shallow carious lesions in 05d.