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Objective: To analyze the reproducibility of a calibration trial, at different diagnostic thresholds of dental caries, in a 12-month evaluation., Methods: A group of dental examiners (n = 11), who had previous experience in epidemiological surveys, participated in the study. An initial training phase (theoretical and clinical) and five calibration exercises (baseline, 3, 6, 9 and 12 months) were arranged. World Health Organization (WHO) criteria, including the active initial lesions (IL) were used. Six- to 7-year-old children took part in the study. They were selected according to past history and dental caries activity. The data were analyzed at WHO and WHO + IL diagnostic thresholds in accordance with tooth and dental surfaces., Results: Excellent mean intra- and inter-examiner Kappa values were obtained for both diagnostic thresholds, in accordance with tooth and surface, during the calibration phases. However, the most relevant errors were related to the decayed component and to IL diagnosis., Conclusion: It was possible to use the methodology proposed in this study in epidemiological surveys when examining the mixed dentition, although new strategies to improve training in IL diagnosis and calibration are necessary.

Objectives: The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent for monitoring occlusal caries longitudinally as part of a routine dental check-up in a public dental clinic., Methods: Children aged 7-8 and 13-14 years at baseline participated in the study. As part of two consecutive dental check-ups with a mean interval of 1,19, years, 423 permanent molars and 315 primary molars in 81 children were examined visually and using DIAGNOdent by one dentist. In teeth where, as judged by visual examination, caries had emerged or progressed during the follow-up, the DIAGNOdent values had increased significantly from the baseline., Results: In permanent teeth with a change in visual score from sound to enamel or dentin caries, the mean DIAGNOdent value increased from 24 to 37 and in primary teeth from 8 to 40. The increase in DIANGOdent values correlated positively with the increase in visual score. The mean DIAGNOdent value at baseline was significantly higher in teeth that became carious than in those that remained sound during the follow-up. For permanent teeth with a visual reversal from inactive or active enamel caries to a sound surface, the mean DIAGNOdent value decreased from 36 to 24., Conclusions: These results suggest that DIAGNOdent is useful in monitoring occlusal caries in both permanent and primary molars.

Aim: To assess the relative impact of changing diagnostic criteria on changes in the prevalence and severity of caries between 1971 and 1997., Material and Methods: All 12- and 13-year-old children attending the same school, "Padre Anchieta Primary School", in Brazil in 1971 (n=202) and 1997 (n=175) were examined by a single dentist. The criteria for the diagnosis of caries proposed by Radike in 1968 were used in both 1971 and 1997. In 1997, a second clinical examination was conducted and the WHO criteria proposed in 1987 were used., Results: Comparison of caries experience expressed as changes in the mean DMFT scores indicated a 67.7% reduction between 1971 and 1997 from 9.2 to 3.0 when Radike's criteria were used in 1971 and the WHO criteria were used in 1997. The reduction in caries was independent of the diagnostic criteria adopted in the 1997 dental examination, but the reduction of caries was smaller, from 9.2 to 6.2 (31.8%), when caries experience in 1971 and 1997 was measured using Radike's criteria., Conclusion: The observed reduction of caries is not a statistical artifact. However, while 47.2% of this reduction is real, 52.8% of it is a statistical artifact due to changes in the criteria for measuring caries used by epidemiologists.

During the 20th century, dental caries was usually diagnosed using tactile-visual criteria that detected the presence of cavitation rather than measured the disease process as a continuum that starts from the appearance of microporosity, as a result of demineralization, to the occurrence of cavitation. With increasing understanding of the dental caries process and the role of primary and secondary prevention in arresting it, sensitive and specific diagnostic systems are needed that could enable dentists to detect signs of early demineralization and possible progression of precavitated carious lesions before the occurrence of cavitation. In this review of the literature, published validity studies of diagnosis of precavitated lesions were reviewed. Overall, the current clinical diagnostic systems have low sensitivity and moderate specificity. Good reliability of diagnosing precavitated carious lesions could be obtained for diagnosing pits and fissures but for smooth tooth surfaces the reliability is poor. As our diagnostic capability of precavitated lesions improves, there is a need for a significant change in dental education, dental insurance, and dental practice to reward dentists for promoting oral health and preserving tooth structure. In this paper, a new model for classifying carious lesions based upon the type of intervention strategies is proposed to assist in this new approach of caries management.

This study reports on the caries susceptibility of tooth surfaces in 4294 adolescents (mean age 12.5 yr) during a 3-yr, double-blind clinical caries trial, conducted in Lanarkshire, Scotland, between 1988 and 1992. Children were selected on the grounds of dental maturity and past caries experience. Clinical examinations with mirror, CPITN probe and fibre optic trans-illumination were carried out on the permanent dentition, with the buccal pits of mandibular molars and palatal pits of maxillary molars being recorded as separate sites. At baseline 6061 surfaces were decayed (1.0% of 601 160 surfaces examined), 20 160 (3.4%) filled, and 10 909 (1.8%) missing due to caries. The number of surfaces recorded as sound at baseline in subjects completing the study was 454 663. Of these 8176 (1.8%) new surfaces were decayed, 14 832 (3.3%) filled and 4000 (0.9%) missing at the final examination. Molar occlusal surfaces showed greatest susceptibility to attack, 35.8%) of those at risk becoming carious in the course of the study. All buccal and lingual smooth surfaces showed a low susceptibility, but 8.8% of buccal and palatal pits developed caries. At the final clinical-only examination, pit and fissure caries accounted for 48%, interproximal surfaces for 39%, and smooth surfaces for 13% of caries prevalence. However, overall the contribution of these surfaces to 3-yr increments was, 40%, 47% and 13%, respectively.

A group of 268 children were checked for caries experience at the age of 7.2 yr later at the age of 9 and 4 yr later at the age of 11 yr. Caries experience of fissures in permanent first molars at the age of 7 yr served as a screening criterion for caries increment between the ages of 7 and 11 yr. This screening resulted in a sensitivity of 0.62, a specificity of 0.82, and a diagnostic power of 0.83 for total caries increment in the permanent dentition and in a sensitivity of 0.68, a specificity of 0.80, and a diagnostic power of 0.78 for caries increment in fissures of permanent first molars. It was concluded that this screening offered the best method available for identifying children at risk from fissure caries in their permanent first molars. Cost effectiveness of preventive treatment directed towards individuals, for instance the application of fissure sealants, can be improved by using this screening method.