Influence of 2 caries-detecting devices on clinical decision making and lesion depth for suspicious occlusal lesions: A randomized trial from The National Dental Practice-Based Research Network.

Background: A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin.

Methods: Eighty-two dentists participated.

Dentists' decision strategies for suspicious occlusal caries lesions in a National Dental PBRN study.

Objective: Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs.

Methods: 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk.

Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network.

Background: A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically.

Methods: Ninety-three dentists participated in the study.

A Predictive Model for Root Caries Incidence.

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance].

Visual-tactile versus radiographic caries detection agreement in caries-active adults.

Objectives: The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE.

Methods: Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE.

Results from the Xylitol for Adult Caries Trial (X-ACT).

Background: Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries.

Methods: The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial.

Dental care plan assessment using the CAHPS Dental Plan Survey.

Objectives: The performance of a recently developed survey instrument that inquires about patients' experiences with the receipt of dental care was examined to evaluate its potential utility as a patient-reported outcome measure for dental care plans.

Methods: Individuals with dental insurance (n = 1,216) were surveyed using the Consumer Assessment of Health Care Providers and Systems (CAHPS) Dental Plan Survey. The instrument's pre-established composite and rating scores were compared across dental insurance carriers (6 most common and all others combined) using ANOVA.

Risk factors for third molar occlusal caries: a longitudinal clinical investigation.

Purpose: To study the third molar occlusal caries incidence and identify related patient-level sociodemographic, dental behavior, and clinical risk factors.

Patients And Methods: A prospective cohort study was used to study caries risk (crude increment and incidence rate) on retained and erupted to the occlusal plane third molars among a moderate-size (n = 215) group of healthy (American Society of Anesthesiologists class I and II) young adults (median age, 26 years) followed up for a mean of 4.6 years.

Changes over time in the prevalence of caries experience or periodontal pathology on third molars in young adults.

Purpose: To assess the prevalence of caries experience and periodontal pathology on third molar teeth compared with first and second molars and teeth more anterior from subjects who had data collected over time in a longitudinal clinical study.

Patients And Methods: Healthy subjects with 4 asymptomatic third molars and data for at least 4 years after enrollment were included in these analyses. The presence or absence of caries experience on the occlusal surface of the third molars and any surface of the first or second molars was assessed using a visual-tactile caries examination.

Antibiotic use for treating dental infections in children: a survey of dentists' prescribing practices.

Background: The authors conducted a study to examine the antibiotic prescribing practices of general and pediatric dentists in the management of odontogenic infections in children.

Methods: The authors relied on a cross-sectional study design to assess the antibiotic prescribing practices of general and pediatric dentists in North Carolina. The survey instrument consisted of five clinical case scenarios that included antibiotic-prescribing decisions in a self-administered questionnaire format.

Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT).

Objective: This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults.

Materials And Methods: Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires.

Prevalence of third molars with caries experience or periodontal pathology in young adults.

Purpose: We assessed the prevalence of caries experience and periodontal pathology on asymptomatic third molars in young adults.

Subjects And Methods: Healthy subjects with 4 asymptomatic third molars were enrolled in an institutional review board-approved study during a 5-year period. Full mouth periodontal probing, 6 sites per tooth, was the measure of clinical periodontal status.

Clinical technical performance of dental therapists in Alaska.

Background: The Alaska Dental Health Aide Therapist program has matured to the point that therapists have been in practice for up to four years.

Methods: A case-study evaluation of the program included assessments of the clinical technical performance of five of these therapists practicing in clinics in small Alaskan villages and towns.

Results: The results indicate that therapists are performing at an acceptable level, with short-term restorative outcomes comparable with those of dentists treating the same populations.

Design of the xylitol for adult caries trial (X-ACT).

Background: Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations.

Root caries risk indicators: a systematic review of risk models.

Objective: To identify risk indicators that are associated with root caries incidence in published predictive risk models.

Methods: Abstracts (n = 472) identified from a MEDLINE, EMBASE, and Cochrane registry search were screened independently by two investigators to exclude articles not in English (n = 39), published prior to 1970 (none), or containing no information on either root caries incidence, risk indicators, or risk models (n = 209). A full-article duplicate review of the remaining articles (n = 224) selected those reporting predictive risk models based on original/primary longitudinal root caries incidence studies.

Four "lessons learned" while implementing a multi-site caries prevention trial.

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four "lessons learned" or considerations important in the planning and initial implementation of RCTs in dentistry that, to our knowledge, have not been discussed in the general dental literature describing trial techniques. These considerations are a) preparing or securing a thorough systematic review; b) developing a comprehensive set of study documents; c) designing and testing multiple recruitment strategies; and d) employing a run-in period prior to enrollment.

Correlation between laser fluorescence readings and volume of tooth preparation in incipient occlusal caries in vitro.

Objective: This study evaluated the correlation between laser fluorescence readings and the extent of incipient occlusal caries as measured by the volume of tooth preparation in vitro.

Materials And Methods: One hundred and three permanent molars and premolars containing incipient occlusal pit-and-fissure caries and sound occlusal surfaces (1/4 of the sample, control) were selected. DIAGNOdent (KaVo Dental Corporation, Lake Zurich, IL, USA) readings were obtained according to manufacturer instructions.

Impact of symptomatic pericoronitis on health-related quality of life.

Purpose: To assess the impact of symptomatic pericoronitis on health-related quality of life (HRQOL).

Patients And Methods: Healthy subjects with symptomatic pericoronitis were enrolled in an institutional review board-approved study. Each was given a third molar condition-specific HRQOL instrument to assess the impact of pericoronitis in the preceding week.

Provisional crown failures in dental school predoctoral clinics.

Following a preliminary study indicating that at least 10 percent of single-unit crown temporary restorations failed in patients who received treatment by predoctoral students, a comprehensive examination of provisional crown failure was initiated to identify strategies to reduce the failure rate. For all provisionalized, natural tooth, single-unit crown preparations in University of North Carolina School of Dentistry predoctoral clinics for one year (N=1008), we noted tooth type, type of crown, student level, faculty coverage experience, treatment clinic, temporary material and luting agent, and retreatment (failure) of the provisional restoration. For failures, we also noted the stage of crown preparation at failure and the time since initial placement of the temporary.

Third molar root development and recovery from third molar surgery.

Purpose: This study was conducted to determine if the completeness of the root formation of mandibular third molars prior to removal affected clinical and health-related quality of life (HRQOL) recovery.

Patients And Methods: Data from HRQOL responses from patients and clinical outcome data were available after third molar surgery conducted by surgeons in community practice and academic centers. The root development of each mandibular third molar on presurgery panoramic radiographs for these patients was assessed by trained clinician observers.

The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries.

Objective: To assess the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries.

Methods: Nine detection and intervention decision points were identified as being central to the management of early occlusal caries and suspected occlusal dentinal caries, or suspicious areas. For each decision point, the evidence for effectiveness was assessed, using existing systematic reviews when available, and nonsystematic review methods when necessary.

Assessment of oral health-related quality of life before and after third molar surgery.

Purpose: This study was designed to further our understanding of recovery after third molar surgery by using 2 instruments to measure quality of life outcomes, the more global Oral Health Impact Profile (OHIP-14), and the condition-specific Health-Related Quality of Life (HRQOL) instrument.

Patients And Methods: Clinical and quality of life data pre- and postsurgery from 63 patients with all 4 third molars below the occlusal plane, treated with topical minocycline during third molar surgery to reduce the incidence of delayed clinical healing, were available for analyses. Each patient was given 2 questionnaires to complete; the more global OHIP-14 and the HRQOL instrument designed to assess recovery after third molar surgery.

Proximity of a lower third molar to the inferior alveolar canal as a predictor of delayed recovery.

Purpose: This study was designed to test the hypothesis that removal of lower third molars below the occlusal plane and in close proximity to the inferior alveolar canal (IAC) delays recovery after surgery as compared with lower third molars below the occlusal plane yet not close to the IAC.

Patients And Methods: Recovery data were available for 579 patients enrolled in an institutional review board-approved clinical trial. After surgery a questionnaire designed to assess health-related quality of life (HRQOL) recovery was given to the patient to be completed each day for 14 days.

Impact of topical minocycline with third molar surgery on clinical recovery and health-related quality of life outcomes.

Purpose: Compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients treated with or without topical minocycline at surgery.

Patients And Methods: Sixty-three patients at least 18 years of age with all 4 third molars below the occlusal plane were treated with topical minocycline during third molar surgery. Topical minocycline (1.

Pain medication as an indicator of interference with lifestyle and oral function during recovery after third molar surgery.

Purpose This study was designed to assess the impact of taking pain medications, as a more comprehensive indicator of perceived pain, on the extent of interference with lifestyle and oral function during recovery after third molar surgery. Patients and Methods Recovery data after the removal of 4 third molars were available for patients enrolled in an institutional review board-approved, prospective, multicenter clinical trial. A self-administered health-related quality of life instrument, designed to assess a patients perception of recovery for pain, lifestyle, and oral function, was completed each postsurgery day (PSD) for 14 days.