Table Of Content

DC-00.qxd 18/12/07 12:53 Page i Dental Caries DC-00.qxd 18/12/07 12:53 Page ii DC-00.qxd 18/12/07 12:53 Page iii Dental Caries The Disease and its Clinical Management Second Edition Edited by Ole Fejerskov and Edwina Kidd with Bente Nyvad and Vibeke Baelum DC-00.qxd 18/12/07 12:53 Page iv © 2003,2008 by Blackwell Munksgaard Ltd Chapter 23 © 2008 J.Frencken Blackwell Munksgaard,a Blackwell Publishing Company, Blackwell Publishing Ltd,9600 Garsington Road,Oxford OX4 2DQ,UK Tel:+44 (0)1865 776868 Blackwell Publishing Professional,2121 State Avenue,Ames,Iowa 50014-8300,USA Tel:+1 515 292 0140 Blackwell Publishing Asia Pty Ltd,550 Swanston Street,Carlton,Victoria 3053,Australia Tel:+61 (0)3 8359 1011 The right ofthe Authors to be identified as the Authors ofthis Work has been asserted in accordance with the Copyright,Designs and Patents Act 1988. All rights reserved.No part ofthis publication may be reproduced,stored in a retrieval system,or transmitted,in any form or by any means,electronic,mechanical,photocopying,recording or otherwise,except as permitted by the UK Copyright,Designs and Patents Act 1988,without the prior permission ofthe publisher. Designations used by companies to distinguish their products are often claimed as trademarks.All brand names and product names used in this book are trade names,service marks,trademarks or registered trademarks oftheir respective owners.The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provided accurate and authoritative information in regard to the subject matter covered.It is sold on the understanding that the publisher is not enggaged in rendering professional services.Ifprofessional advice or other expert assistance is required,the services ofa competent professional should be sought. First published 2003 by Blackwell Munksgaard Ltd Second edition published 2008 ISBN:9781405138895 Library ofCongress Cataloging-in-Publication Data Dental caries:the disease and its clinical management/edited by Ole Fejerskov and Edwina A.M.Kidd,with Bente Nyvad and Vibeke Baelum.-- 2nd ed. p.XX;cm. Includes bibliographical references and index. ISBN-13:978-1-4051-3889-5 (hardback :alk.paper) ISBN-10:1-4051-3889-0 (hardback :alk.paper) 1.Dental caries--Diagnosis.2.Dental caries--Treatment.I.Fejerskov,Ole.II.Kidd,Edwina A.M. [DNLM:1.Dental Caries--diagnosis.2.Dental Caries--therapy.3.Dental Restoration,Permanent.WU 270 D4145 2008] RK331.D465 2008 617.6’7--dc22 2007021650 A catalogue record for this title is available from the British Library Set in Minion and Frutiger by Gray Publishing,Tunbridge Wells,UK Printed and bound in Singapore by Markono Print Media Pte Ltd The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy,and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices.Furthermore,the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. For further information on Blackwell Munksgaard,visit our website: www.dentistry.blackwellmunksgaard.com DC-00.qxd 18/12/07 12:53 Page v Contents Preface: an Editors’guide to reading the book xiii Contributors xix Part I The disease and its diagnosis 1 Chapter 1 Defining the disease:an introduction 3 O.Fejerskov,E.A.M.Kidd,B.Nyvad and V.Baelum Introduction 4 Terminology 5 Background literature 6 References 6 Chapter 2 Clinical appearances ofcaries lesions 7 O.Fejerskov,B.Nyvad and E.A.M.Kidd What do caries lesions look like clinically? 8 Deciduous dentition 8 Permanent dentition 10 References 18 Chapter 3 Pathology ofdental caries 19 O.Fejerskov,B.Nyvad and E.A.M.Kidd Introduction 20 Enamel reactions during eruption 21 Enamel changes during early caries lesion development 23 The approximal white-spot lesion 27 Progression ofthe enamel lesion 32 Arrest ofthe caries lesion 32 Occlusal caries 35 Dentin reactions to caries progression 39 Pulpo-dentinal reactions 42 Root-surface caries 44 Background literature 47 References 48 Chapter 4 Visual–tactile caries diagnosis 49 B.Nyvad,O.Fejerskov and V.Baelum Introduction 50 The diagnostic process 50 Why do we diagnose caries? 51 Diagnosis in a dental caries perspective 51 How early should caries lesions be detected? 53 What are the best visual–tactile caries diagnostic criteria? 53 Commonly used visual–tactile criteria 55 Differential diagnosis 60 Visual–tactile caries examination: a systematic clinical approach 62 Additional aids in visual–tactile caries diagnosis 64 Benefits and limitations ofvisual–tactile caries diagnosis 66 References 67 DC-00.qxd 18/12/07 12:53 Page vi vi Contents Chapter 5 Radiography for caries diagnosis 69 I.Mejàre and E.A.M.Kidd Introduction 70 Technical and quality aspects 70 Prescription and timing ofbitewing radiography 79 References 87 Chapter 6 Additional diagnostic measures 89 A.Lussi and B.Angmar-Månsson Introduction 90 Methods based on X-ray 90 Methods based on light 92 Methods based on electrical current 97 Are the methods suitable for use in clinical practice or only useful for research? 98 Can the methods stand alone or are they only adjuncts to a clinical–visual examination? 99 References 99 Chapter 7 The foundations ofgood diagnostic practice 103 V.Baelum,B.Nyvad,H.-G.Gröndahl and O.Fejerskov Introduction 104 The making ofa dentist 104 The dental examination: in the best interest ofpatients 105 What are we looking for – what is caries? 106 The wealth ofcaries diagnostic methods 108 The evolution in caries diagnostic methods 108 Evaluating caries diagnostic methods 109 Diagnostic test assessment in the essentialistic gold-standard paradigm 109 Leaps in the essentialistic gold-standard reasoning 111 Diagnostic test evaluation in the nominalistic caries paradigm 113 Interexaminer and intraexaminer errors in caries diagnosis 114 How do we deal with the unavoidable diagnostic uncertainty? 115 The additional diagnostic yield argument 116 Concluding remarks 117 References 118 Part II Clinical caries epidemiology 121 Chapter 8 The epidemiology ofdental caries 123 B.A.Burt,V.Baelum and O.Fejerskov Introduction 124 Measuring dental caries 125 Distribution ofcaries 129 Summary 141 References 141 Chapter 9 The impact ofdiagnostic criteria on estimates ofprevalence, 147 extent and severity ofdental caries N.Pitts Introduction 148 Diagnostic criteria for dental caries: an epidemiological perspective 148 Caries diagnostic thresholds and specific epidemiological considerations 151 Impact ofdiagnostic criteria on estimates ofcaries prevalence 154 Impact ofdiagnostic criteria on estimates ofcaries extent 155 DC-00.qxd 18/12/07 12:53 Page vii Contents vii Impact ofdiagnostic criteria on estimates ofthe severity ofdental caries 157 A framework for considering the choice ofappropriate diagnostic criteria for 158 epidemiological studies Summary 158 References 158 Part III Dental caries in a biological context 161 Chapter 10 The oral microflora and biofilms on teeth 163 P.D.Marsh and B.Nyvad Introduction 164 The resident microflora 164 Dental biofilms: development,structure,composition and properties 166 Caries microbiology: a briefhistorical perspective 178 Methodological problems in microbiological studies ofdental caries 178 Microbiology ofcaries 179 Cariogenic features ofdental biofilm bacteria 182 Concluding remarks 185 Background literature 185 References 185 Chapter 11 The role ofsaliva 189 A.Bardow,F.Lagerlöf,B.Nauntofte and J.Tenovuo Introduction 190 Formation ofsaliva 190 Hypofunction ofsalivary glands 194 Oral clearance 195 Inorganic saliva composition 196 Saliva buffer capacity and pH regulation 198 Saliva proteins 200 Role ofthe pellicle 202 Other caries-related components in saliva 203 Saliva and the risk ofdeveloping caries lesions 204 Management ofsalivary gland hypofunction 206 Concluding remarks 206 Background literature 207 References 207 Chapter 12 Chemical interactions between the tooth and oral fluids 209 J.M.ten Cate,M.J.Larsen,E.I.F.Pearce and O.Fejerskov Introduction 210 The importance ofthe mineral phase in enamel 210 Enamel mineral and oral fluids 213 Demineralization and remineralization ofthe dental hard tissues 217 Remineralization 220 Dentin caries 221 Fluoride reactions in the oral environment 225 Dental calculus 229 Background literature 230 References 230 DC-00.qxd 18/12/07 12:53 Page viii viii Contents Chapter 13 Erosion ofthe teeth 233 M.J.Larsen Introduction 234 Clinical manifestations and diagnosis 234 Histological and chemical features 236 Classification by depth ofthe lesion 237 Classification by etiology 237 Erosion caused by food and drinks 238 Erosion caused by stomach contents 243 Erosion caused by airborne acids 243 Idiopathic erosion 244 Prophylaxis and treatment oferosion 244 Conclusion 246 Background literature 246 References 246 Part IV Non-operative therapy 249 Chapter 14 The control ofdisease progression:non-operative treatment 251 E.A.M.Kidd and O.Fejerskov Introduction 252 Can the caries process be prevented? 252 Controlling disease progression 252 Should disease control be considered as ‘treatment’ofthe caries lesion? 253 Why use the term ‘non-operative treatment’? 254 Does the approach work? Is it cost-effective? 254 References 254 Chapter 15 Role oforal hygiene 257 B.Nyvad Introduction 258 Some theoretical considerations 258 The biological effect oftooth cleaning 258 The clinical effect oftooth cleaning 259 The effect ofprofessional tooth cleaning 262 The effect ofdental flossing 263 Concluding remarks 263 References 263 Chapter 16 Antimicrobials in caries control 265 A.A.Scheie and F.C.Petersen Dental plaque: the biofilm lifestyle and the rationale for antimicrobial intervention 266 Biological activity and mode ofaction 267 Modification ofdental biofilm biochemistry and ecology 269 Vehicles for administration ofcaries-prophylactic agents 269 Specific agents 270 Other agents proposed for caries prophylaxis,but without documented anticaries effect 273 Concluding remarks and future approaches 275 Background literature 276 References 276 DC-00.qxd 18/12/07 12:53 Page ix Contents ix Chapter 17 Might caries control involve immunization and gene therapy? 279 R.R.B.Russell Introduction 280 Dental caries vaccine 280 Alternative approaches to targeting cariogenic bacteria 284 Natural defense mechanisms ofthe tooth 284 Conclusion 285 References 285 Chapter 18 Fluorides in caries control 287 R.Ellwood,O.Fejerskov,J.A.Cury and B.Clarkson Introduction 288 How fluoride came into dentistry 288 Physiological and toxicological aspects offluoride delivery 293 Current methods offluoride delivery 304 Appropriate use offluoride in caries control 319 Summary ofrecommendations for fluoride-delivery methods 322 Background literature 323 References 323 Chapter 19 The role ofdietary control 329 D.T.Zero,P.Moynihan,P.Lingström and D.Birkhed Introduction 330 Diet and dental caries in humans 330 Influence ofdifferent intake patterns 333 Influence offluoride on the relationship between sugars and caries 334 Groups at increased risk ofdental caries in relation to diet 336 Relative cariogenicity ofdifferent carbohydrates 338 Novel carbohydrates and dental health 338 Protective factors in foods 344 Diet and dental erosion 346 Promoting good dietary habits for dental health 346 References 349 Part V Operative intervention 353 Chapter 20 The role ofoperative treatment in caries control 355 E.A.M.Kidd,J.P.van Amerongen and W.E.van Amerongen Introduction 356 What is happening in your dental school? 356 The outcome ofnon-operative treatment 356 Does this approach always work? 358 Occlusal surfaces 358 Approximal surfaces 359 Recurrent caries 359 Deciduous teeth 361 Summary 363 References 364