Caries Process on Occlusal Surfaces: Evolving Evidence and Understanding

Management of the caries process on occlusal surfaces of permanent molars has proven a major challenge. The onset of caries on these surfaces takes place soon after their eruption, and the permanent first molars, followed by the second molars, remain the sites in the dentition which show the highest caries prevalence. This paper is structured in the form of questions and answers in which traditional concepts of caries susceptibility of occlusal surfaces are appraised and confronted with the current evidence. Then, research studies examining the role of biological determinants on the development and arrest of occlusal caries in young permanent teeth are discussed. Finally, the contribution of these studies in terms of developing the available scientific evidence and our understanding of the caries process on occlusal surfaces is analyzed. The current evidence does not support the concept that the early onset and high prevalence of occlusal caries in young permanent teeth are due to a particularly low inherent resistance of the occlusal surface or due to the presence of inaccessible fissure-like structures on these surfaces. Evidence is provided to show that the most influential biological determinants of the development and arrest of occlusal caries are thick plaque accumulation on the groove-fossa system and the stage of tooth eruption limiting mechanical oral function. Consequently, active occlusal lesions are significantly more prevalent in erupting than in fully erupted teeth. The major contribution of this review is to provide updated knowledge about the biological principles determining the development and arrest of caries on occlusal surfaces of erupting teeth.

[1]  G. Eckert,et al.  The Natural History of Dental Caries Lesions , 2012, Journal of dental research.

[2]  D. Droz,et al.  Definition of at-risk occlusal surfaces of permanent molars--a descriptive study. , 2009, The Journal of clinical pediatric dentistry.

[3]  P. Marsh,et al.  Dental Plaque as a Microbial Biofilm , 2004, Caries Research.

[4]  O. Fejerskov,et al.  Dental fluorosis: chemistry and biology. , 2002, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[5]  T. Marthaler,et al.  Changes in Dental Caries 1953–2003 , 2004, Caries Research.

[6]  A. Ismail,et al.  Predictors of Dental Caries Progression in Primary Teeth , 2009, Journal of dental research.

[7]  R. Hickel,et al.  Irregularities below the Enamel-Dentin Junction May Predispose for Fissure Caries , 2012, Journal of dental research.

[8]  B. Nyvad,et al.  Caries Ecology Revisited: Microbial Dynamics and the Caries Process , 2008, Caries Research.

[9]  W. D’hoore,et al.  The decline in dental caries among Belgian children between 1983 and 1998. , 2001, Community dentistry and oral epidemiology.

[10]  A. Yoshihara,et al.  Changes in Electrical Resistance of Sound Fissure Enamel in First Molars for 66 Months from Eruption , 2007, Caries Research.

[11]  P. Frazão.  Effectiveness of the bucco-lingual technique within a school-based supervised toothbrushing program on preventing caries: a randomized controlled trial , 2011, BMC oral health.

[12]  A. Thylstrup,et al.  Dental plaque and caries on permanent first molar occlusal surfaces in relation to sagittal occlusion. , 1993, Scandinavian journal of dental research.

[13]  A. I. Darling,et al.  Influence of posteruptive age of enamel on its susceptibility to artificial caries. , 1991, Caries research.

[14]  C. Chu,et al.  Randomized Trial on Fluorides and Sealants for Fissure Caries Prevention , 2012, Journal of dental research.

[15]  Jaime Aparecido Cury,et al.  Fluoride: its role in dentistry. , 2010, Brazilian oral research.

[16]  A. Thylstrup,et al.  Rational use of fluorides in caries prevention. A concept based on possible cariostatic mechanisms. , 1981, Acta odontologica Scandinavica.

[17]  A. Thylstrup,et al.  In Vivo Caries Models-Mechanisms for Caries Initiation and Arrestment , 1994, Advances in dental research.

[18]  L. Bjørndal,et al.  Structural analyses of plaque and caries in relation to the morphology of the groove-fossa system on erupting mandibular third molars. , 1997, Caries research.

[19]  R. Watt.  From victim blaming to upstream action: tackling the social determinants of oral health inequalities. , 2007, Community dentistry and oral epidemiology.

[20]  C. Longbottom,et al.  Relationship between Electrical Resistance Measurements and Microradiographic Variables during Remineralization of Softened Enamel Lesions , 2004, Caries Research.

[21]  Jean-Pierre Van Nieuwenhuysen,et al.  Traitement non-opératoire de la carie dentaire , 2004 .

[22]  O. Fejerskov,et al.  Changing Paradigms in Concepts on Dental Caries: Consequences for Oral Health Care , 2004, Caries Research.

[23]  B. Nyvad,et al.  Diagnosis versus Detection of Caries , 2004, Caries Research.

[24]  K. Ekstrand,et al.  Two and a Half–Year Outcome of Caries– Preventive Programs Offered to Groups of Children in the Solntsevsky District of Moscow , 1999, Caries Research.

[25]  A. Thylstrup,et al.  Dental Plaque and Caries on Occlusal Surfaces of First Permanent Molars in Relation to Stage of Eruption , 1989, Journal of dental research.

[26]  P. Rautava,et al.  Behavioural and demographic factors during early childhood and poor dental health at 10 years of age , 2005, Caries Research.

[27]  M. Maltz,et al.  Results after two years of non-operative treatment of occlusal surface in children with high caries prevalence. , 2003, Brazilian dental journal.

[28]  A. Thylstrup,et al.  Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars. , 1991, Community dentistry and oral epidemiology.

[29]  T. Ozaki.  [Dental morphology]. , 1986, Nichidai koku kagaku = Nihon University journal of oral science.

[30]  A. Thylstrup,et al.  Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars. , 1992, Community dentistry and oral epidemiology.

[31]  J. Carvalho,et al.  Caries Trends in Brazilian Non-Privileged Preschool Children in 1996 and 2006 , 2008, Caries Research.

[32]  K. Klock,et al.  Tracking of parents' attitudes to their children's oral health-related behavior–Oslo, Norway, 2002–04 , 2010, Acta odontologica Scandinavica.

[33]  A. Hofman,et al.  Deciduous Molar Hypomineralization and Molar Incisor Hypomineralization , 2012, Journal of dental research.

[34]  M. Fontana,et al.  Risk Factors of Caries Progression in a Hispanic School-aged Population , 2011, Journal of dental research.

[35]  Xi Chen,et al.  Dental caries and first permanent molar pit and fissure morphology in 7- to 8-year-old children in Wuhan, China , 2012, International Journal of Oral Science.

[36]  J. Carvalho,et al.  Clinical report on plaque formation, distribution and maturation within the primary, mixed and permanent dentitions. , 2009, European journal of paediatric dentistry.

[37]  H. Stenlund,et al.  Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden , 2004, Caries Research.

[38]  J. H. Vermaire.  Optimizing oral health: towards a tailored, effective and cost-effective dental care , 2013 .

[39]  M. Larsen,et al.  Fluoride in Enamel Lining Pits and Fissures of the Occlusal Groove–Fossa System in Human Molar Teeth , 1999, Caries Research.

[40]  A. Schulte,et al.  Posteruptive Changes of Electrical Resistance Values in Fissure Enamel of Premolars , 1999, Caries Research.

[41]  J. Carvalho,et al.  Impact of Enamel Defects on Early Caries Development in Preschool Children , 2011, Caries Research.

[42]  J. M. Cate.  Contemporary perspective on the use of fluoride products in caries prevention , 2013, BDJ.