Better Understanding of Caries May Improve Preventive Efforts

Better Understanding of Caries May Improve Preventive Efforts

Although the etiology of dental caries is well researched, little is known about why some incipient caries lesions remain innocuous while others progress to decay. Understanding this process could help dental professionals provide better preventive care with the hope of reducing the prevalence of tooth decay among all populations. The National Institutes of Health (NIH) funded a 4-year study, led by Andrea Ferreira Zandona, DDS, MSD, PhD, director of the Graduate Preventive Dentistry and Early Caries Management programs at Indiana University School of Dentistry in Indianapolis, to investigate the natural history of dental caries.

The team looked at whether the International Caries Detection and Assessment System (ICDAS) could be used to predict which lesions would progress to decay and which would remain inactive. This visual detection system rates the severity of lesions, with a one signifying a very small lesion, and a five or six rating representing a completely cavitated lesion that requires restorative care. Study participants included 388 children between the ages of 5 and 13 who were examined periodically over 2 years.

The researchers tracked all lesions, noting the ICDAS score and an estimation of whether a lesion was active. Results showed that active lesions identified as greater than one were more likely to progress to cavitation. As the ICDAS scores grew from one to four, the percentage of lesions that completely cavitated grew from 19% to 66%. The study, which was published in the September 2012 issue of the Journal of Dental Research, also found that lesions on occlusal surfaces were the most likely to progress to decay, followed by buccal pits, lingual grooves, proximal surfaces, and buccal and lingual surfaces. Age, gender, and tooth type also affected the cavitation risk.

The team hopes that this information will help dental professionals note which caries lesions are more likely to progress to decay so that effective preventive strategies—such as sealants and fluoride varnish—can be employed. “We don’t want dental professionals to wait for a lesion to become a cavity,” Ferreira Zandona commented. “In reality, if a lesion is active and has an ICDAS score higher than one, chances are it will become a cavity. Providers should do something preventively—before a filling needs to be placed.”

Thanks to additional NIH funding, the researchers will now investigate whether the metabolic signals produced by plaque biofilms that overlay caries lesions determine a lesion’s active status.