Читать книгу Caries Excavation: Evolution of Treating Cavitated Carious Lesions - Группа авторов - Страница 31

This question was discussed by Frencken [34] in the following manner. “The fluoride studies from the 1950s to the 1980s showed that the largest reduction in the extent and severity of carious lesions in children took place in smooth surfaces, followed by approximal surfaces. Fluoride was less effective in occlusal surfaces.” Other researchers have also reported this hierarchy in carious lesion susceptibility [11, 38, 39]. On the basis of data from 20,000 schoolchildren aged 5–16 years in the USA, it was established that the predominant susceptible tooth sites in low dentine carious lesion individuals (DMFS <5) were pits and fissures (95%). The proportion of approximal surfaces and smooth surfaces increased with an increase in mean DMFS score in this age group. In high-dentine carious lesion individuals (DMFS >25), the proportion of dentine carious lesions was about 20% for smooth surfaces, 30% for approximal surfaces, and 50% for pits and fissures [39].

Is there also a hierarchy in dentine carious lesions by tooth type? On the basis of the findings of the same US study, it could be concluded that occlusal surfaces of first molars and buccal pits of lower first molars were the most carious lesion-susceptible type of tooth and tooth surface. If all the first molars are affected, then a high probability exists that the second molars will be affected. The occlusal surfaces of the second molars and the buccal surfaces of the lower second molars are the second most susceptible sites for dentine carious lesion development in children with a low DMFS count. Smooth surfaces on the lower anterior region are least susceptible. A New Zealand birth-cohort study confirmed that the first followed by second permanent molars are most affected by dental caries over a period of 38 years [40].

All in all, pits and fissures in occlusal and pits in buccal tooth surfaces appear to be the most vulnerable sites for dentine carious lesions in the permanent teeth of children and adolescents. In children at high-caries risk these sites may need extra protection to keep them healthy.

Table 5. Trends in the prevalence of cavitated dentine carious lesions and in mean DMFT scores in adolescents, young adults, and 35- to 44-year-olds, and number of sound teeth over decades in a number of countries (data from Frencken et al. [30])

Table 6. Median mean DMFT scores and range interval among 35- to 44-year-olds, proportion of D-component and range interval by category of country income, using WHO Data Bank data from 2000 to 2015 (data from Frencken et al. [30])