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USING AIR ABRASIVE TECHNOLOGY TO
DIAGNOSE
AND RESTORE PIT AND FISSURE CARIES.
RONALD E GOLDSTEIN, D.D.S.; FREDERICK M. PARKINS, D.D.S., M.S.D., PH.D.
JADA,Vol.126.June 1995 p.761-765
PIT AND FISSURE CARIES
Changing patterns of dental caries suggest the need for a new emphasis
on diagnosing and treating pit and fissure caries. (Footnote: 7,8) By
1985,Ripa noted that although occlusal surfaces constitute only 12 percent
of the total permanent dentition surface area, they are the sites for
the development of more than 50 percent of the caries reported among school-age
children. (Footnote: 9) This high rate may reflect the dramatic decline
in the incidence of smooth-surface caries noted by Hicks in his discussion
of sealants and caries-preventive resins. (Footnote: 10) Pit and fissure
caries, however, has not proportionally decreased in incidence and therefore
has become a more significant problem. (Footnote: 5) A national study
of more than 30,000 school-age children dramatically documents this shift
in caries incidence:the National Institute of Dental Research found that
from 1980 to 1987.
Decay in pits and fissures was reduced by 31 percent, while caries in
other surfaces dropped by 51 to 59 percent. (Footnote: 6) In areas with
non-fluoridated water, pit and fissure caries accounted for 80 percent
of the total caries detected. This proportion jumped to 90 percent in
areas with fluoridated water. Researchers in France reported similar findings.
(Footnote: 11) Among other conclusions, the authors who reviewed the NIDR
studies stated that "the greatest caries susceptibility of both permanent
and primary teeth is in the pit and fissure surfaces of the molars."
(Footnote: 5)
In addition, researchers have begun to re-evaluate the methods used to
detect pit and fissure lesions (Footnote: 12-14); specifically they question
the traditional use of the explorer to probe for caries. (Footnote: 15-17)
Enamel undermined by carious dentin but strengthened by fluorides appears
less likely to fracture and collapse than non-fluoridated enamel, (Footnote:
12) making detection of underlying diseased dentin difficult. (Figure-1,
Figure-2). Additional reports
scrutinize the effectiveness of radiographs and other diagnostic methods
in diagnosing pit and fissure caries. (Footnote: 12,18) Difficulty in
distinguishing a stain on the surface from a darker-colored organic plug
within the pit or fissure that can promote caries (Footnote: 8,19) also
contributes to the diagnostic dilemma. (Footnote: 13)
• pit and fissure
caries • air-abrasive technoligy/methods
•
• discussion • summary
• bibliography • close
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