Sonia K Makhija1, Gregg H Gilbert2, Ellen Funkhouser3, James D Bader4, Valeria V Gordan5, D Brad Rindal6, Vibeke Qvist7, Pia Nørrisgaard8. 1. Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Diagnostic Sciences, 1919 7th Ave. South, SDB 115, Birmingham, Ala. 35294-0007, e-mail smakhija@uab.edu. Address correspondence to Dr. Makhija. 2. Dr. Gilbert is a professor and the chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham. 3. Dr. Funkhouser is an associate professor, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham. 4. Dr. Bader is a research professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill. 5. Dr. Gordan is a professor, Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, University of Florida Health Science Center, Gainesville. 6. Dr. Rindal is a practitioner in the HealthPartners Dental Group, Minneapolis, and an investigator at the HealthPartners Institute for Education and Research, Minneapolis. 7. Dr. Qvist is an associate professor, Department of Cariology and Endodontics, School of Dentistry, University of Copenhagen, Denmark. 8. Ms. Nørrisgaard is a research assistant, Department of Cariology and Endodontics, School of Dentistry, University of Copenhagen, Denmark.
Abstract
BACKGROUND: A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions. METHODS: Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. RESULTS: At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion's being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinician's deciding at some point after follow-up to seal the lesion or treat it invasively. CONCLUSIONS: Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. PRACTICAL IMPLICATIONS: Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions.
BACKGROUND: A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions. METHODS: Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. RESULTS: At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion's being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinician's deciding at some point after follow-up to seal the lesion or treat it invasively. CONCLUSIONS: Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. PRACTICAL IMPLICATIONS: Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions.
Authors: S K Makhija; G H Gilbert; E Funkhouser; J D Bader; V V Gordan; D B Rindal; D J Pihlstrom; V Qvist Journal: Caries Res Date: 2014-01-29 Impact factor: 4.056
Authors: Gregg H Gilbert; O Dale Williams; James J Korelitz; Jeffrey L Fellows; Valeria V Gordan; Sonia K Makhija; Cyril Meyerowitz; Thomas W Oates; D Brad Rindal; Paul L Benjamin; Patrick J Foy Journal: J Dent Date: 2013-04-15 Impact factor: 4.379
Authors: Sonia K Makhija; Gregg H Gilbert; Ellen Funkhouser; James D Bader; Valeria V Gordan; D Brad Rindal; Michael Bauer; Daniel J Pihlstrom; Vibeke Qvist Journal: J Am Dent Assoc Date: 2012-12 Impact factor: 3.634
Authors: James C Hamilton; Joseph B Dennison; Kenneth W Stoffers; William A Gregory; Kathleen B Welch Journal: J Am Dent Assoc Date: 2002-12 Impact factor: 3.634
Authors: Sonia K Makhija; Michael E Robinson; James D Bader; Daniel A Shugars; Mark S Litaker; Hong R Im; D Brad Rindal; Daniel J Pihlstrom; Cyril Meyerowitz; Valeria V Gordan; Meredith K Buchberg; Gregg H Gilbert Journal: J Dent Date: 2017-11-11 Impact factor: 4.379
Authors: Jacob C Simon; Hobin Kang; Michal Staninec; Andrew T Jang; Kenneth H Chan; Cynthia L Darling; Robert C Lee; Daniel Fried Journal: Lasers Surg Med Date: 2017-03-24 Impact factor: 4.025
Authors: Rahma Mungia; Ellen Funkhouser; Sonia K Makhija; Stephanie C Reyes; Rachel A Cohen; David L Cochran; Cyril Meyerowitz; D Brad Rindal; Valeria V Gordan; Jeffrey L Fellows; Meredith Trejo; Thomas W Oates; Jason D McCargar; Pamela A McMahon; Gregg H Gilbert Journal: J Am Board Fam Med Date: 2020 Sep-Oct Impact factor: 2.657
Authors: Jennifer S Holtzman; Daniel Kohanchi; John Biren-Fetz; Margherita Fontana; Manisha Ramchandani; Kathryn Osann; Lucy Hallajian; Stephanie Mansour; Tasneem Nabelsi; Na Eun Chung; Petra Wilder-Smith Journal: Lasers Surg Med Date: 2015-09-28 Impact factor: 4.025
Authors: Sonia K Makhija; Daniel A Shugars; Gregg H Gilbert; Mark S Litaker; James D Bader; Rebecca Schaffer; Valeria V Gordan; D Brad Rindal; Daniel J Pihlstrom; Rahma Mungia; Cyril Meyerowitz Journal: J Am Dent Assoc Date: 2017-10-18 Impact factor: 3.634