Clinical cavitation and radiographic lesion depth in proximal surfaces in an Indian population

Abstract

Objectives. To assess the relationship between clinical cavitation and radiographic caries lesion depth in proximal surfaces of permanent posterior teeth in an Indian population. This study also assessed the clinical feasibility of applying ’western guidelines’ to this population from the developing world. Materials and methods. Relationship between clinical cavitation and radiographic caries lesion depth in proximal surfaces in an Indian population was assessed. Proximal surfaces (n = 126) without restorations were examined on bitewing radiographs in patients with suspected caries and lesion depth was recorded by five observers. The radiographic scoring scale was 0 = sound; 1 = lesion in enamel; 2 = lesion in outer 1/3 of dentine and 3 = lesion in inner 2/3 of dentine. Orthodontic separators were placed interdentally and removed after 3 days, where surfaces were recorded as cavitated (yes/no) by two clinical validators (gold standard). Results. Enamel lesions were cavitated in 25.6–38.3%, outer dentinal lesions were cavitated in 83.3–100% and inner dentinal lesions were cavitated in 96.4–100% depending on observer and validator. On applying ‘western guidelines’ for treatment decision to the radiographic findings of lesion depth, 80–100% of the lesions observed in outer dentine would lead to a false (non-operative) treatment decision. Conclusions. Radiographic shallow carious lesions were often cavitated in this population. The threshold for cavitation in this study population is suggested to be set between enamel and outer dentine in contrast to western guidelines.