ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Unsealed Mandibular Premolars are Less Susceptible to Occlusal Caries Than Unsealed Permanent Posterior Teeth
Clinical Question In a high caries risk patient, is an unsealed mandibular premolar less susceptible to occlusal caries than other unsealed permanent posterior teeth?
Clinical Bottom Line Unsealed mandibular premolars are just as susceptible, and in some cases more susceptible, to occlusal caries over 5 years than other unsealed permanent posterior teeth. This is supported by two cross-sectional observational studies with nearly identical results with very large sample sizes from different patient groups.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23064960Shaffer/2013Center for Oral Health in Appalachia: patients had higher dental caries prevalence than general US population N= 1,068 63% female 90% white mean age= 34.7 yrs.Cross-Secitonal Observational Study
Key resultsThe article demonstrated a comparison for caries incidence in different tooth surfaces of 1,068 patients in a patient pool that represents NHANES data. It shows a predilection for caries to occur in molar occlusal surfaces than on occlusal of premolars. Maxillary first premolars are more susceptible than mandibular first premolars. 
#2) 20613915Demirci/2010Patients attending the Department of the Faculty of Dentistry at Istanbul University, examined between 2001 and 2004. 11915 caries surfaces (or 17558 caries sites) in 2383 teeth were recorded.Cross-Sectional Observational Study
Key resultsOcclusal fissures on the first and second molars contributed most significantly to caries frequency, from 52.7% to 66.3%, respectively. Maxillary and mandibular first and second premolars had the highest frequency of caries on the distal surfaces. 
Evidence Search ("Bicuspid"[Mesh]) AND "Dental Caries Susceptibility"[Mesh]
Comments on
The Evidence
Both articles are cross-sectional observational studies pertaining to a population and caries incidence at a point in time. The first article has a very large patient pool. Although the patients in the study were disproportionately underserved with lower oral health, the caries distribution results were stated to mirror NHANES data, and therefore still valid. For the first study, the dental examinations were performed in the same manner on each patient in accordance with the National Center for Health Statistics Dental Examiners Procedures Manual (Section 4.9.1.3) to maximize comparability with other national data sets and yielded high-quality reproducible data. In the second article, patients were evaluated according to WHO guidelines. Perspective: Though the studies are cross-sectional observational studies, the level of evidence provided answers the clinical question sufficiently.
Applicability The dental status of the subjects in the studies was generally lower than the general US population. The patient pools were of specific populations (90% white in Appalachia, patients in Turkey) but the results were the same and mirrored those of NHANES. The information can help providers understand risk factors for specific teeth, base preventative or restorative decisions off of the data, and have a better understanding of overall caries outcomes.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords bicuspid, dental caries susceptibility, dental sealants, occlusal caries, posterior teeth
ID# 2670
Date of submission: 03/11/2014spacer
E-mail bakkea@livemail.uthscsa.edu
Author Andrea Bakke
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author John Roberts, DDS
Faculty mentor/Co-author e-mail jr2148327480@hotmail.com; John.Roberts@dads.state.tx.us
Basic Science Rationale
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