S. Sahba et al Journal of Dentistry, Tehran University of Medical Sciences
2004; Vol. 1, No. 3 11
Evaluation of Interproximal Caries with Using of Bitewing Radiography in Dental Student of
Islamic Azad University
S. Sahba,1 AR. Talaeipour,2 S. Mokhtari3
1 Associate Professor, , Department of Oral Medicine, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Associate Professor, Faculty of Dentistry, Department of Oral Radiology, Tehran University of Medical Sciences, Tehran, Iran
3 Dentist
Statement of Problem: Dental caries is one of the common diseases in the world. It is an infective disease which is caused by loss of minerals and destruction of dental tissues. One of the most effective ways to diagnose the interproximal caries is radiography. Bitewing radiography is the best way for caries diagnosis.
Purpose: The aim of this study was to evaluate the prevalence of the interproximal caries in dental students of Islamic Azad University.
Materials and Methods: This research was a cross sectional study that was conducted on 89 students of the Azad University consisting of 48 females and 41 males who were selected by random sampling. For each individual student left and right posterior bitewing radiographs were taken with a standard method (the interproximal spaces were between 6- 7,5,6 and 4,5). Thus 12 interproximal spaces were examined in each individual. The most proximal cavitation surfaces were detected in the upper Jaw.
Results: Results revealed that 6 individuals (6.7%) were totally caries free and 83 individuals (93.3%) showed interproxmal caries. Out of 1068 proximal spaces which had been studied 794 Spaces (73.4%) were caries free and 274 surfaces (25.7%) had caries.
Conclusion: The high incidence of proximal caries and the possibility of missing them in the routine examinations make the bitewing radiographs an effective procedure for diagnosis.
Key Words: Proximal caries; Bitewing radiography; Prevalence
Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2004; Vol. 1, No. 3)
ental caries is a multi factorial and chronic disease and perhaps the most common chronic disease in the world.
Although the rate of caries in developed and industrial countries has obviously decreased, it is still high in developing countries, so, the preventive and controlling methods are emphasized. (1)
However, early diagnosis of primary caries and
limiting its harmful effects is the first aim in epidemiological studies.
Interproximal caries diagnosis is difficult and can stay hidden from both the patient and the clinician under routine dental examination. (2) Interproximal caries are seen as small cust in the enamel surface and mostly found under the contact points. These lesions spread in triangular shape with their base under the
D
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surface and the head towards DEJ. In DEJ, it spreads laterally and continues towards the pulp.
In fact the appearance of a cavity is the last step in caries activity.(3)
Bitewing radiography is the best way for demineralization diagnosis in proximal smooth surfaces since these surfaces are usually not reachable under routine dental examinations.
In bitewing radiography the crown and its surrounding tissues in both jaws can be developed in one film. Using this method, we can diagnose dental caries, control caries progress, diagnose overhang restorations; study pulp situation and its changes, alveolar crest resorption and occlusal relation of the teeth.
Russel et al implied that the bitewing accuracy for proximal caries diagnosis was about 70%.
They also mentioned that if radiolucency was not visual in dental surfaces then the chances that these surfaces would be caries free was 98%. Russell et al also reminded that finding proximal caries must accompany a thorough dental examination of the patient.(4)
In 1999, Hintze and Wenzel reported that 92 to 99 percent of caries occurrence happens in the posterior teeth. The proximal spaces in this research were spaces between teeth 4-5 and 6-7.(5)
In another study performed by Petridou et al in 1996, they could not find an obvious difference in caries rate incidence between girls & boys although oral hygiene was better in females.(6) In a research performed by Murry in 1986 that was held by WHO, Iran regarding to DMF had a low position and out of 23 countries being the members, it had the place of 22nd.(7)
Nolte reported that the range of pH in interdental plaques were more than other places because the plaque is thicker with more micro- organisms. These areas are also deprived of saliva’s washing function having contact area instead of contact point increases the incidence of proximal caries.(8)
In a similar study which was performed in 2003, Talaipour and his colleagues evaluated the
incidence of proximal surface cavities among 60 dental students in Tehran University of Medical Sciences. In this study about 20% of the students did not have any cavities. Most cavitated surfaces were found in the first and second premolar proximal surfaces of the upper Jaw.(9)
To evaluate the prevalence of the interproximal caries in dental students of Islamic Azad University, a cross sectional study was performed.
Materials and Methods
This research was a descriptive study carried on 89 dentistry students (48 females and 41 males) in the age range of 20-25 with an average age of 21.8. For each student 2 standard right and left bite wing radiographs were taken. Considering Hintze and Wenzel method a total of 12 spaces between teeth 4-5, 5-6 and 6-7 in both jaws for each individual was studied. The reason for omitting wisdom teeth was that this tooth was not erupted in the majority of students.
AGFA radiography film made (CE, Belgium) with D speed, bitewing loop and plastic frame and labels were used in this research. This research was done on clinical course students in the Radiology department of the Dentistry School of Azad University.
A radiography apparatus (Trophy, French) with 70Kv, 8 mA and 0.6 second exposure time was used in a standard procedure.
The films were developed and fixed by standard procedure and after drying were placed in a 3 housed plastic frame with the label of the name of students.
The radiographs were then studied by three individuals (oral medicine specialist, oral radiologist and a dentist).
Additional informative page was attached to the frames. (Caries lesions were shown here):
7-6, 6-5, 5-4 4-5, 5-6, 6-7 7-6, 6-5, 5-4 4-5, 5-6, 6-7
The number of proximal spaces for each individual and each surface were calculated.
S. Sahba et al Journal of Dentistry, Tehran University of Medical Sciences
2004; Vol. 1, No. 3 13
Results
Out of 41 male students, only one was caries free. The other 40 male students had at least one carious lesion (97.5%). From 48 female students, five were caries free and 43 female students had at least one carious lesions (89.5%). In the total population studied only 6 students out of 89 (93.3%) were caries free. Out of total 576 (48î 12) proximal spaces in female students, 446 spaces (76.7%) were caries free and 134 spaces (23.3%) had caries. (Table I and II)
Out of total 1068 inter- proximal spaces studied, 794 spaces (73.4%) were caries free and 274 spaces (25.7%) had caries. In comparative studies for caries incidence in both jaws 51% of total caries were in maxilla while 49% were in mandible.
Table I- The number of decayed and caries free participants according to sex.
Sex Decayed Caries Free Total
No. 40 1 41
Men Percent 97.6 2.4 100
No. 43 5 488
Women
Percent 89.6 10.4 100
No. 83 6 89
Total
Percent 93.3 6.7 100 Table II- The number of decayed and caries free
spaces according to sex
Sex Decayed Caries Free Total
No. 140 352 492
Men Percent 28.5 71.5 100
No. 134 442 576
Women
Percent 23.3 76.7 100
No. 274 794 1068
Total
Percent 25.7 74.3 100
Discussion
Diagnosing the primary caries on time and limiting caries activity before tooth destruction is the primary goal in an effective diagnosis and correct treatment plan.
Bitewing radiography is one of the procedures to diagnose caries on time. This was implied in
Russell’s research in 1993.(4) In his research, bitewing radiography was used as the best procedure for diagnosing proximal caries. In this study 93.3% of students had at least one decayed tooth. This was in accordance with Wenzel and Hintze research where 92-96% of caries occurrence was between first premolar to distal surface of second molar.(5)
In this research 97.5% of male and 89.6% of female had proximal caries. There were no significant differences in caries incidence between two sexes.
It was the same in a research by Petridou et al even though oral hygiene was slightly better in females.(6)
In this research it was clear that 93.3% of the studied population had at least one proximal caries which was in accordance with WHO report by Murry.(7)
Nolte mentioned that because dental plaque accumulate more in proximal posterior teeth and saliva doesn’t have ability to wash the area, proximal caries occur more frequently.(8)
Most of the caries in this research were found in proximal spaces between second premolar and first molar teeth in maxilla. The least caries were found in proximal spaces between first and second premolar teeth in mandible, the same as Nolte’s research.
The reason could be lower pH in maxilla because the existence of only one salivary gland. Also in mandible, the ducts of both salivary glands open lingually therefore washing of saliva is very well.
In this study, only 7% of the target group was caries free. However, in Talaipour’s study, caries free cases were around 20%. The reason for this difference could be the social and economical condition of the studied groups.(9) The studied group with higher percentage of caries is from higher social class with higher use of carbohydrate and sweets which leads to more cavities.
In this study, women had lower caries incidence than men, which is in accordance with
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Talaipour’s study. The reason could be better dental hygiene among women. In this study the highest number of cavities were in mesial surfaces of first molar and distal of second premolar of the upper jaw, which is in ret alive accordance with Talaipour’s study.
In this research only 6 students were caries free and 83 of them had caries (93.3%). Therefore for controling caries, oral hygiene must
improve. Students must be notified of this important fact.
Conclusion
Facilities such as check up and routine radiographic examination should be reachable for university and school students and this educated people must also try more for prevention of dental caries.
References:
1- Summit JB, Robbins JW, Schwartz RZ. Fundamentals of Operative Dentistry: a contemporary approach. 2nd ed.
Chicago: Quintessence; 2001: 27-8.
2- Roberson TM, Heymann HD, Swift EJ. Sturdevant’s the Art and Science of Operative Dentistry. 4th ed. St. Louis:
Mosby; 2002: 81-4.
3- Mount GJ, Hume WR. Preservation and Restoration of Tooth Structure. London: Mosby; 1998: 15-16.
4- Rassel M, Pitts NB. Approximal caries diagnosis, a comparison of three methods. Adv Dent Res 1993; 7(2): 53.
5- Hintze H, Wenzd A. A two film versus a four-film bitewing examination for caries diagnosis in adults. Caries Res.
1999; 33(5): 380-86.
6- Petridou E, Athenassoali T, Panaqopouds H, Revinthi K. Sociodemographic and dietry factors in relation to dental health among Greek adolescents. Community Dent Oral Epidemiol 1996; 24(5): 307-11.
7- Murray JJ. Appropriate use of fluoride for human health. Geneva: WHO, 1986; 2: 33-37.
8- Nolte WA. Oral Microbiology. 4th ed. St. Louis: Mosby; 1982: 235-42.
9- Talaipour AR, Shamlo N. Evaluation of interproximal caries with using of Bitewing radiography in dental student of Islamic Tehran University. Thesis No 4198. Faculty of Dentistry. Tehran University of Medical Sciences 2003.
