Board Reveiw - Pediatric Dental Medicine & Surgery

The evidence for the efficacy of fluoride varnishes as a preventive measure in caries control is only fair. Some studies have shown a 30% reduction in new lesions, while others have shown no statistically significant difference between fluoride varnish and placebo groups. This suggests that fluoride varnishes may have some effectiveness in preventing caries, but it is not consistently demonstrated in all studies. Therefore, the statement "True" is an accurate reflection of the evidence presented.

The most common method among US dentists for the clinical diagnosis of pit and fissure caries is a combination of visual examination, tactile examination, and the use of radiographs as an aid. Visual examination involves visually inspecting the tooth surfaces for any signs of decay or cavities. Tactile examination involves feeling the tooth surfaces with dental instruments to detect any roughness or softness that may indicate caries. Radiographs, such as X-rays, can provide additional information by showing the extent of the decay and any hidden caries that may not be visible to the naked eye. Therefore, options a, b, and d are all correct methods used by dentists for diagnosing pit and fissure caries.

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The correct answer is "large number of unneeded restorative intervention". This is because the web-based evaluations had moderately high sensitivity, meaning they were able to correctly identify a large number of lesions. However, they had low specificity, meaning they also identified a large number of lesions that did not actually require restorative intervention. Therefore, pursuing these judgments clinically would result in a large number of unnecessary restorative interventions.

The correct answer is "yes" because caries refers to the decay or cavities in teeth caused by the breakdown of enamel and dentin. Therefore, if the question asks if caries extends into dentin, the answer would be "yes" as dentin is one of the layers of the tooth that can be affected by caries.

1. Kaste L, Selwitz R, Oldakowski R, Brunelle J, Winn D, Brown L. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res 1996;75(spec issue):631-41.
2. Winn F, Brunelle J, Selwitz R, et al. Coronal and root caries in the dentition of adults in the United States, 1988-1991. J Dent Res 1996;75(spec issue):642-51.

The statement suggests that the penalty for restorative intervention, which carries the risk of overtreatment, is greater than the penalty for "watchful waiting," which carries the risk of supervised neglect. However, this statement is false. Restorative intervention may involve unnecessary or excessive treatment, leading to potential harm or complications. On the other hand, "watchful waiting" involves closely monitoring a condition without immediate intervention, which can be a valid and safe approach in certain cases. Therefore, the penalty for restorative intervention is not necessarily greater than the penalty for "watchful waiting."

Overtreatment with PRR (preventive resin restoration) refers to the placement of resin restorations on teeth that may not necessarily require them. The advantages of overtreatment with PRR over undertreatment with remineralization strategies are claimed patient preference and reduced likelihood of extensive carious lesions developing. Claimed patient preference implies that some patients may prefer to have a resin restoration placed rather than opting for a remineralization strategy. Additionally, overtreatment with PRR can help prevent the development of extensive carious lesions, which may require more complex and invasive treatments such as endodontic treatment.