Makhija Sonia K, Gilbert Gregg H, Funkhouser Ellen, Bader James D, Gordan Valeria V, Rindal D Brad, Qvist Vibeke, Nørrisgaard Pia
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
Dr. Gilbert is a professor and the chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
J Am Dent Assoc. 2014 Nov;145(11):1112-8. doi: 10.14219/jada.2014.82.
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.
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.
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.
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.
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.
可疑咬合面龋损（QOC）可定义为在X线片上无龋损证据，但因临床表现而怀疑有龋损的咬合面。在本研究中，作者报告了对这些病损进行20个月随访的结果。
来自国家基于牙科实践的研究网络的53名临床医生参与了本研究，记录基线时的病损特征和20个月时的病损状态。
在基线时，检查了1341个QOC病损；基线时计划对其中1033个病损进行监测（口腔卫生指导、应用或开处方使用氟化物或护齿剂，或两者皆用），其余308个接受了窝沟封闭（n = 192）或侵入性治疗（n = 116）。在20个月的随访时，临床医生继续对1033个监测病损中的927个（90%）进行监测。临床医生决定对1033个病损中的61个（6%）进行窝沟封闭（平均随访19个月），并对其中45个（4%）进行侵入性治疗（平均随访15个月）。年轻患者年龄（< 18岁）（比值比 = 3.4；95%置信区间，1.7 - 6.8）以及病损位于磨牙（比值比 = 1.8；95%置信区间，1.3 - 2.6）与临床医生在随访后的某个时间决定对病损进行窝沟封闭或侵入性治疗有关。
基线时计划进行监测的几乎所有（90%）QOC病损在20个月后仍计划进行监测。这一发现表明对这些病损进行非侵入性管理是合适的。
先前来自基线的研究结果表明QOC病损的患病率较高（34%）。临床医生在对这些病损做出治疗决策时应考虑长期监测。
