title: Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: findings from the National Dental Practice-Based Research Network.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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 smakhija@uab.edu. Address correspondence to Dr. Makhija.
authors.forename: Sonia K
authors.initials: SK
authors.lastname: Makhija
authors.affiliation: Dr. Gilbert is a professor and the chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham.
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Gilbert
authors.affiliation: Dr. Funkhouser is an associate professor, Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham.
authors.forename: Ellen
authors.initials: E
authors.lastname: Funkhouser
authors.affiliation: Dr. Bader is a research professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill.
authors.forename: James D
authors.initials: JD
authors.lastname: Bader
authors.affiliation: Dr. Gordan is a professor, Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, University of Florida Health Science Center, Gainesville.
authors.forename: Valeria V
authors.initials: VV
authors.lastname: Gordan
authors.affiliation: Dr. Rindal is a practitioner in the HealthPartners Dental Group, Minneapolis, and an investigator at the HealthPartners Institute for Education and Research, Minneapolis.
authors.forename: D Brad
authors.initials: DB
authors.lastname: Rindal
authors.affiliation: Dr. Qvist is an associate professor, Department of Cariology and Endodontics, School of Dentistry, University of Copenhagen, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Qvist
authors.affiliation: Ms. Nørrisgaard is a research assistant, Department of Cariology and Endodontics, School of Dentistry, University of Copenhagen, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Nørrisgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D003718:Denmark / Q000453:epidemiology; D003731:Dental Caries / Q000453:epidemiology* / Q000628:therapy; D055094:Evidence-Based Dentistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: Evidence-based dentistry; caries; clinical research; dental caries; longitudinal study; multicenter studies; practice-based research; private practice; questionable lesions