Characteristics, Detection Methods and Treatment of Questionable Occlusal Carious Lesions: Findings from The National Dental Practice-Based Research Network

Questionable occlusal carious lesions (QOC) can be defined as an occlusal tooth surface with no cavitation and no radiographic radiolucencies, but caries is suspected due to roughness, surface opacities, or staining. An earlier analysis of data from this study indicates ⅓ of patients have a QOC. The objective of this report is to quantify the characteristics of these common lesions, diagnostic aids used, and treatment of QOC. A total of 82 dentist and hygienist practitioner-investigators from the United States and Denmark in The National Dental Practice-Based Research Network participated. When consented patients presented with a QOC, information was recorded about the patient, tooth, lesion, and treatments. 2,603 QOC from 1,732 patients were analyzed. Lesions were usually associated with a fissure, on molars, and varied from yellow to black in color. Half presented with a chalky luster and had a rough surface when examined with an explorer. There was an association between color and luster, 10% were chalky-light, 47% were shiny-dark, and 42% were mixtures. A higher proportion of chalky than shiny lesions were light (22% vs. 9%; p < 0.001). Lesions light in color were less common in adults than pediatric patients (9% vs. 32%; p < 0.001). Lesions that were chalky and light were more common among pediatric than adult patients (22% vs. 6%, p < 0.001). This is the first study to investigate characteristics of QOC in routine clinical practice. Clinicians commonly face this diagnostic uncertainty. Determining the characteristics of these lesions are relevant when making diagnostic and treatment decisions