European Archives of Paediatric Dentistry

, Volume 17, Issue 6, pp 445–454 | Cite as

Histochemical changes of occlusal surface enamel of permanent teeth, where dental caries is questionable vs sound enamel surfaces

  • M. MichalakiEmail author
  • C. J. Oulis
  • N. Pandis
  • G. Eliades
Original Scientific Article



This in vitro study was to classify questionable for caries occlusal surfaces (QCOS) of permanent teeth according to ICDAS codes 1, 2, and 3 and to compare them in terms of enamel mineral composition with the areas of sound tissue of the same tooth.


Partially impacted human molars (60) extracted for therapeutic reasons with QCOS were used in the study, photographed via a polarised light microscope and classified according to the ICDAS II (into codes 1, 2, or 3). The crowns were embedded in clear self-cured acrylic resin and longitudinally sectioned at the levels of the characterised lesions and studied by SEM/EDX, to assess enamel mineral composition of the QCOS. Univariate and multivariate random effect regressions were used for Ca (wt%), P (wt%), and Ca/P (wt%).


The EDX analysis indicated changes in the Ca and P contents that were more prominent in ICDAS-II code 3 lesions compared to codes 1 and 2 lesions. In these lesions, Ca (wt%) and P (wt%) concentrations were significantly decreased (p = 0.01) in comparison with sound areas. Ca and P (wt%) contents were significantly lower (p = 0.02 and p = 0.01 respectively) for code 3 areas in comparison with codes 1 and 2 areas. Significantly higher (p = 0.01) Ca (wt%) and P (wt%) contents were found on sound areas compared to the lesion areas.


The enamel of occlusal surfaces of permanent teeth with ICDAS 1, 2, and 3 lesions was found to have different Ca/P compositions, necessitating further investigation on whether these altered surfaces might behave differently on etching preparation before fissure sealant placement, compared to sound surfaces.


Incipient lesions Questionable for caries occlusal surfaces ICDAS-II codes 1 and 2 Altered enamel composition 


Compliance with ethical standards

Conflict of interest

All of the authors declare they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. AAPD American Academy of Pediatric Dentistry Clinical Affairs Committee, Clinical Affairs Committee. Guideline on periodicity of examination, preventive dental services, anticipatory guidance counseling and oral treatment for infants, children and adolescents. Reference Manual. 2008;29(7):102–7.Google Scholar
  2. Beauchamp J, Caufield PW, Crall JJ, et al. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2008;139(3):257–68.CrossRefPubMedGoogle Scholar
  3. Bravo M, Osorio E, Garcia-Anllo I, Llodra JC, Baca P. The influence of dft index on sealant success: a 48-month survival analysis. J Dent Res. 1996;75(2):768–74.CrossRefPubMedGoogle Scholar
  4. Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res. 1955;34:849–53.CrossRefPubMedGoogle Scholar
  5. Cochrane NJ, Anderson P, Davis GR, et al. An X-ray microtomographic study of natural white-spot enamel lesions. J Dent Res. 2012;91(2):185–91.CrossRefPubMedGoogle Scholar
  6. Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth on the occlusal surface: an in vitro examination. Caries Res. 1997;31:224–31.CrossRefPubMedGoogle Scholar
  7. Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, CDC Dental Sealant Systematic Review Work Group, et al. The effectiveness of sealants in managing caries lesions. J Dent Res. 2008;87(2):169–74.CrossRefPubMedGoogle Scholar
  8. Handelman SL, Washburn F, Wopperer P. Two-year report of sealant effect on bacteria in dental caries. J Am Dent Assoc. 1976;93(5):967–70.CrossRefPubMedGoogle Scholar
  9. Heller KE, Reed SG, Bruner FW, Eklund SA, Burt BA. Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. J Public Health Dent. 1995;55(3):148–53.CrossRefPubMedGoogle Scholar
  10. Jablonski-Momeni A, Stachniss V, Ricketts DNJ, Heinzel-Gutenbrunner M, Pieper K. Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res. 2008;42(2):79–87.CrossRefPubMedGoogle Scholar
  11. Jablonski-Momeni A, Stachniss V, Ricketts DNJ, et al. Impact of scoring single or multiple occlusal lesions on estimates of diagnostic accuracy of the visual ICDAS-II system. Int J Dent. 2009;2009:798283. doi: 10.1155/2009/798283
  12. Leskinen K, Ekman A, Oulis C, et al. Comparison of the effectiveness of fissure sealants in Finland, Sweden and Greece. Acta Odont Scand. 2008;66:65–72.CrossRefPubMedGoogle Scholar
  13. Mertz-Fairhurst EJ, Schuster GS, Williams JE, Fairhurst CW. Clinical progress of sealed and unsealed caries. Part I: depth changes and bacterial counts. J Prosthet Dent. 1979;42(5):521–6.CrossRefPubMedGoogle Scholar
  14. Michalaki MG, Oulis CJ, Lagouvardos P. Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: an in vitro study. Eur Arch Paediatr Dent. 2010;11(1):26–31.CrossRefPubMedGoogle Scholar
  15. Oong EM, Griffin SO, Kohn WG, Gooch BF, Caufield PW. The effect of dental sealants on bacteria levels in caries lesions. J Am Dent Assoc. 2008;139:271–8.CrossRefPubMedGoogle Scholar
  16. Oulis CJ, Berdousis E. Fissure sealant retention and caries development after resealing on first permanent molars of children with low, moderate and high caries risk. Eur Arch Paediatr Dent. 2009;10(4):210–7.CrossRefGoogle Scholar
  17. Pitts N. ‘ICDAS’—an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Commun Dent Health. 2004;21:193–8.Google Scholar
  18. Thylstrup A, Poulsen S. Retention and effectiveness of a chemically polymerized pit and fissure sealant after 2 years. Eur J Oral Sci. 1978;86(1):21–4.CrossRefGoogle Scholar
  19. Tickle M, Yeung CA, Milsom KM, Blinkhorm AS. The prescription and outcomes of fissure sealants applied to a group of high caries risk children by general dental practitioners working in the North West England. Commun Dent Health. 2007;24(3):135–9.Google Scholar
  20. Topoliceanu C, Stoleriu S, Ghiorghe A, et al. Chemical changes of enamel occlusal surfaces affected by incipient dental caries: an EDX study. Rev Chim. 2013;64(11):1324–8.Google Scholar
  21. Weintraub JA, Stearns SC, Rozier RG, Huang CC. Treatment outcomes and costs of dental sealants among children enrolled in Medicaid. Am J Public Health. 2001;91(11):1877–81.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Welbury R, Raadal M, Lygidakis NA. EAPD guidelines for the use of pit and fissure sealants. Eur J Paed Dent. 2004;5:179–84.Google Scholar

Copyright information

© European Academy of Paediatric Dentistry 2016

Authors and Affiliations

  • M. Michalaki
    • 1
    Email author
  • C. J. Oulis
    • 1
  • N. Pandis
    • 2
    • 3
  • G. Eliades
    • 4
  1. 1.Department of Paediatric Dentistry, School of DentistryUniversity of AthensAthensGreece
  2. 2.Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine/Medical FacultyUniversity of BernBernSwitzerland
  3. 3.CorfuGreece
  4. 4.Department of Biomaterials, School of DentistryUniversity of AthensAthensGreece

Personalised recommendations