Dr. James Hamilton and colleagues reported on a 12-month study of air-abrasion treatment of questionable carious lesions ("A Clinical Evaluation of Air-Abrasion Treatment of Questionable Carious Lesions: A 12-Month Report," June JADA).
Their data indicated that they enrolled 223 teeth in the study and classified each one as having "a questionable incipient pit-and-fissure carious lesion." They then assigned 113 of these to be treated with air abrasion. Of the 113 treated teeth, the investigators found that 50 teeth (44 percent) had dentinal caries! Eight of those 50 (16 percent) had "more than minimal extension into dentin."
The conclusion stated by these investigators is that "early operative intervention should not be recommended until proven clinical benefits have been demonstrated." How much better demonstration do they need? A diagnosis that is only 56 percent accurate is unacceptable in my office.
How can they possibly accept only 56 percent accuracy in their clinical diagnosis of decay? To find that 44 percent of those teeth thought to be questionable are indeed decayed should tell everyone that there must be something wrong with the diagnostic criteria.
My conclusion when reading such data is this: by all means, treat each of those questionable lesions. I would even suggest that every pit and fissure be explored using the finest of air-abrasion tips and significant magnification (x3.5 at least).
