Caries Process on Occlusal Surfaces: Evolving Evidence and Understanding

Management of the caries process on occlusal surfaces of permanent molars has proven a major challenge. The onset of caries on these surfaces takes place soon after their eruption, and the permanent first molars, followed by the second molars, remain the sites in the dentition which show the highest caries prevalence. This paper is structured in the form of questions and answers in which traditional concepts of caries susceptibility of occlusal surfaces are appraised and confronted with the current evidence. Then, research studies examining the role of biological determinants on the development and arrest of occlusal caries in young permanent teeth are discussed. Finally, the contribution of these studies in terms of developing the available scientific evidence and our understanding of the caries process on occlusal surfaces is analyzed. The current evidence does not support the concept that the early onset and high prevalence of occlusal caries in young permanent teeth are due to a particularly low inherent resistance of the occlusal surface or due to the presence of inaccessible fissure-like structures on these surfaces. Evidence is provided to show that the most influential biological determinants of the development and arrest of occlusal caries are thick plaque accumulation on the groovefossa system and the stage of tooth eruption limiting mechanical oral function. Consequently, active occlusal lesions Received: June 2, 2013 Accepted after revision: October 14, 2013 Published online: February 22, 2014 Joana Carvalho School of Medicine and Dentistry, Catholic University of Louvain Avenue Hippocrate 10 BE–1200 Brussels (Belgium) E-Mail joana.carvalho @ uclouvain.be © 2014 S. Karger AG, Basel 0008–6568/14/0484–0339$39.50/0