Although some primary teeth look like their permanent successors, they are not permanent in miniature. The developer of the TOCE proposes its use as an outcome measure in public health dentistry to evaluate the prevention of tooth decay in the community. In a study published in the Journal of Public Health Dentistry (August 16, 2011), it compared the results of the evaluation of a community caries prevention program for children with other measures against tooth decay and found that it was a robust approach. Dr.
Ruff, an adjunct professor of epidemiology and health promotion at the New York University School of Dentistry, previously developed the TOCE while analyzing data from a large tooth decay prevention program in children. He defined TOCE as the total number of cavities and fillings in the primary and permanent dentition observed over time for use as an alternative measure to evaluate tooth decay prevention in the community. At the start of the study, the average DMFT was 5.80, the average DMFT was 1.23 and the average TOCE was 4.58, and 95% of the children had untreated cavities in any tooth and 52% in any permanent tooth. During the study, the prevalence of untreated cavities in any permanent tooth increased to 91% of participants. The benefits of this measure include its ability to be used even if study participants receive dental care outside of the study or if observation periods are not evenly spaced. Ruff noted that this measure better reflects cumulative disease, is not biased due to dental exfoliation and seems useful for evaluating tooth decay prevention programs.
He emphasized that the TOCE was developed to evaluate tooth decay prevention programs and has not been used for other purposes, so its effectiveness for other uses is unknown. At the same time, he is working on tooth decay prevention studies that compare silver diamine fluoride with sealants, which will use TOCE as one of the results, and is also developing a simulation model for children of different ages in order to further evaluate the behavior of OCD. When a tooth is extracted, the teeth move to fill the space. The space must remain open for the permanent tooth. This can cause alignment problems when the permanent tooth comes out.
Using a dental filling instead of removing teeth prevents this problem and makes children less likely to have alignment problems when their permanent teeth come out. This reduces the risk of orthodontic treatment in the future. During the first visit, cavities or an old filling are removed. An impression is taken to record the shape of the tooth being repaired and the teeth that surround it. The impression is sent to a dental laboratory that performs the indirect filling.
A temporary filling (described below) is placed to protect the tooth while the restoration is being performed. During the second visit, the temporary filling is removed and the dentist checks the fit of the indirect restoration. If it is acceptable, it will be permanently cemented in place. In some cases, a permanent tooth may not come out because it's growing in the wrong direction. Usually, teeth that grow incorrectly require orthodontic treatment to help redirect them and allow them to come out properly.
Because permanent teeth are wider than baby teeth, it's natural for baby teeth to have spaces between them. However, it became clear that there was a great deal of controversy as to the definition of tooth decay in early childhood and, more importantly, as to the age range that this definition could be considered to encompass. The lack of high-quality trials that guide clinical decisions in practice (one of the pillars of evidence-based dentistry) is a matter of great concern, since informed decisions by doctors and patients about the best filling material to use in a particular clinical situation could lead to a series of biases. Tooth decay and the early loss of these baby teeth can cause the loss of space for the permanent teeth, which causes the permanent teeth to move and, therefore, causes orthodontic problems for the child. These extra teeth can prevent permanent teeth from coming out and can also cause overcrowding, displacement and impacted teeth. Inlays and coatings weaken the tooth structure, but do so to a much lesser extent than traditional fillings. The type of filling material was randomly assigned to the tooth to be restored, but this process was not described in detail. A final aspect to consider when talking about tooth preparation is the use of magnification during surgical procedures.
One of the most common reasons why permanent teeth don't come out properly is because there isn't enough space for them. There are certain medical conditions that affect bone growth and development, which can cause the eruption of permanent teeth to be delayed. Black described several steps for preparing decayed permanent teeth for an amalgam restoration. However, in cases where there are no spaces between the baby teeth, the permanent teeth may not have enough space to come out.