Background The Bangkok Declaration and the Developmental Origins of Health and Disease (DOHaD) concept can guide paediatric dentists in promoting oral health during the first 1,000 days of life. Teledentistry can help translate these guidelines into practice, facilitating education for parents.Aim To evaluate the impact of a teledentistry service as an innovative approach to adopting healthy habits to prevent early childhood caries (ECC).Design In total, 64 parents of children aged 0-5 received teleconsultations from 118 supervised undergraduate students. The students, working in pairs under a lecturer's supervision, collected caries risk information and educated parents. Fisher's exact test and Wilcoxon rank-sum test assessed associations, while multivariate analysis identified factors influencing habit changes.Results The parents of 55 children (86%) participated in at least two teleconsultations, with the majority of children (78.2%) aged up to three years. Positive changes in habits were noted, particularly among children with employed and more educated mothers (p = 0.007 and p = 0.019, respectively). Significant improvements included increased use of fluoride toothpaste (p = 0.02), higher brushing frequency (p = 0.0004), and reduced sugar consumption frequency (p = 0.025).Conclusion Teledentistry can be an important tool for implementing healthy habits in the first years of life, increasing oral hygiene and reducing sugar consumption, thus preventing ECC and chronic non-communicable diseases.

Artikkeli on tiivistelmä pohjoismaisissa hammaslääkärilehdissä keväällä 2025 julkaistuista 11 artikkelista, jotka käsittelivät suuhygienian merkitystä suunterveyden ylläpidossa. Artikkeleissa todetaan, että kariesta, ientulehdusta ja parodontiittia voidaan hallita kiinnittämällä huomiota yleisiin riskitekijöihin.Parodontaalisairauksien ehkäisyssä ja hoidossa tulisi noudattaa European Federation of Periodontologyn suosituksia. Olennaisia keinoja ehkäistä kariesta ovat sokerin välttäminen ja fluoridin käyttö. Myös hampaiden harjaus kahdesti päivässä ikäryhmälle sopivalla määrällä fluorihammastahnaa on suositeltavaa. Fluoridia sisältäviä suuhuuhteita ja muita paikallisvalmisteita suositellaan niille henkilöille, joilla on suurentunut kariesriski, kun taas fluoritonta hammastahnaa ei voida suositella nykytiedon valossa. Kouluissa tapahtuvan, suunterveyttä edistävän toiminnan mahdollisuuksia kannattaaartikkelien kirjoittajien mukaan pohtia. Tämänhetkisen tutkimustiedon perusteella biofilmin poistamisessa hammasväliharjat ovat tehokkaampia kuin hammaslanka, ja antibakteerisia valmisteita tulisi harkita vain lyhytaikaiseen käyttöön. Näyttö suuhuuhteiden tehosta halitoosiin on heikko. Myös näyttö sähköhammasharjan paremmuudesta verrattuna manuaaliseen hammasharjaan pitkällä aikavälillä on artikkelien mukaan vähäistä. Heikkokuntoisten ikäihmisten kohdalla on olennaista, että suun terveydenhuollon ammattilaisten ja hoitohenkilökunnan välinen yhteistyö on aktiivisempaa, jotta ikäihmisten suunterveyttä voidaan parantaa. Mekaanisen biofilmin poiston tulisi olla yhtä aikaa sekä tehokasta että hellävaraista, jotta haittavaikutuksilta vältytään. Etähammaslääketieteen sovellukset voivat puolestaan tulevaisuudessa tarjota vaihtoehtoisia menetelmiä hallita kariesta ja parodontaalisairauksia.

BACKGROUND:A large number of older people depend on others for help with their daily personal care, including oral health care. Nursing home and elder-care staff often face challenges identifying older people, who are exposed to or at an increased risk of oral diseases. Thus, the aim of this study was to identify risk factors that non-dental care staff can use to identify older people at risk of oral diseases and poor oral hygiene. METHODS:In this cross-sectional study, the oral health and risk factors for poor oral health were determined for 217 care dependent older people living in two nursing homes and a rehabilitation centre or receiving home care in two Danish municipalities. The outcome variables for oral disease i.e. caries, periodontitis, and gingivitis, and oral hygiene, i.e. plaque and calculus, were assessed using standardised oral examinations. Risk factors for oral diseases and poor oral hygiene were assessed based on a questionnaire concerning (1) background information, (2) health status, (3) social support, (4) oral health behaviours, and (5) self-reported oral health. The associations between oral health and risk factors were investigated using logistic regression analyses. RESULTS:In general, older people with different living arrangements had quite similarly distributed risk factors. The oral examinations showed that 54.5% had oral diseases, and 14.8% had poor oral hygiene. Not seeing a dentist regularly was significantly associated with having oral diseases (Odds Ratio, 2.87; CI, 1.53-5.39) and poor oral hygiene (OR, 4.50; CI, 1.83-11.05). A significant association was found between the presence of an oral disease and adversely affected quality of life (OR, 2.65; CI, 1.42-4.95), especially due to challenges eating (OR, 3.76; CI, 1.64-8.60) and/or smiling and showing teeth (OR, 3.64; CI, 1.27-10.42). A significant association was also found between poor oral hygiene and taking psychotropic drugs (OR, 2.61; CI, 1.08-6.30). CONCLUSION:Questions regarding the use of the dental care system and oral health problems could be used by nondental care staff in conversations with older people to determine their risk of oral diseases and poor oral hygiene.

Klinisk relevans Dette nordiske tema fokuserer på forskellige aspekter af mundhygiejnens betydning for opretholdelse af oral sundhed. Caries, gingivitis og parodontitis kan kontrolleres ved tiltag over for fælles risikofaktorer. Inden for tandplejen er motiverende samtale den mest anvendte model til adfærdsændring på individniveau. Desuden kan teletandpleje på sigt blive en supplerende strategi til kontrol af caries og parodontale sygdomme. Følgende tiltag kan bidrage til bedre mundhygiejne gennem plakreduktion: grundig tandbørstning med elektrisk eller manuel tandbørste, interdental rengøring med mellemrumsbørster fremfor tandtråd. Fluorid i diverse udgaver modvirker caries ved at reducere progressionshastigheden.

Background/Objectives: Contact areas between first and second primary molars, shaped by concave/convex proximal surface morphology, are associated with proximal caries with concave surfaces linked to biofilm stagnation. This study aimed to evaluate the accuracy and clinical feasibility of a scoring system for classifying contact types (concave–concave, concave–convex, convex–convex, convex–concave) for dental practitioners. Methods: Following ethical approval and informed consent, 116 4–5-year-old children were enrolled. A calibrated examiner assessed caries on the distal of first molars and mesial of second molars using ICDAS-merged criteria and scored 464 proximal contacts clinically and radiographically. Stone models from silicone impressions were also scored by 17 trained practitioners, who repeated scoring a week later and assessed contacts clinically in six children. Practitioners completed a feasibility and satisfaction questionnaire. Results: Convex–convex contacts were most prevalent (58.6%), followed by convex–concave (32.6%). Contact type significantly correlated with caries (OR = 13.5; 95% CI: 6.4–28.3). Inter- and intra-examiner reproducibility ranged from 0.71 to 0.82. Most practitioners felt very (64.7%) or moderately (35.3%) capable of applying the system, found it low in difficulty (70.6%), and expressed high satisfaction (82.4%). Conclusions: The study indicated that it is possible for dental practitioners to classify the proximal contact types between primary molars both in an accurate and clinically feasible way. The system exhibited high reproducibility and practitioner satisfaction, indicating its potential as a valuable tool for identifying caries-prone surfaces and supporting evidence-based caries management.

English summary Nor Tannlegeforen Tid. 2025; 135: 10-6. Caries and periodontal/peri-implant diseases are two of the most common oral diseases, and, according to the most recent definitions, are considered non-communicable biofilm-induced diseases . In the 1970s, caries and periodontal diseases were prevalent across all Nordic countries. However, today, for most younger generation individuals, caries rates are very low, whilst gingivitis and periodontitis remain common in the adult populations of the Nordic countries. These dental diseases also affect the elderly due to longer tooth retention. Caries and, in particular, periodontal diseases are associated with several systemic conditions, although a direct causality remains elusive, and the relationship may be partly explained by the other factors. According to the integrated hypothesis of dental caries and periodontal diseases, the biofilm is considered a common risk factor alongside fermentable carbohydrates. Therefore, these two oral diseases could be simultaneously controlled by addressing common risk factors. However, due to differences in pathogenesis, separate management procedures are recommended for each disease, which are well-integrated into the dental practices in the Nordic countries. In conclusion, etiology and pathogenesis are well described for caries and periodontal diseases. Both share some essential risk factors, but most importantly, management of these diseases requires adequate oral hygiene and discipline concerning fermentable carbohydrate intake.

BACKGROUND:Regular follow-up after dental treatment is essential to prevent the development and progression of new caries lesions in children. However, there is no consensus on the optimal recall interval. AIM:The aim of the present clinical trial was to evaluate the effectiveness of two different recall intervals for high caries risk children. DESIGN:A total of 224 preschool children (aged 3-5 years) with at least one active caries lesion were selected. After treatment, children were randomized into two different groups according to the recall interval: every 4 months or every 8 months. A single trained and calibrated examiner re-evaluated participants according to their group. The primary outcome was caries lesion progression into dentine (ICDAS 5-6). Logistic regression analysis was used to evaluate the association between the independent variables and primary outcome (α = 5%). RESULTS:Children in the 8-month recall group were 2.5 times more likely to develop new cavitated caries lesions when compared to those in the 4-month recall group, over 30 months. CONCLUSION:High caries risk children on an 8-month recall schedule had a significantly higher risk of developing new cavitated caries lesions compared to those with a 4-month recall interval.

OBJECTIVE:To assess the diagnostic validity of ICDAS clinical criteria on 3D dental models from intraoral scanning. METHODS:This is a retrospective analysis on part of the baseline sample collected in a cohort study and included 73 participants (12-19 years) from Denmark and Greece. The assessment was made by visual inspection, and then by visual inspection associated with radiographs. All participants were scanned with TRIOS 4 which uses white light to obtain the 3D models with tooth color, as well as blue light source (415 nm) for fluorescence. The 3D models' evaluation was conducted using tooth-color texture and subsequently fluorescence. Two scores were obtained for the 3D model examination: i) ICDAS based on tooth-color information; ii) ICDAS based on tooth-color information supplemented with fluorescence. For the analysis, weighted kappa, sensitivity (SE), specificity (SP) and accuracy (ACC) were calculated. RESULTS:Regarding all lesions the values for SE, SP, and ACC were respectively 0.804, 0.801, and 0.802 for tooth-color, and 0.819, 0.808, and 0.810 for tooth-color supplemented with fluorescence. In terms of accuracy parameters for moderate-extensive lesions, the values for SE, SP, and ACC for tooth color were 0.709, 0.948, and 0.944, while for fluorescence they were 0.815, 0.937, and 0.934. CONCLUSION:Caries assessment with ICDAS criteria on 3D dental models produces reliable scores. Visual caries analysis using 3D models demonstrates commendable diagnostic accuracy and reasonable consistency with traditional methods. The use of intraoral scanners may be beneficial in evaluating occlusal caries. CLINICAL SIGNIFICANCE:The importance of this study is to prove the diagnostic accuracy of caries lesions diagnosis made using and intraoral scanner and to offer greater confidence to professionals who use this diagnosis tool in their daily clinical practice. Intraoral scanners demonstrate to be an accurate tool for diagnosing occlusal caries.

ObjectiveThe principal aim of this randomized clinical trial (RCT) was to test the effectiveness in the prevention of Early Childhood Caries (ECC) through an educational intervention program with the use of a printed guide for pediatricians and parents both designed by pediatric dentists.Materials and methodsAfter ethical approval, the first step was to design the educational guides, which were based on the information obtained from a focus group with pediatricians (n = 3), phone interviews with mothers to toddlers' (n = 7), and the best evidence available about children's oral health. For the RCT, 309 parents with their 10-12 months old children were randomly allocated to either the intervention or the control group. Parents in the intervention group received oral health education from the pediatricians supported by the printed guides. Parents in both groups received an oral health kit with a toothbrush and toothpaste at the first visit as well as at each 6-month follow-up visit. After 18 months the children were evaluated using ICDAS criteria.ResultsAt baseline, data were available from 309 children (49.8% girls). The mean age of the children was of 10.8 months (SD = 0.8) and 69.3% had not had their teeth brushed with toothpaste. After 18 months, a total of 28 (22%) children in the intervention group and 44 (24%) in the control group were clinically examined. Regarding the number of tooth surfaces with caries lesions, the children in the intervention group had a mean of 6.50 (SD = 6.58) surfaces, while the children in the control group had a mean of 5.43 (SD = 4.74) surfaces with caries lesions. This difference was not significant (p = 0.460).ConclusionThe RCT showed no effectiveness in caries-progression control. Despite this result, this study managed to identify barriers that do not allow pediatricians from offering parents adequate oral health recommendations. With this learning, it is possible to work on collaborative programs with pediatricians that over time likely will increase dental health by controlling for ECC.

Objectives: To determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10-12 months. Methods: A total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhoosus, LGG & REG; (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431 & REG; (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0-6) and radiographically (R0-6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was fol-lowed, including external monitoring. Results: A total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group. Conclusion: Daily consumption of a lozenge combining arginine and probiotics for 10-12 months given to 5-9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group. ClinicalTrials.gov (NCT03928587). Clinical significance: Since all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

OBJECTIVES:To investigate the effect of daily use of a lozenge containing arginine and probiotics for 10-12 months on caries increment, gingivitis- and plaque occurrence in children aged 5-9 years. METHODS:In this placebo-controlled, double-blinded, parallel-grouped randomized clinical trial, 343 children were randomly assigned to one of the study arms (1:1). The intervention group (n = 172) received a lozenge containing Lacticaseibacillus rhamnosus, LGG® (DSM33156), Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451) and prebiotic (arginine 2%). The placebo group (n = 171) received an identical lozenge without arginine or probiotics. Primary canines and molars, and permanent first molars were examined clinically (d/D= ICDAS1-6) and radiographically (d/D = R1-6) at baseline and follow-up. Missing (m/M), sealed (s/S), and filled (f/F) surfaces (-s/-S) in both dentitions were also included. Utilizing clinical and radiographic scorings, caries experience was classified as dICDAS1-6msf-s (primary teeth), DICDAS1-6MSF-S (permanent teeth), d/DICDAS1-6 m/M-s/S-f/F-s/S (mixed dentition). A weighted and an unweighted score system was applied. RESULTS:The study was completed by 288 children. The dropout rate was 15%. The increase in ∆mean dICDAS3-6msf-s and ∆mean d/DICDAS3-6m/M-s/S-f/F-s/S was lower in the intervention group (p = 0.007). No differences were found for gingivitis- and plaque occurrence. No product-related side effects were reported. This study followed ICH-GCP including external monitoring. CONCLUSION:Daily consumption of a lozenge containing prebiotic arginine and two strains of probiotics showed safe use and statistically significantly reduction in caries incrementbut no effect on the mean plaque or gingivitis occurrence in children. The use of a lozenge with arginine and probiotics combined has a promising potential as a supplementary tool for future management of caries. www. CLINICALTRIALS:gov (NCT03928587). CLINICAL SIGNIFICANCE:The combination of prebiotic arginine and probiotics shows clinical potential as a supplementary approach to toothbrushing with fluoride toothpaste in managing caries increment in children. A new era in the management of caries may be emerging.

Abstract Introduction: The International Caries Classification and Management System (ICCMS) was developed to standardize caries diagnosis, risk assessment and treatment decisions based on overall evidence. To evaluate its criteria in practice, a clinical trial assessed the professionals' perceptions of two caries management systems. Methods A perception questionnaire was administered to two groups: one using ICCMS criteria and other using non-ICCMS criteria. An online questionnaire, constructed by using the Google Forms platform, included quantitative scale questions to measure effort and satisfaction and two open-ended questions to collect the positive and negative perceptions of dentists by using either criteria system. The questionnaires were administered six months after the study's implementation. Results Both groups showed high levels of effort and satisfaction. Professionals using ICCMS reported more positive perceptions by citing improved diagnosis (71.4%) and standardized patient care (43%). However, they also noted negative aspects such as increased number of questionnaires and records (58%), longer clinical sessions (43%), and higher rates of patient absenteeism (29%). Conclusion Professionals who used the ICCMS had a positive outlook on the system, with benefits seen in diagnosis and patient monitoring. However, there is room for improvement in terms of automation and simplification to enhance the professional use of the system in the clinical setting.

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were 7 days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman’s correlation coefficient (Rho) and 95% confidence intervals (95% CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system, and treatment decisions. Spearman’s correlation between the visual and scanner evaluation with the reference standard was performed. Spearman’s rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman’s correlation coefficients (Rho; 95% CI) between the following variables versus histology were the FDI presence of caries (0.65; 0.53–0.74); CARS scores (0.65; 0.52–0.74); FDI treatment decision (0.46; 0.31–0.59); and CARS treatment decision (0.62; 0.49–0.72). Rho (95% CI) between histology and the gap assessment by the visual inspection was 0.59 (0.45–0.70), the gap measurement by the visual inspection was 0.49 (0.33–0.62), and the gap measured by the scanner was 0.37 (0.18–0.53). Both visual criteria present similar performance in detecting caries. The correlation among treatment decisions is moderate for the FDI and CARS criteria, and both are moderately correlated with lesion depth, with a slight CARS superiority. However, visual examination presents better performance than the 3D intraoral scanner on gap size assessment.

OBJECTIVES:Identifying additional information obtained by X-rays combined with clinical examination concerning primary caries, caries adjacent to restorations and quality of restorations.MATERIAL AND METHODS:A total of 240 adult patients, equally distributed in gender and six age-groups, were randomly selected from an original study population of 4,402 subjects (DANHES). Clinical and radiographical registrations on occlusal and approximal surfaces in posterior teeth were categorized into unrestored surfaces (sound/primary caries) and restored surfaces (without/with caries adjacent to restorations). Material and quality of restorations were also recorded. Chi-square and Fisher-exact tests were used for statistical analyses.RESULTS:Of potentially 11,520 surfaces, 3,015 occlusal and 5,112 approximal surfaces were analysed. Occlusal: Of 907 unrestored surfaces, 110 had primary caries and 53% were detected radiographically. A total of 183 of 2,108 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 190 restorations were over/under-extended, and 89% were registered radiographically. Approximal: Of 2,649 unrestored surfaces 648 had primary caries, and 92% were registered radiographically. A total of 565 of 2,463 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 638 restorations were over/under-extended, and 98% were found radiographically. For all restorations, material and depth influenced quality of restorations and incidence of caries adjacent to restorations. At least one independent variable (gender/age group/tooth-type/jaw/side/mesial-distal surface) influenced frequencies of primary caries, caries adjacent to restorations and quality of restorations.CONCLUSIONS:First-time clinical examination must be supplemented with X-rays to obtain a complete impression of caries status in posterior regions regarding diagnostics of caries, assessment of lesion depth and quality of restorations.

Objectives: To assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam). Methods: Ninety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N1=158). Histological assessment was used as the reference standard. Results: All methods showed excellent intra-examiner reliability (kappa intra >= 0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (kappa inter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30). Conclusions: The intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages. Clinical significance: Considering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining, and the presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3–10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700), and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study’s lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.