{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:06:39Z","timestamp":1784649999444,"version":"3.55.0"},"reference-count":55,"publisher":"Operative Dentistry","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale:<\/jats:title>\n                    <jats:p>In adults, caries lesions develop predominantly on proximal surfaces; however, evidence regarding the rate of proximal caries progression in this population remains limited. A clearer understanding of the progression rate of proximal caries in adults is essential for establishing appropriate radiographic examination intervals and optimizing the timing of operative interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the rate of radiographic progression of initial proximal caries lesions and the factors associated with it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Materials:<\/jats:title>\n                    <jats:p>\n                      Serial bitewing radiographs from 105 patients, aged 18-61 years, were retrospectively analyzed for the progression of 364 enamel and outer dentin proximal caries lesions. The interval between baseline and follow-up radiographs ranged from six to 72 months. Lesion progression across study variables was summarized using descriptive statistics. A multivariable generalized estimating equation (GEE)-based Poisson regression model with robust variance estimation was performed to identify factors associated with proximal caries progression, including patient-level variables (age, gender, fluoride varnish exposure, plaque score, BOP score, DMFT, and DMFS) and tooth-level variables (jaw, tooth type, surface, and initial lesion depth), while accounting for clustering of lesions within patients and variable follow-up duration (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05; 95% CI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mean interval between the initial and follow-up radiographs was 19.9 \u00b1 12.6 months (median = 18 months). Caries progression was observed in approximately one-third of the initial proximal lesions (112 lesions; 30.8%). No lesions progressed from enamel to inner dentin, and only 12 of 43 outer dentin lesions advanced to inner dentin. According to multivariable GEE Poisson regression analysis, maxillary lesions exhibited a higher rate of progression than mandibular lesions (IRR 1.52; 95% CI 1.07 - 2.16), and lesions on distal surfaces demonstrated a higher progression rate than those on mesial surfaces (IRR 1.37; 95% CI 1.01 - 1.85).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The rate of proximal caries progression was relatively low. Tooth location (maxillary arch) and distal surfaces were the only significant predictors of lesion progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2341\/24-178-c","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T01:45:43Z","timestamp":1783734343000},"page":"112-122","source":"Crossref","is-referenced-by-count":0,"title":["Rate of Initial Proximal Caries Lesion Progression in High Caries-Risk Adults"],"prefix":"10.2341","volume":"51","author":[{"given":"I","family":"Alfarhan","sequence":"first","affiliation":[{"name":"*Isra Alfarhan, Assistant Professor, Department of General Dental Practice, College of Dentistry, Kuwait University, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Faridoun","sequence":"additional","affiliation":[{"name":"Afnan Faridoun, Assistant Professor, Department of General Dental Practice, College of Dentistry, Kuwait University, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Q","family":"Alomari","sequence":"additional","affiliation":[{"name":"Qasem Alomari, Professor and Chairman, Department of Restorative Sciences, College of Dentistry, Kuwait University, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1188","reference":[{"key":"b1","series-title":"Journal of Dentistry","first-page":"104335","article-title":"Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis","volume":"127","author":"Borg-Bartolo R","year":"2022","unstructured":"Borg-Bartolo R, Roccuzzo A, Molinero-Mourelle P, Schimmel M, Gambetta-Tessini K, Chaurasia A, Koca-\u00dcnsal RB, Tennert C, Giacaman R, & Campus G (2022) Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis Journal of Dentistry 127 104335. https:\/\/doi.org\/10.1016\/j.jdent.2022.104335"},{"issue":"1","key":"b2","series-title":"BMC Oral Health","first-page":"1535","article-title":"Burden of permanent and deciduous dental caries in middle East and North Africa (MENA): An epidemiological analysis of global burden of disease study from 1990 to 2021","volume":"25","author":"Khorasani N","year":"2025","unstructured":"Khorasani N, Nikaein M, Khayatzadeh S, Feyzabadi AA, & Panahandeh N (2025) Burden of permanent and deciduous dental caries in middle East and North Africa (MENA): An epidemiological analysis of global burden of disease study from 1990 to 2021 BMC Oral Health 25(1) 1535. https:\/\/doi.org\/10.1186\/s12903-025-06774-w"},{"issue":"4","key":"b3","series-title":"Caries Research","first-page":"475","article-title":"Association of enamel caries lesions with oral hygiene and DMFT among adults","volume":"53","author":"Laajala A","year":"2019","unstructured":"Laajala A, Pesonen P, Anttonen V, & Laitala M-L (2019) Association of enamel caries lesions with oral hygiene and DMFT among adults Caries Research 53(4) 475-481. https:\/\/doi.org\/10.1159\/000497358"},{"issue":"9","key":"b4","series-title":"Clinical Oral Investigations","first-page":"3315","article-title":"How to intervene in the caries process in adults: Proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement","volume":"24","author":"Schwendicke F","year":"2020","unstructured":"Schwendicke F, Splieth CH, Bottenberg P, Breschi L, Campus G, Dom\u00e9jean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Opdam N, Paris S, Santamaria R, Tassery H, Zandona A, Zero D, Zimmer S, & Banerjee A (2020) How to intervene in the caries process in adults: Proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement Clinical Oral Investigations 24(9) 3315-3321. https:\/\/doi.org\/10.1007\/s00784-020-03431-0"},{"issue":"5","key":"b5","series-title":"Dentomaxillofacial Radiology","first-page":"20160039","article-title":"A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs","volume":"45","author":"Senneby A","year":"2016","unstructured":"Senneby A, Elfvin M, Stebring-Franzon C, & Rohlin M (2016) A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs Dentomaxillofacial Radiology 45(5) 20160039. https:\/\/doi.org\/10.1259\/dmfr.20160039"},{"issue":"5","key":"b6","series-title":"Community Dentistry and Oral Epidemiology","first-page":"409","article-title":"Radiographic assessment of proximal surface carious lesion progression in Chilean young adults","volume":"48","author":"Phillips M","year":"2020","unstructured":"Phillips M, Bernab\u00e9 E, & Mustakis A (2020) Radiographic assessment of proximal surface carious lesion progression in Chilean young adults Community Dentistry and Oral Epidemiology 48(5) 409-414. https:\/\/doi.org\/10.1111\/cdoe.12552"},{"issue":"3","key":"b7","series-title":"Caries Research","first-page":"171","article-title":"Detection of cavitated proximal carious lesions in permanent teeth: A visual and radiographic assessment","volume":"56","author":"Mu\u00f1oz-Sandoval C","year":"2022","unstructured":"Mu\u00f1oz-Sandoval C, Gambetta-Tessini K, Botelho JN, & Giacaman RA (2022) Detection of cavitated proximal carious lesions in permanent teeth: A visual and radiographic assessment Caries Research 56(3) 171-178. https:\/\/doi.org\/10.1159\/000525193"},{"issue":"4","key":"b8","series-title":"Caries Research","first-page":"247","article-title":"Detection methods for early caries diagnosis: A systematic review and meta-analysis","volume":"55","author":"Foros P","year":"2021","unstructured":"Foros P, Oikonomou E, Koletsi D, & Rahiotis C (2021) Detection methods for early caries diagnosis: A systematic review and meta-analysis Caries Research 55(4) 247-259. https:\/\/doi.org\/10.1159\/000516084"},{"issue":"5","key":"b9","series-title":"Caries Research","first-page":"511","article-title":"Organization for caries research-European federation of conservative dentistry consensus report on clinical recommendations for caries diagnosis paper II: Caries lesion activity and progression assessment","volume":"58","author":"Neuhaus KW","year":"2024","unstructured":"Neuhaus KW, K\u00fchnisch J, Banerjee A, Martignon S, Ricketts D, Schwendicke F, van der Veen MH, Dom\u00e9jean S, Fontana M, Lussi A, Jablonski-Momeni A, Mendes FM, Douglas G, Schmalz G, Campus G, Aps J, Horner K, Opdam N, Huysmans M-C, & Splieth CH (2024) Organization for caries research-European federation of conservative dentistry consensus report on clinical recommendations for caries diagnosis paper II: Caries lesion activity and progression assessment Caries Research 58(5) 511-520. https:\/\/doi.org\/10.1159\/000538619"},{"issue":"1","key":"b10","series-title":"Caries Research","first-page":"3","article-title":"A clinical and microbiological study of approximal carious lesions. 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