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1 Organization for Health Research T. K. O., Laboratory of Microbiology, University of Utreclzt, The Netherlands
In a longitudinal examination of children (7 to 15 years of age), surface changes in the enamel were studied clinically. Where the various surfaces (fissures, approximal, and free smooth surfaces) required different kinds of examination, the data for these surfaces are presented separately.
In fissures and pits, the caries process starts early, and the first visible changes are soon followed by the formation of cavities. The changes in the proximal surfaces were diagnosed only on the radiographs and were classified in different categories. An important number (26 to 48 per cent) of the incipient translucent areas in the enamel did not progress within the period of observation (8, 6, or 4 years). The effect of different environmental conditions at and shortly after eruption on caries resistance was demonstrated in children using artificially fluoridated water and in children whose first molars erupted during a period of serious food restriction. A process called "posteruptive maturation" seemed to be of importance in caries resistance.
In the free smooth surfaces, the changes can be diagnosed much earlier than in the other surfaces. Shortly after eruption, many surfaces in the cervical region show a white opaque spot. If no visible change in the enamel took place within 1
years after eruption, it is unlikely that any visible change will occur before the age of 15. A small fraction of the white spots progresses soon to a cavity. The other white spots either seem to be unchanged, to have regained their normal surface gloss, or to have disappeared completely. It seems most likely that remineralization or a process of recrystallization, or both, took place.
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