Which surface is the primary site for caries in school-aged children?

• A. Lingual
• B. Buccal
• C. Proximal
• D. Occlusal

Answer: (D)

Occlusal surfaces are the main site where caries show up in school-aged children because these chewing surfaces have pits and fissures that form sheltered niches for plaque. These grooves trap food particles and provide a protected environment where bacteria can withstand regular brushing, leading to early demineralization when acids from carbohydrate fermentation accumulate. The first permanent molars, which erupt around this age, have especially deep fissures, making their occlusal surfaces particularly vulnerable. While caries can occur on other surfaces, most decay in this age group begins on the occlusal surfaces of the molars due to this anatomy and eruption pattern. Preventive measures like sealants on these pits and fissures are especially effective for reducing caries risk in school-aged children.