Influence of examiner experience on clinical performance of visual inspection in detecting and assessing the activity status of caries lesions.

Our hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy.

Oral manifestation associated with multiple pituitary hormone deficiency and ectopic neurohypophysis.

Multiple pituitary hormone deficiency (MPHD) is the diminished secretion of all the hormones produced in the anterior lobe of the pituitary gland. The oral manifestation of this condition includes delayed eruption and prolonged retention of primary teeth, delayed formation and eruption of permanent teeth, delay in development and growth of the jaws, tendency towards development of deep bite and enamel disturbances. This paper reports the case of an adolescent patient with MPHD. Clinical examination revealed partial ankylosis and prolonged retention ofprimary second molars, primary maxillary canines and deep bite. Dental treatment included extraction of all molars with prolonged retention preceded by the necessary medical care with clinical and radiographic follow-up afterwards. The patient was also referred to an orthodontist for orthodontic treatment. Patients' medical condition should always be investigated by clinicians when faced with cases of delayed tooth eruption and bone development.

Mineral loss on adjacent enamel glass ionomer cements restorations after cariogenic and erosive challenges.

OBJECTIVES: the purpose of this study was to determine the mineral loss on surrounding enamel restored with glass ionomer cements (GIC) after erosive and cariogenic challenges. METHODS: Bovine enamel specimens were randomly assigned into six groups according to the restorative material: G1 - composite resin; G2 - high viscous GIC; G3 - resin-modified glass ionomer with nanoparticles; G4 - encapsulated resin-modified GIC; G5 - encapsulated high viscous GIC; G6 - resin-modified GIC. After restorative procedures, half of specimens in each group were submitted to caries challenge using a pH cycling model for 5 days, and the other half were submitted to erosive challenge in citric acid for 10 min. Before and after the challenges, surface Knoop microhardness assessments were performed and mineral changes were calculated for adjacent enamel at different distances from restorative margin. RESULTS: Data were compared for significant differences using two-way ANOVA and Student-Newman-Keuls tests (p<0.05). Erosive challenge significantly reduced enamel surface hardness, but no significant difference was observed irrespectively restorative materials (p>0.05). The cariogenic challenge promoted a higher surface hardness loss for the resin-modified GIC (G4) and only for the High viscous GIC (G2) an increase in surface hardness was observed. For enamel analyses, significant differences were observed with respect to the different materials (p<0.001) and distances (p=0.023). Specimens restored with the composite resin presented higher mineral loss and specimens restored with the conventional high viscous GIC and the encapsulated resin-modified GIC presented the lowest values for mineral loss. CONCLUSION: The GICs exerts protective effect only for cariogenic challenge.