ICCMS™ root caries lesions stages and their underlying depth towards the pulp: an in vitro study with histologic evaluation.

OBJECTIVE: To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155). MATERIAL AND METHODS: A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp. RESULTS: Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman's rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively. CONCLUSION: Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high. CLINICAL RELEVANCE: By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.

Follow-up interval for dental appointments: a randomized clinical trial with children with low caries risk

Abstract The objective of this study was to evaluate the effect of different follow-up consultation intervals on caries incidence in children with low caries risk. The study was composed of 224 children aged between 3 and 5 years and with low risk of caries. The children were randomly allocated into two groups, according to two different follow-up consultation intervals: Group 1 (G1) - 12-month follow-up interval; Group 2 (G2) - 18-month follow-up interval. All oral clinical examinations were performed by a single examiner who was previously calibrated and blinded in relation to the study groups. An external dentist provided the advice on oral hygiene and diet and evaluated the children's socioeconomic conditions. The Chi-square and Mann-Whitney tests were used to evaluate the differences between groups. Poisson regression analyses were performed to assess the association of caries incidence with the other variables. At the end of the study there was a significant difference between the groups regarding initial active lesions (p = 0.012), and children in G2 were at a higher risk of developing initial active lesions than those in G1 (p = 0.047). Children who had a higher number of teeth with initial active lesions in the follow-up consultations were at a higher risk of developing cavitated dentin caries (p = 0.001). Both follow-up intervals are justifiable. Although significant results have been observed for initial active caries lesions within the 18-month follow-up interval, it should be noted that these lesions can be treated using just preventive measures. Besides, different return interval had no effect in cavitated dentin lesions.

Follow-up interval for dental appointments: a randomized clinical trial with children with low caries risk.

The objective of this study was to evaluate the effect of different follow-up consultation intervals on caries incidence in children with low caries risk. The study was composed of 224 children aged between 3 and 5 years and with low risk of caries. The children were randomly allocated into two groups, according to two different follow-up consultation intervals: Group 1 (G1) - 12-month follow-up interval; Group 2 (G2) - 18-month follow-up interval. All oral clinical examinations were performed by a single examiner who was previously calibrated and blinded in relation to the study groups. An external dentist provided the advice on oral hygiene and diet and evaluated the children's socioeconomic conditions. The Chi-square and Mann-Whitney tests were used to evaluate the differences between groups. Poisson regression analyses were performed to assess the association of caries incidence with the other variables. At the end of the study there was a significant difference between the groups regarding initial active lesions (p = 0.012), and children in G2 were at a higher risk of developing initial active lesions than those in G1 (p = 0.047). Children who had a higher number of teeth with initial active lesions in the follow-up consultations were at a higher risk of developing cavitated dentin caries (p = 0.001). Both follow-up intervals are justifiable. Although significant results have been observed for initial active caries lesions within the 18-month follow-up interval, it should be noted that these lesions can be treated using just preventive measures. Besides, different return interval had no effect in cavitated dentin lesions.

Efetividade de dois intervalos de retorno clínico distintos na incidência de cárie em pré-escolares que apresentaram alto risco de cárie / Effectiveness of two distinct clinical recall intervals in caries incidence in preschool children with high caries risk

Objetivos: Avaliar a efetividade de dois intervalos de retorno clínico na incidência de cárie (proposição geral) em pré-escolares que apresentaram alto risco de cárie. E avaliar o nível de ansiedade, (proposição específica) de acordo com cada intervalo empregado. Métodos: A amostra foi composta por 224 crianças de 3 a 5 anos de idade, com alto risco de cárie, de acordo com os critérios da Secretaria Municipal de Saúde de São Paulo. As crianças foram randomizadas em dois grupos: Grupo 1 (G1) - exame clínico bucal + orientação de higiene bucal e dieta com retorno de 4 meses, Grupo 2 (G2) - exame clínico bucal + orientação de higiene bucal e dieta com retorno de 8 meses. O nível de ansiedade foi avaliado pela Escala de Imagem Facial, por um dentista externo cego aos grupos de estudo e as características clínicas. O exame clínico bucal foi realizado por um examinador previamente treinado e calibrado, cego aos grupos de estudo. A detecção de lesões de cárie foi feita de acordo com o ICDAS (International Caries Detection and Asessment System). Todos os grupos foram acompanhados durante um período de 30 meses, totalizando sete consultas de retorno para o G1 e três consulta de retorno para o G2. Para as análises foi utilizado um programa estatístico (SPSS), onde o teste de Fischer e Qui-quadrado foram utilizados para avaliar a proporção de crianças com lesões de cárie entre os grupos de estudo no final do estudo, e também para comparar o nível de ansiedade das crianças entre os grupos de estudo no final do estudo. Resultados: A incidência de cárie nas crianças que tiveram retorno a cada 8 meses foi maior do que aquelas que tiveram retorno a cada 4 meses quando comparado os dois grupos no final do estudo (p=0,033). A ansiedade relatada pelas crianças apresentou melhora significantemente maior para o grupo de retorno a cada 4 meses quando comparada ao grupo de retorno a cada 8 meses no final do estudo (p= 0,027). Conclusão: Os intervalos de retorno a cada 4 meses resultaram em menor incidência de cárie para pré escolares com alto risco de cárie e as crianças pertencentes a esse mesmo grupo apresentaram menores níveis de ansiedade.

Changes in preschool children's OHRQoL after treatment of dental caries: responsiveness of the B-ECOHIS.

BACKGROUND: Oral health-related quality of life (OHRQoL) measures should be tested for responsiveness to change if they are to be used as outcomes in randomized clinical trials. AIM: To assess the responsiveness of the Brazilian ECOHIS (B-ECOHIS) to dental treatment of dental caries. METHODS: One hundred parents of 3- to 5-year-old children completed the B-ECOHIS prior to their children's treatment and 7-14 days after completion of treatment. The post-treatment questionnaire also included a global transition judgment that assessed parent's perceptions of change in their children's oral health following treatment. Change scores, longitudinal construct validity, standardized effect sizes (ES) and standardized response mean (SRM) were calculated. RESULTS: Improvements in children's oral health after treatment were reflected in mean pre- and post-treatment B-ECOHIS scores. They declined considerably significantly from 17.4 to 1.6 (P < 0.0001), as did the individual domain scores (P < 0.0001). There were significant differences in the pre- and post-treatment scores of children who reported little improvement (P < 0.0001) as well as in those who reported large improvements (P < 0.0001). The ES and SRM based on change scores mean for total scores and for categories of global transitions judgments were large. CONCLUSIONS: Dental treatment resulted in significant improvement of the preschool children's OHRQoL. The B-ECOHIS is responsive.

Efetividade de dois intervalos de retorno clínico na incidência de cárie em pré-escolares que apresentaram alto risco de cárie: acompanhamento inicial de oito meses de um ensaio clínico randomizado / Effectiveness of two clinical recall intervals in the incidence of caries in preschool children who has high risk of caries: Initial follow-up, eight months of a randomized clinical

O objetivo principal deste estudo foi avaliar a efetividade de dois intervalos de retorno clinico na incidência de cárie em pré-escolares que apresentaram alto risco de cárie. Também, foram avaliadas como desfechos secundários a paralisação de lesões de cárie já existentes, o nível de ansiedade, e a qualidade de vida relacionada à saúde bucal (QVRSB), de acordo com cada intervalo empregado. A amostra foi composta por 224 crianças entre 3 a 5 anos de idade, de ambos os gêneros, com alto risco de cárie, de acordo com os critérios clínicos adaptados da Secretaria da Saúde do Estado de Saúde de São Paulo. As crianças foram alocadas aleatoriamente em dois grupos: Grupo 1 (G1) - exame clínico bucal mais, orientação de cuidados de higiene bucal e dieta com intervalos de retornos clínicos de 4 meses; Grupo 2 (G2) - exame clínico bucal mais, orientação de cuidados de higiene bucal e dieta com intervalos de retornos de 8 meses. Os exames clínicos bucais foram realizados por um único examinador treinado e calibrado, cego aos grupos de estudo em que as crianças estavam alocadas. O exame clínico bucal abrangeu a detecção e atividade de lesões de cárie de acordo com o índice ICDAS (International Caries Detection and Asessment System) e as características clínicas de lesões de cárie ativas e inativas foram associadas com os critérios descritos no manual do Comitê ICDAS. Um dentista externo cego aos grupos de estudo realizou as orientações sobre cuidados de saúde bucal, avaliou o nível de ansiedadeatravés da Escala de Imagem Facial, e a QVRSB mensurada pelo B-ECOHIS. Todos os grupos foram acompanhados durante um período de 8meses, totalizando duas consultas de retorno para o G1 e uma consulta para o G2. Todas as análises foram realizadas por intenção de tratar (ITT). A curto prazo, os resultados apresentam que retorno de 4 e 8 meses apresentaram-se similares em todos os desfechos do estudo para pré-escolares com alto de risco de cárie a nível de saúde pública.

The aim of this study was to evaluate the effectiveness of two clinical recall intervals in the incidence of caries in preschool children who has high risk of caries. Was also evaluated as secondary endpoints the stoppage of existing caries lesions, the level of anxiety, and oral health related quality of life (OHRQoL), according to each interval was assess. The sample consisted of 224 children between 3-5 years of age, of both genders, with high risk of caries, according to clinical criteria adapted the Municipal Department of Health of São Paulo. Children were randomly allocated into two groups: Group 1 (G1) - oral clinical examination, orientation for oral hygiene and diet with a 4-months intervals of clinical returns; Group 2 (G2) - oral clinical examination, orientation for oral hygiene and diet with a 8-month intervals of clinical returns. The oral clinical examination of each child consist in detection and activity of caries lesions according to the ICDAS index (International Caries Detection and Asessment System) and clinical characteristics of active and inactive caries lesions were associated with the criteria described in the manual ICDAS committee. An external dentist, blind to the study groups conducted the assessment of oral health care, level of anxiety using the Facial Image Scale, and also assessed the QVRSB measured by B-ECOHIS. All groups were followed for a period of 8 months, totaling two return visits for G1 and one return visit to the G2. All analyzes were done by intention to treat (ITT). In a short time, both returns, 4 and 8 moths are similar in all outcomes of this study for preschool children with high caries risk in terms of health service.

Effectiveness of a preventive program based on caries risk assessment and recall intervals on the incidence and regression of initial caries lesions in children.

BACKGROUND: Evidence on caries risk assessment (CRA) and recall intervals are limited in terms of caries prevention. AIM: To assess the effectiveness of a program on the incidence and regression of initial caries lesions. DESIGN: A total of 296 children aged 1-12 years old were assessed by calibrated examiners for Gingival Bleeding Index, Dental Plaque Index, dmf-t/DMF-T Index, initial caries lesions, and caries lesion activity. Children were classified as low, moderate, and high caries risk with different recall interval visits. Statistical analysis included Cox regression and Kaplan-Meier curves. RESULTS: The mean (SD) time of total follow-up for the sample was 11.5(5.5). Higher dmft index at baseline showed a higher risk of new initial lesions (HR = 1.93; P < 0.0001). Higher number of active initial lesions, at baseline and during follow-up visits, is a higher risk predictor for new initial lesions (HR = 9.49; P < 0.0001), as well as for no arrestment of active lesions during follow-up (HR = 1.32; P < 0.0001). Each follow-up visit attended presented a 77% lower risk of initial lesions. The majority (94.8%) of patients did not show new initial lesions. CONCLUSIONS: The Program is effective on reducing the incidence and promoting regression of initial caries lesions in children.

Concordância entre os relatos do núcleo familiar em relação à qualidade de vida da criança / Agreement between the nucleus family reports regarding child's quality of life

Objetivos: Avaliar a concordância entre os relatos de pai, mãe e filhos em relação a qualidade de vida relacionada a saúde bucal (OVRSB) da criança. Métodos: Um total de 80 tríades pai-mãe-criança responderam a versão brasileira do Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) validado para crianças de 5 e 6 anos de idade e seus respectivos pais O preenchimento do SOHO-5 foi realizado por meio de entrevistas independentes face-a-face. A concordância entre os escores totais e de itens foi avaliada usando a comparação de médias e a análise de correlação calculada pelo coeficiente de correlaçâo intraclasse (CCI). Resultados: Houve diferença significativa entre as médias dos relatos pai-criança nos escores totais (p<0.001) e itens relacionados a não sorrir devido à dor e à aparência (p<0,01). O CCI para o escore total dos relatos mãe-criança foi de 0,83 (IC 95% 0,74- 0,89) e de 0,41 (IC 95% 0,09- 0,63) para os relatos pai-criança, indicando uma concordância excelente e moderada, respectivamente. Conclusões: As mães relatam a QVRSB de seus filhos de forma semelhante às crianças enquanto que os pais subestimam os impactos. As mães podem ser consideradas respondentes secundárias preferíveis aos pais.

Objective: To assess the agreement between father, mother and children regarding child'l oral health-related quality of life (OHROoL). Methods: A total of 80 mother-father-child triads answered the Brazilian version of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-51, validated for children aged 5-6 years and their parents. The SOHO-5 was completed through face-to-face independent interviews. Agreement between total and items scores was assessed using mean comparisons and correlation analyses by computing the Intraclass Correlation Coefficient (ICC). Results: There were significant differences between the mean total scores for father-child pairs (p<0.001) and items related to avoid smiling due to pain and avoid smiling due to appearance (p<0,01). The ICC for total score was 0.83 (CI 95% 0.74; 0.89) for mother-child pairs and 0.41 (CI 95% 0.09; 0.63) for father-child pairs indicating an excellent and moderate agreement, respectively. Conclusions: Mothers do rate their children's OHRQol similarly to children's self-reports, while fathers underreport the impact. Mothers may be considered preferable proxies than fathers.