Comparison of two visual methods for detecting caries among obese and non-obese children.

OBJECTIVE: The study aimed to compare two visual methods for detecting caries among obese and non-obese children in Salvador, Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted from 2011-2012, which evaluated 180 paediatric patients, 6-14 years old, girls and boys, categorized into two groups: obese and non-obese (healthy weight), according to the body mass index. For the evaluation of dental caries, the decayed, missing or filled teeth index (DMFT/dmft) and International Caries Detection and Assessment System II (ICDAS II) visual criteria were used. RESULTS: The mean DMFT value was 0.98 in obese children and 0.57 in the non-obese children, without significant differences between groups (p = 0.206). The mean dmft value in the non-obese children (1.66) was higher than in obese children (0.95), with significant differences between groups (p = 0.021). According to ICDAS II criteria, there was a higher prevalence of non-cavitated enamel lesions (D1-3) in obese children (n = 156, 10.5%) compared to the non-obese children (n = 55, 1.9%), with significant differences between the groups (p < 0.001). CONCLUSIONS: The inclusion of non-cavitated lesions during the caries evaluation represents a challenge in diagnosis, which allows for control of this process before the evolution of these lesions to cavitation.

Remineralization Capacity of Three Fissure Sealants with and without Gaseous Ozone on Non-Cavitated Incipient Pit and Fissure Caries.

OBJECTIVE: The purpose of this study was to investigate the remineralization activation of the application of three fissure sealants (FSs), alone or with gaseous ozone (GO), on non-cavitated initial caries and evaluate the clinical success of FS. STUDY DESIGN: Sixty children who had DIAGNOdent scores between 10-30 on bilateral symmetric mandibular first permanent molars were included in study. In a split-mouth design, teeth were assigned to experimental (with GO) and control (without GO) groups. GO was applied to teeth on one side and then the same brand of randomly selected FSs was applied to the teeth on both sides. Children were divided into 3 groups based on type of FS (Group 1: Aegis {Bosworth Co, North Hamlin Avenue Skokie, Illinois, USA}, Group 2: Fuji Triage {GC, Tokyo, Japan}, Group 3: Helioseal {Ivoclar Vivadent, Liechtenstein, Germany}). All FSs were then examined for retention rates at 1, 3, 6, 9, and 12 months; at the end of 12 months, all FSs were removed with an air-abrasion device and DIAGNOdent scores noted to compare with the initial values. RESULTS: The application of GO with either Fuji Triage or Aegis FS was effective on remineralization (p<0.05); however, the application of Helioseal FSs was not effective (p>0.05). The 1(st) and 12(th) months' full retention rates of Fuji Triage FSs was a significant difference (p<0.05) from other FSs (Aegis and Helioseal) (p>0.05). CONCLUSIONS: GO+Aegis FS showed the highest remineralization; and, at the end of 12 months, its clinical success was higher than other FSs.

How do dental students determine patients' caries risk level using the Caries Management By Risk Assessment (CAMBRA) system?

Research has demonstrated the validation of specific caries risk assessment (CRA) systems, but little is known about how dental practitioners assign a caries risk level to their patients. The aim of this study was to explore dental students' decision making in caries risk assignment when using the Caries Management By Risk Assessment (CAMBRA) system. Multiple correspondence analysis and chi-squared automated interaction detector analysis were performed on data collected retrospectively for a period of six years (2003-09) at the University of California, San Francisco predoctoral dental clinic. The study population consisted of 12,952 patients from six years of age through adult who received a baseline CRA during the period, were new to CAMBRA, and had not received any prior CAMBRA recommendations. The results showed variation in decision making and risk level assignment, illustrated by the range of percentages for the three scores (low, moderate, and high/extreme caries risk) when CRA was assigned for the first time. For those first-time CRAs, decision making was mainly based on four factors: cavities or caries lesions into dentin on radiograph, restorations during the last three years due to caries, visible heavy plaque, and interproximal lesions into enamel (by radiographs). This study's findings provide important data regarding one group of CAMBRA users and thus contribute to the development of knowledge about the implementation of caries risk assessment in contemporary dental practice.

Quality assurance study of caries risk assessment performance by clinical faculty members in a school of dentistry.

The goal of this quality assurance study was to explore the decision making of clinical faculty members at the University of California, San Francisco School of Dentistry predoctoral dental clinic in terms of caries risk level assignment using the caries risk assessment (CRA) as part of the Caries Management by Risk Assessment (CAMBRA) concept. This research was done in part to determine if additional training and calibration were needed for these faculty members. The study tested the reliability and reproducibility of the caries risk levels assigned by different clinical teachers who completed CRA forms for simulated patients. In the first step, five clinical teachers assigned caries risk levels for thirteen simulated patients. Six months later, the same five plus an additional nine faculty members assigned caries risk levels to the same thirteen simulated and nine additional cases. While the intra-examiner reliability with weighted kappa strength of agreement was very high, the inter-examiner agreements with a gold standard were on average only moderate. In total, 20 percent of the presented high caries risk cases were underestimated at caries levels too low, even when obvious caries disease indicators were present. This study suggests that more consistent training and calibration of clinical faculty members as well as students are needed.

Reproducibility and diagnostic outcomes of two visual-tactile criteria used by dentists to assess caries lesion activity: a cross-over study.

UNLABELLED: The aim of this study was to evaluate the reproducibility and differences in diagnostic outcomes by practicing dental clinicians previously inexperienced in using the Nyvad criteria and the ICDAS II criteria with the Lesion Activity Assessment system (ICDAS II + LAA). Four volunteer dentists were randomly allocated to one of two groups. Both groups of dentists examined the same voluntary sample (n = 140) of caries active young adults using Nyvad and ICDAS II + LAA criteria in different sequences. The first group used the Nyvad criteria during period 1, followed by ICDAS II + LAA during period 2; the second group did the examinations in the opposite sequence. Before the period 1 and 2 examinations, dentists from both groups were trained with the Nyvad or ICDAS II + LAA criteria, depending on the group to which they were assigned. Intra-examiner agreement for lesion severity was high for both diagnostic instruments (weighted kappa 0.62-0.80). For lesion activity the intra-examiner unweighted kappa values ranged from 0.31 to 0.61 for ICDAS II + LAA and from 0.36 to 0.51 for Nyvad. The mean number of active non-cavitated caries lesions was significantly higher for ICDAS II + LAA (6.14 ± 5.4) than for Nyvad (3.90 ± 3.9) (p < 0.001). Active cavitated/dentinal caries lesions were significantly higher for ICDAS II + LAA (4.14 ± 4.1) than for Nyvad (2.13 ± 3.1) (p < 0.001). Both the Nyvad and ICDAS II + LAA diagnostic criteria showed high reproducibility for lesion severity assessment. The mean number of active caries lesions among high caries risk subjects was significantly higher using the ICDAS II + LAA criteria, which may subsequently lead to more caries treatment. TRIAL REGISTRATION: ISRCTN65592532.

Caries diagnosis: agreement between WHO and ICDAS II criteria in epidemiological surveys.

OBJECTIVE: The aim of this study was to ascertain the equivalence between WHO caries diagnosis criteria and the ICDAS II caries classification scale for comparisons in epidemiological studies. MATERIALS AND METHODS: Two intraoral examinations, one using the ICDAS II caries codes and the other the WHO caries assessment method, were performed in a random sample of 101 children (29 aged 5-6 years, 32 aged 12 and 40 aged 15). Both examinations were performed not more than one month apart by two calibrated examiners (one for ICDAS II criteria, Kappa=0.86, and the other for WHO criteria, Kappa=0.91). The DMFT/dft, DMFS/dfs and caries prevalence (DMFT or dfs>0) indices were obtained in accordance with WHO assessment criteria and by applying 5 cut-off points on the ICDAS II scale. The differences between means were analysed with the Wilcoxon test and those between proportions with the McNemar test. Agreement was determined by the intraclass correlation index and the Kappa statistic. RESULTS: The least differences between the WHO and ICDAS 11 criteria were found at cut-off point 3 (ICDAS 11 codes 3 to 6). The greatest agreement was found at the same cut-off point. CONCLUSION: While the equivalence between both methods used in epidemiological studies does not appear to be clear, possible errors could be reduced by locating this equivalence at cut-off point 3 and not at cut-off point 4.

Clasificación de las alteraciones cefalogénicas desde una visión integradora craneomaxilofacial / Classification of cephalogenic alterations from a craneomaxilofacial integrative visión

Introducción: las clasificaciones sobre las alteraciones cefalogénicas presentan una gran dispersión debido a la multiplicidad de especialidades médicas que intervienen en la región de la cabeza. Objetivo: describir las clasificaciones más relevantes de las malformaciones craneofaciales y proponer una nueva clasificación. Métodos: se realizó un estudio mixto, hermenéutico y cuantitativo descriptivo, durante el cual se analizó la producción de clasificaciones sobre este tema en la Web of Sciences en el periodo comprendido desde 1992 hasta 2012. Luego de seleccionar 263 artículos que trataban este tema se estudiaron 22 de ellos en los que proponían clasificaciones o modificaciones al respecto. Se estudió la región anatómica, el tipo de clasificación, el tipo de malformación que describe y la revista de publicación. Resultados: hubo predominio del tipo de clasificación morfogénica en el 60 porciento, el tipo de malformación mayormente clasificada fue por defecto (fisuras e hipoplasias) en 72 por ciento y la revista con mayor representación de publicaciones sobre clasificaciones de alteraciones cefalogénicas fue TheJournal of Craniofacial Surgery donde se publicaron el 44 por ciento de ellas. Se propuso una clasificación integradora morfo-fisiopatológica y se analizó su validación interna y externa. Conclusiones: se demostró la ausencia de una clasificación que agrupara todas las malformaciones cefalogénicas, que incluyera a todas sus regiones anatómicas y tipos de malformaciones. La clasificación propuesta podría ser de utilidad para las especialidades médicas y estomatológicas afines a esta región anatómica(AU)

Introduction: classifications on cephalic alterations have great dispersion secondary to diversity of medical specialties involved in head region. Objective: to describe relevant classifications in craniofacial malformations and recommend a new classification. Method: was carried out a mixed study: hermeneutic and quantitative descriptive, to analyze the production of this kind of classifications on the Web of Sciences during the years 1992 to 2012. As result 263 papers was find on this topic and 22 papers were selected because provided classifications or modifications in this respect. This research analyzed the anatomical region, the classification type, the type of malformation and the magazine of publication. Results: there was a prevalence of the type of morphogenic classification in 60 percent, the mostly classified malformation type of by defect (fissures and hypoplasia) in 72 percent and the representative magazine of cephalic alterations classifications was the Journal of Craniofacial Surgery where 44 percent of them were published. An integrative morpho-physiopathologic classification was suggested and internal and external validation was analyzed. Conclusions: was demonstrated the absence of any classification that joined all the cephalic malformations of all the anatomical cephalic regions. The recommended classification would being of utility for medical and dentistry specialties related to this anatomical region(AU)

Preventive resin restorations: practice and billing patterns of pediatric dentists.

PURPOSE: The purpose of this study was to determine practice patterns of pediatric dentists for preventive resin restorations (PRRs) and if they believe a code should be added to the American Dental Association's current dental terminology (CDT) for the PRR. METHODS: A 16-question survey sent to 475 pediatric dentists randomly selected from the American Academy of Pediatric Dentistry database, addressed demographics, treatment planning, techniques in preparation and restoration, billing practices, and perceptions about the need for a CDT code for PRRs. RESULTS: Two hundred thirty-eight (50%) surveys were returned, revealing that 72% of respondents perform PRRs and 64% feel that a PRR code should be added to the CDT Fifty-two percent believe not having a CDT code could cause dentists to perform more invasive dentistry to comply with billing requirements that Class I restorations be in dentin. PRRs are commonly treatment planned for deep pits and fissures with questionable decoy not entering dentin. Up to 50% of respondents could be erroneously billing for PRRs. CONCLUSIONS: Most pediatric dentists perform preventive resin restorations in their office and believe that a code for the procedure needs to be added to the current dental terminology.

A proposal for a new classification of lesions of exposed tooth surfaces.

In the presence of improved methods of identification and treatment of lesions on the exposed surfaces of teeth, it should now be acknowledged that the GV Black "classification of carious cavities" is out of date. This paper describes a new system, proposed in 1997, discussed broadly throughout the profession, and eventually modified. The system has been adopted in several regions around the world as being a useful corollary to the current developing concept of minimal intervention dentistry. It is now desirable to adopt a new approach to the identification and recording of the lesions caused by both caries and non-carious tooth loss. A major advantage arising from its adoption would be that it would encourage the profession to minimise the amount of normal healthy tooth structure that is often sacrificed in pursuit of the cavity designs as suggested by Black. The authors are members of a Project Group of the FDI Science Committee, and this paper explains the concept and offers justification for the adoption of the system.

Microleakage assessment of pit and fissure sealant with and without the use of pumice prophylaxis.

OBJECTIVES: This study evaluated the effect of pumice prophylaxis on the level of microleakage around and between the sealant and enamel. MATERIALS AND METHODS: A total of 32 freshly extracted sound upper first premolars, assigned as suitable for sealant application, were chosen and divided randomly into two groups: (1) a test group, without prophylaxis; and (2) a control group, with prophylaxis. Sealant was applied to all teeth using the same conventional technique, with prophylaxis being omitted in the test group. The sealed teeth were thermocycled (120 x 30 s, 5 and 55 degrees C cycles) and then immersed in 2% Basic Fuchsin solution for 72 h. Each tooth was sectioned and examined for dye penetration under a stereomicroscope (x 60 magnification). RESULTS: No dye penetration was seen in 19 (29.6%) of the teeth in the test group and 36 (56.2%) of the teeth in the control group. Dye had penetrated to the base of the fissure in 31 (48.4%) of the teeth in the test group and 23 (35.9%) of the teeth in the control group. Using a chi-square test for trend, the frequency of microleakage was significantly higher in the test group compared to the controls (P < 0.016). CONCLUSION: Prophylaxis has a role in improving sealant retention. Removing this step may cause an increase in microleakage.

Classification of dental caries patterns in the primary dentition: a multidimensional scaling analysis.

OBJECTIVE: Clinical patterns of early childhood caries (ECC) encompassing specific teeth or surfaces have been previously proposed on an a priori basis and have been used as case definitions. The underlying assumption is that the patterns result from different host response and environmental conditions. Identifying caries patterns has utility in refining case definitions of ECC. Well-defined caries patterns should enhance the ability of an analysis to identify meaningful associations between suspected risk factors and ECC. The purpose of this project was to identify patterns of caries in the dentition of preschool children using multidimensional scaling without a priori pattern delineation. METHODS: Between February 1994 and September 1995, five examiners visually examined 5171 Arizona preschool children aged 5-59 months old. Multidimensional scaling (MDS) was used as a classification/taxonomy technique to identify any underlying structure of the caries data. MDS provided a classification scheme for individual tooth surfaces based on the dissimilarity measures of squared Euclidean distance and of variance using an alscal analysis. Both two- and three-dimensional solutions were pursued; s-stress, stress, R-square and residual patterns were assessed in determining the best dimensional model, with the resulting quadrant positions of the tooth surfaces suggesting potential caries patterns. RESULTS: All models demonstrated excellent fit. Two- and three-dimensional solutions suggested four caries patterns: (i) any maxillary incisor surfaces, (ii) first molar occlusal surfaces, (iii) second molar pit and fissure surfaces, and (iv) any smooth surfaces, excluding the maxillary incisor surfaces. CONCLUSIONS: This is the first delineation of primary dentition caries patterns produced by a classification analysis without a priori pattern definitions. The identified caries patterns may arise from specific risk factors and/or be a function of the timing of various risk factor exposures. Use of these patterns as case definitions should enhance the ability to identify associations between suspected risk factors and ECC.

Restorative treatment decisions on occlusal caries in Scandinavia.

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.

Caries assessment and restorative treatment thresholds reported by Swedish dentists.

The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service.

Patterns of dental caries severity in Chinese kindergarten children.

The dental caries status of a population group is traditionally described by mean values of decayed, missing and filled teeth or surfaces (DMFT or S). Because of the limitations of the DMF values alone, additional measures of dental caries become important. A system of describing the pattern of dental caries attack hierarchically according to severity of caries was suggested by Poulsen & Horowitz (Community Dent Oral Epidemiol 1974;2:7-11). The purpose of the present study was to analyze caries data from a group of 3-6-year-old Chinese kindergarten children according to this hierarchical system, assess the hierarchical assumptions of the system with deciduous teeth and evaluate its usefulness as an additional caries description for a kindergarten population. As part of a longitudinal field trial, baseline caries data were collected from 452 children. Caries was registered by tooth surface without the use of radiographs. Each child was assigned to one of six mutually exclusive zones of increasing caries severity, from zone 0=caries free through zone 5, the most severe, assuming that once a child was classified into a given zone it automatically belonged to all zones of lesser severity (except zone 0). On the basis of the original six zones, 61% of the children were classified correctly according to the hierarchical concept, but different alternative models which merged one or more zones together demonstrated varying percentages of correct classification, the cariologically most acceptable one placing 83% correctly. For each age group there was a close correlation between mean dmfs and increasing severity. The hierarchical model provides a valuable additional description of the caries status in deciduous teeth and is consistent with professional and epidemiological knowledge of caries attack patterns.

Caries experience in inner-city preschoolers at the time of their initial dental visit.

This retrospective study examined caries experience in a population of inner-city preschoolers at their initial dental visit. Clinical and sociodemographic data for 103 patients aged five years and under at the time of their first dental visit were obtained from the dental records of an inner-city community health center clinic located in a fluoridated area. The sample consisted of fifty-eight males and forty-five females who were seen during a continuous six-month period in 1991. The mean age of the subjects was 44.1 months (S.D. +/- 10.5 months). Sixty-seven percent of the children in the sample were found to have caries. The mean number of decayed surfaces (ds) was 6.54 (+/- 7.16), with the following distribution by surface type: occlusal--2.89 (+/- 3.15); proximal--1.75 (+/- 2.91); buccal/lingual--1.90 (+/- 2.73). Caries prevalence and severity increased with age. Findings from this sample demonstrate that dental caries remains a significant problem in inner-city preschoolers, thereby underscoring the importance of early intervention programs.

Clinical diagnosis of occlusal dentin caries.

An occlusal restoration is usually considered necessary when a lesion extends into the dentin. This study aimed to assess the relationship between the clinical appearance of occlusal caries and the lesion depth. Special attention was paid to differentiate the inner, partly demineralitzed layer of carious dentin that should be preserved from the outer carious layer that should be removed before placing a restoration. Fissures in extracted premolars and molars were classified clinically by the authors. The mean pairwise interobserver agreement, weighted Cohen's kappa (kappa), was 0.73, which indicated 'substantial agreement'. The depth of zones revealing softness by probing and/or discoloration was assessed on ground surfaces. Of the carious fissures that were scored sound by clinical examination (n = 17), 76% revealed enamel lesions on the ground surfaces. Of those occlusal surfaces with a discoloration only but no cavitation (n = 57), 13 showed dentin lesions, but only 5 of these revealed softness by probing. Of those lesions with very small cavitations (n = 60), 19 were confined to enamel, 41 showed dentin lesions and of these 32 revealed softness by probing. All but 1 of the lesions with small cavitations (n = 28) showed dentin involvement and all but 2 of these revealed softness. If cavitation in the occlusal lesion was used as a criterion for identifying dentin lesions with softness, the sensitivity and specificity values were 0.92 and 0.69, which means a relatively high frequency of overregistration.