Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial.

OBJECTIVE: This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments. MATERIAL AND METHODS: With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed. RESULTS: Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15). CONCLUSION: Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.

Dental caries prevalence in children and youths with vertically-transmitted HIV/AIDS from the pediatric HIV clinic (Cali, Colombia) and its relationship with biological factors, 2013 / Prevalencia de caries dental en niños y jóvenes con VIH/SIDA de transmisión vertical de la clínica pediátrica de VIH, Cali, Colombia, y su relación con factores biológicos, 2013

ABSTRACT. Introduction: among the oral pathologies afflicting children with HIV/AIDS is dental caries, a preventable disease if detected and controlled in its early stages to avoid further complications. The aim of this study was to determine the prevalence of caries in children and youths with vertically-transmitted HIV/AIDS from the Pediatric HIV Clinic in Cali, Colombia, in 2013, and to explore relationships with biological factors. Methods: descriptive prevalence study in 101 clinical records of children and youths aged 1 to 17 years with vertically-transmitted HIV/AIDS from the Pediatric HIV Clinic in Cali. The ICDAS and DMF/def classification systems were used. Multivariate analysis and confounding variable adjustment were included to explore relationships with demographic, paraclinical, nutritional, and dental factors. The institutional ethics committees endorsed the study. Results: the prevalence of caries experience in children with HIV was 34.65% DMF/deft (5-6) 3.29 ± 3.06. This prevalence increases 83.17% with the ICDAS 2-6 system. The point prevalence of active caries was 74.26% DMFT 5.68 ± 5.48. No statistically significant association was found with any socioeconomic or immunologic variables. Patients with moderate to severe immunosuppression had OR 1.13 CI95% (0.33-3.81) p = 0.84. A probable association was found with plaque index OR 4.58 CI95% (1.44-14.55) p = 0.006 and caries experience OR 4.21 CI95% (1,09-16.13) Conclusion: HIV patients from the Pediatric Clinic show high caries prevalence when pre-cavitated lesions are assessed. No probable association was found between caries and immunological or clinical status, and therefore this aspect is not an additional risk factor.

RESUMEN Introducción: entre las patologías bucales que aquejan a los niños con VIH/sida se encuentra la caries dental, entidad prevenible si se detecta y controla en sus etapas iniciales para evitar mayores complicaciones. El objetivo del presente estudio consistió en determinar la prevalencia de caries en niños y jóvenes con VIH/sida de transmisión vertical de la Clínica Pediátrica de VIH, de Cali, Colombia, 2013, y explorar relaciones con factores biológicos. Metodología: estudio descriptivo de prevalencia en 101 historias clínicas de niños y jóvenes de 1 a 17 años con VIH/sida por transmisión vertical de la Clínica Pediátrica de VIH, de Cali. Se usaron los sistemas de clasificación ICDAS y COP/ceo. Se incluyó análisis multivariado y ajuste por variables confusoras para explorar relaciones con factores sociodemográficos, paraclínicos, nutricionales y odontológicos. Se contó con el aval de los comités de ética institucionales. Resultados: la prevalencia de vida de caries cavitada en niños con VIH fue de 34,65% COP/ceo_d (5-6) 3,29 ± 3,06. Esta prevalencia aumenta 83,17% con el sistema ICDAS2-6. La prevalencia puntual de caries activa fue de 74,26% COP-d 5,68 ± 5,48. No se encontró asociación estadísticamente significativa con ninguna variable socioeconómica ni inmunológica. Los pacientes con inmunodepresión moderada y severa presentaron un OR 1,13 IC95% (0,33-3,81) p = 0,84. Se encontró una probable asociación con el índice de placa OR 4,58 IC95% (1,44-14,55) p = 0,006 y con la historia de caries OR 4,21 IC95% (1,09-16,13) Conclusión: los pacientes con VIH de la Clínica Pediátrica presentan alta prevalencia de caries cuando se valoran lesiones precavitacionales. No se encontró una probable asociación de caries con el estadio inmunológico ni con el clínico, por lo que este aspecto no es un factor de riesgo adicional.

Correlation of clinical and radiographic diagnosis of carious lesions in posterior teeth / Correlación del diagnóstico clínico y radiográfico de la lesión de caries en dientes posteriores

ABSTRACT. Introduction: dental caries is a public health problem affecting a large percentage of the population. The carious process is highly variable and has periods of progression that alternate with periods of stability of the damaged tissue. There are different techniques to diagnose dental caries, including clinical and radiographic evaluation. Objective: the objective of this study was to establish correlation between the clinical and radiographic caries diagnosis suggested by ICCMSTM, in deciduous and permanent molars of a school population. Methods: descriptive study evaluating a sample for convenience of 1174 proximal and occlusal tooth surfaces of permanent and deciduous molars, taken from the database of 35 outpatients treated at the school of dentistry, who were clinically and radiographically evaluated for caries as recommended by the ICCMSTM based on bitewing x-rays. Results: the clinical and radiographic diagnosis was correlated in 1174 proximal and occlusal surfaces, with 0.41 Spearman's rank correlation coefficient (p < 0,05). The findings suggest that 95.6% of teeth diagnosed as healthy coincided with the clinical and radiographic results; in early mild stages, there was coincidence in only 8.16% and 6.4% respectively. Conclusions: there is low correlation between the clinical diagnosis of caries and the radiographic examination, in relation to ICCMSTM standards.

RESUMEN. Introducción: la caries dental es un problema de salud pública que afecta a un gran porcentaje de la población. El proceso de actividad de la caries es muy variable y presenta períodos de progresión que alternan con períodos de detención del tejido dañado. Actualmente existen diversas técnicas para el diagnóstico de caries dental, entre las cuales se encuentra la evaluación clínica y radiográfica. Objetivo: el objetivo de este estudio consistió en establecer la correlación entre el diagnóstico clínico de caries y el diagnóstico radiográfico propuesto por el ICCMSTM, en molares temporales y permanentes de una población escolar. Métodos: estudio descriptivo, en el que se evaluó una muestra por conveniencia de 1174 superficies dentales proximales y oclusales de molares permanentes y temporales, tomada de la base de datos de 35 pacientes atendidos en área extramural de la escuela de odontología, los cuales fueron evaluados clínica y radiográficamente para caries según lo propuesto por el ICCMSTM a partir de radiografías aleta de mordida. Resultados: se correlacionó el diagnóstico clínico y radiográfico en 1174 superficies proximales y oclusales con un coeficiente de correlación de Spearman de 0,41 (p<0,05). Se encontró que el 95,6% de los dientes diagnosticados como sanos coincidió con los resultados clínicos y radiográficos; en estadios iniciales y moderados se encontró coincidencia solo en el 8,16% y 6,4% respectivamente. Conclusiones: hay baja correlación entre el diagnóstico clínico de caries y el examen radiográfico, según lo propuesto por ICCMSTM.