Do progression rates of initial and moderate caries lesions and sound surfaces of primary teeth increase significantly after 7 years?

BACKGROUND: Initial caries lesions in primary teeth have presented a low progression rate after 2 years, but it could be higher in longer follow-ups. AIM: To evaluate the progression rates of sound surfaces and initial and moderate caries lesions after 7 years. DESIGN: This prospective 7-year cohort study included 639 preschool children aged 1-5 years in 2010. In 2017, 449 children were reassessed (70.3% retention rate). Dental caries was collected using the International Caries Detection and Assessment System (ICDAS) in both assessments. Incidence rate (IR) per 100 surface-years estimated the progression rates of sound surfaces and initial and moderate lesions for worse conditions. Cox regression with shared frailty evaluated the possible risk factors. RESULTS: IR was 1.0% for sound surfaces, 2.8% and 4.2% for ICDAS scores 1 and 2, respectively, and about 17.0% for moderate lesions. The most significant risk factor for the progression was the presence of cavitated lesions in other teeth. The type of surface and tooth also influenced the outcome. CONCLUSION: The progression rate of initial caries lesions in primary teeth remains low even after 7 years, but cavitated caries lesions in other teeth increase this risk. Moderate lesions demonstrate a higher risk of progression when compared to sound surfaces and initial caries lesions.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment.

OBJECTIVES: The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS: The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS: Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION: Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE: The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: A 10-year cohort study.

PURPOSE: To evaluate the effect of individual and contextual socioeconomic inequalities in the occurrence of untreated dental caries during the transition from childhood to adolescence. METHODS: This 10-year prospective cohort study followed up an initial sample of 639 1-5 years old schoolchildren from southern Brazil. After 7 and 10 years from the baseline (T1), two other reassessments were conducted (T2 and T3), respectively. Untreated dental caries was measured through the International Caries Detection and Assessment System (ICDAS- scores 3, 5 and 6) at T1 and T3. Socioeconomic status (SES) at the contextual and individual level was assessed at T1. At T2, socioeconomic, behavioural and psychosocial characteristics were evaluated as possible pathways of explanation. Structural equation modelling was used to estimate the direct and indirect effects among the variables over 10 years. RESULTS: A total of 429 adolescents were reevaluated at 10-year follow-up (cohort retention rate of 67.1%). About 30.6% presented untreated dental caries at T3. Low individual SES at T1 directly impacted a higher occurrence of dental caries at T3. Non-white skin colour at T1 also indirectly impacted a higher occurrence of dental caries at T3 through low individual SES at T1 and lower household income at T2. Contextual SES did not predict, directly or indirectly, dental caries at T3. CONCLUSION: There is strong evidence that socioeconomic inequalities at the individual level play an important role on the occurrence of dental caries from childhood to adolescence. On the other hand, there was no evidence that contextual SES influences the occurrence of dental caries over time.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China.

Background: Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments. Methods: We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific. Results: Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries. Conclusions: The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Early childhood factors in the development of oral health behaviours in adolescence: A structural equation modelling approach.

OBJECTIVES: Oral health behaviour is a learning process that begins in the early years of an individual's life. The aim of this study was to evaluate the associations between demographic, socioeconomic, and psychosocial factors and oral health behaviours during the transition period from childhood to adolescence. METHODS: This was a cohort study with a follow-up of 7 years. The baseline assessment occurred in 2010 with a random sample of 639 preschool children from southern Brazil. Demographic, socioeconomic and psychosocial oral health conditions were assessed at baseline. Oral health habit variables were collected at follow-up and included questions regarding dental care and oral hygiene behaviours. Structural equation modelling was performed to assess the direct and indirect relationships between predictors at baseline in oral health behaviours at follow-up. RESULTS: A total of 449 children were re-examined at follow-up (70.3% cohort retention rate). Factors directly related to poorer oral health behaviours (lower use of dental services, dental visits for emergency reasons and lower frequency of toothbrushing) were lower household income, lower maternal education, lower frequency of visits to neighbours or friends, and male sex. Considering indirect pathways, the household income and maternal education at baseline influenced oral health behaviours at follow-up via visits to neighbours or friends. CONCLUSIONS: Our findings suggest that household income, maternal education and social capital play an important role in the development of oral health behaviours during the transition from childhood to adolescence. Acquisition of healthy oral behaviours is an important factor to consider in childhood. With this knowledge, public health policies can be developed to intervene in specific causal factors and improve oral health during this transitional period.

Use of rubber dam versus cotton roll isolation on composite resin restorations' survival in primary molars: 2-year results from a non-inferiority clinical trial.

BACKGROUND: This non-inferiority randomised clinical trial aimed to evaluate the survival of direct bulk fill composite resin restorations in primary molars using different methods of moisture control: rubber dam isolation (RDI-local anaesthesia and rubber dam) and cotton roll isolation (CRI-cotton roll and saliva ejector). Secondary outcomes included baseline and 2-year incremental cost, self-reported child's pain scores and patient behaviour during the restorative procedure. METHODS: A total of 174 molars (93 children) with dentine caries lesions were randomly allocated to study groups (RDI or CRI) and restored with bulk fill composite resin by trained operators. Two blinded examiners assessed the restorations for up to 24 months. Wong-baker faces and Frankl's behaviour rating scales were used for accessing the child's pain and behaviour, respectively. The primary outcome (restoration survival) was analysed using the two-sample non-inferiority test for survival data using Cox Regression (non-inferiority/alternative hypothesis HR > 0.85; CI = 90%). Bootstrap Linear regression was used for cost analysis and logistic regression for pain and behaviour analysis (α = 5%). RESULTS: After 2-years, 157 restorations were evaluated (drop-out = 9.7%). The survival rate was RDI = 60.4% and CRI = 54.3%. The non-inferiority hypothesis was accepted by the Cox Regression analysis (HR = 1.33; 90% CI 0.88-1.99; p = 0.036). RDI was 53% more expensive when compared to the CRI group. No differences were found between the groups regarding pain (p = 0.073) and behaviour (p = 0.788). CONCLUSION: Cotton roll isolation proved to be non-inferior when compared to rubber dam for composite restorations longevity in primary molars. Furthermore, the latest presented the disadvantage of higher cost and longer procedure time. Clinical Significance The moisture control method does not influence the longevity of composite restorations in primary molars. Cotton roll isolation proved to be non-inferior to rubber dam isolation and is a viable option for restoring primary molars. Clinical trial registration registered NCT03733522 on 07/11/2018. The present trial was nested within another clinical trial, the CARies DEtection in Children (CARDEC-03-NCT03520309).

Efficacy of an iodoform-based filling material for pulpectomy of primary teeth: A 24-month non-inferiority randomized clinical trial.

AIM: The aim of this non-inferiority randomized clinical trial was to compare the efficacy of an iodoform-based paste (Guedes-Pinto -(GP)) as a filling material in pulpectomies of primary teeth, and a standard material composed by calcium hydroxide and iodoform (CaOH/Iodof paste; Vitapex® ). DESIGN: A total of 104 teeth from 61 children (3-8 years old) were randomly allocated to two groups according to filling materials. Children were followed up for 24 months. The primary endpoint was the treatment success rate evaluated through clinical and radiographic examinations at follow-up, and the secondary outcome was the analysis of the canal filling quality. Differences in the proportion of treatment success was calculated based on 95% confidence intervals (95% CI) and with the Miettinen and Nurminen method in the intention-to-treat population, considering a -20% of the non-inferiority limit. RESULTS: From 104 randomized teeth, 102 were followed up after 24 months (attrition rate of 1.9%). The success rate of teeth treated with the GP paste was 86.8% (95% CI: 69.9-94.9) and 78.4% (95% CI: 61.8-89.1) with the CaOH/Iodof paste. Consequently, a non-inferiority of the GP paste was observed when compared to the CaOH/Iodof paste (P < .001). CONCLUSION: The GP paste has a non-inferior success rate than the CaOH/Iodof paste used as filling material for pulpectomy in primary teeth.

Intranasal Dexmedetomidine Compared to a Combination of Intranasal Dexmedetomidine with Ketamine for Sedation of Children Requiring Dental Treatment: A Randomized Clinical Trial.

Outpatient pediatric sedation is challenging. This study aimed to test intranasal dexmedetomidine efficacy as a single drug or combined with ketamine (DK) to sedate children undergoing dental treatment. Children < 7 years were randomized into dexmedetomidine 2 mcg/kg and ketamine 1 mg/kg (DK) or dexmedetomidine 2.5 mcg/kg (D) groups. Videos from the dental sedation allowed the systematic assessment of children's behavior (primary outcome) according to the Ohio State University Behavioral Rating Scale (OSUBRS). Secondary outcomes were parental and dentist satisfaction, adverse events, and recovery time. The data were analyzed descriptively and through regression models. Participants were 88 children (44 per group; 50 boys). The duration of quiet behavior (OSUBRS) was higher than 50% (DK mean 58.4 [standard deviation 38.1]; D 55.2 [39.1]; p = 0.225). Parents (DK 78.0 [32.2]; D 72.7 [35.1]; p = 0.203) and dentists (KD 62.7 [41.0]; D 62.8 [40.1]; p = 0.339) were overall satisfied. Adverse events occurred in 16 cases (DK n = 10, 62.5%; D n= 6, 37.5%; p = 0.104) and were minor. The median recovery time in the DK group was 1.3 times greater than in group D (p < 0.05). Intranasal sedation with dexmedetomidine alone is equally efficacious and satisfactory for pediatric sedation with fewer adverse events and faster recovery than the DK combination.

What is the most accurate method for detecting caries lesions? A systematic review.

OBJECTIVE: To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface. METHODS: Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken. RESULTS: Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings. CONCLUSION: Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.

Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children.

BACKGROUND: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. METHODS: This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3-6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. RESULTS: 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. CONCLUSIONS: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.

What diagnostic strategy performs better for caries lesion detection on proximal surfaces of adolescents?

OBJECTIVE: To evaluate the performance of visual inspection alone and associated to radiographic and laser fluorescence (LF) methods in detecting non-evident caries lesions at adolescents' proximal surfaces. MATERIALS AND METHODS: Adolescents (12 to 17 years old) were assessed for the presence of caries lesions through visual inspection, radiographic examination, and LF method (DIAGNOdent pen), at non-cavitated (NC) and cavitated lesion (CAV) thresholds. Temporary separation with orthodontic rubbers followed by direct visual inspection was the reference standard method. Two examiners conducted the examinations, and the first examiner reassessed around 20% of the sample, to evaluate inter- and intra-examiner reproducibility, respectively. Sensitivity, specificity, accuracy, and utility values were calculated for the methods alone and combined with visual inspection using two different strategies: simultaneous and sequential combination. RESULTS: A total of 834 proximal surfaces (51 adolescents) were included. Visual inspection presented higher reproducibility values (higher than 0.98). Moreover, visual inspection presented higher sensitivity (around 0.51) than those obtained with other diagnostic strategies (varying from 0.09 to 0.20) at the NC threshold. For CAV, visual inspection presented higher specificity (0.996) than the sequential association with adjunct methods (around 0.97), but with lower sensitivity. Accuracy and utility values for combined strategies were similar or lower than those achieved with the visual inspection performed alone. CONCLUSION: Visual inspection alone performs better for detecting caries lesions in premolars and molars of adolescents than other diagnostic strategies. CLINICAL RELEVANCE: The best diagnostic strategy for caries detection of proximal caries lesions in adolescents is the visual inspection alone.

How researchers should select the best outcomes for randomised clinical trials in paediatric dentistry?

Randomised clinical trial (RCT) is the best study design to evaluate the effect of the treatment and preventive healthcare procedures. The effects of the tested treatments on patient's health are compared in terms of outcomes, which are used to evaluate the participants' health changes. However, these outcomes should be relevant for the target population. In that way, RCTs represent the type of primary study design that provides the most reliable evidence to implement therapies into the clinical practice. In this review, an outline of some aspects related to the choice of RCTs' outcomes was presented, focusing on the conduction of relevant trials in Paediatric Dentistry. The importance and necessity of defining a primary outcome were addressed, preferentially a clinically relevant endpoint. The patients should perceive this outcome, and changes in this variable should reflect directly patient's health improvement or impairment. Moreover, considerations about the objective or subjective variables, use of surrogate outcomes, and the increasing tendency to develop core outcome sets were also presented in this review. The main idea of this manuscript is the RCTs must evaluate outcomes relevant to the children's oral health in order to contribute to the implementation of treatments in the evidence-based health practice.

Methodological quality and risk of bias of systematic reviews about loading time of multiple dental implants in totally or partially edentulous patients: An umbrella systematic review.

BACKGROUND: There are several systematic reviews of multiple implant loading techniques, but results are conflicting. AIM: To perform an umbrella review on methodological quality of systematic reviews about techniques for loading multiple dental implants. MATERIAL AND METHODS: MEDLINE (PubMed) and Scopus were searched up to December 31, 2019. Unpublished literature was searched through OpenGray and references of included articles were manually verified. Eligibility criteria were: articles had to (1) be about multiple dental implants; (2) mention the moment of loading; (3) be a systematic review. Two independent reviewers participated in the entire process. Qualitative description of included studies as well as methodological quality measurement and risk of bias through AMSTAR and ROBIS were performed. RESULTS: 21 reviews were included. Thirteen stated that there was a similarity between loading techniques, two did not affirm which one was more appropriate and six mentioned that conventional technique was better. Eight papers were classified as high risk of bias, twelve as low and one as uncertain risk. CONCLUSION: When evaluating only studies with a low risk of bias, there are no significant differences in implant loading time.

Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial: The Caries Detection in Children-1 study.

BACKGROUND: Visual inspection (VIS) with radiographic examination (RAD) is the recommended diagnostic strategy for detecting caries in children; however, this recommendation is based on accuracy studies. The authors conducted a clinical trial to compare the detection and subsequent treatment of carious lesions in primary molars performed with VIS alone and with RAD. METHODS: Children (3-6 years old) were randomly assigned to 2 groups according to the diagnostic strategy used for caries detection on primary molars: VIS or RAD. Participants were diagnosed and treated according to the management plan related to the allocated group. The primary outcome was the number of new operative interventions during the 2-year follow-up period. Other secondary outcomes were also compared. Comparisons were performed with Mann-Whitney test using an intention-to-treat approach. RESULTS: Of the 252 children included and randomized, 216 were followed-up after 2 years (14.3% attrition rate). There was no difference between the groups for the primary outcome (P = .476). For the secondary outcomes, the RAD group had more restoration replacements (P = .038) and more restorations performed since the beginning of the study (P = .038) compared with the VIS group. In addition, the RAD group had a higher number of false-positive results than the VIS group (P < .001). CONCLUSIONS: Simultaneous use of VIS and RAD for caries diagnosis in primary molars of children who seek dental treatment does not provide additional benefits compared with VIS alone. PRACTICAL IMPLICATIONS: Dentists should perform VIS only, not RAD, for detecting carious lesions in preschool-aged children. ClinicalTrials.gov: NCT02078453.

Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study.

BACKGROUND: Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched. AIM: To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used. DESIGN: Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods. RESULTS: The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR. CONCLUSIONS: The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.

The Hall Technique and exfoliation of primary teeth: a retrospective cohort study.

Introduction There has been speculation about early exfoliation of carious primary molar teeth treated with the Hall Technique (HT).Aim To investigate the hypothesis that there is a difference in exfoliation times between teeth treated with the HT and contralateral teeth not treated with the HT.Methods Split-mouth retrospective cohort study of children treated in Dundee Dental Hospital and School (DDH&S). Radiographs and clinical records were assessed to compare children's ages at exfoliation for HT-treated primary molars and their contralateral teeth not treated with the HT. Primary molars' root resorption was also evaluated to assess whether the HT influenced the rate of root resorption.Results Using DDH&S's clinical systems, children's records (n = 13,160) were screened for children's ages and sequential radiographs, with 192 children potentially eligible. After assessing radiographs and clinical records, 39 children met the inclusion criteria. Their mean age at time of HT treatment was 7.2 years (range = 4.0 to 11.0; SD = 1.5). There was no evidence of a difference (p = 0.41) between children's ages at exfoliation of HT teeth (10.7; SD = 1.2 years) and contralateral teeth (11.0; SD = 1.4 years).Conclusion There is no evidence that use of the Hall Technique is associated with early exfoliation of primary molars.

Impact of a diagnostic workshop on undergraduate teaching-learning process for the diagnosis and management of tooth restorations-A randomised controlled study.

OBJECTIVE: The aim of this study was to investigate the impact of a diagnostic workshop on undergraduate teaching-learning process for the diagnosis and management of tooth restorations. METHODS: The first stage of the study was a randomised controlled study with two parallel groups: lecture (L) and lecture coupled with a diagnostic workshop (LW). A pool of cases of tooth restorations including secondary caries and marginal defects was used for training. Theoretical knowledge, perception about the activity and practical abilities were evaluated. The second stage of the study assessed students' theoretical knowledge retention six months following intervention. All students included in the first stage of the study were exposed to LW. Hence, a new control group of students not exposed to LW was selected. One-way analysis of variance, Fisher's exact test, Kruskal-Wallis test and multilevel regression analysis were used as part of statistical analysis. RESULTS: The LW group had greater scores for the assignment of lesion severity and activity, presence of marginal defect and treatment indication than the L group (P < 0.05). Multilevel regression analysis showed a positive impact of the workshop diagnosis in the correct assessment of lesion activity (P = 0.03). There was no statistical difference between the LW and L groups in students' perception of the activity. The LW group showed greater knowledge retention after six months than the L group (P = 0.027). CONCLUSION: Lecture coupled with diagnostic workshop improved students' practical skills of diagnosis restorations and knowledge retention in the six months following intervention.

Impact of the radiographic method on treatment decisions related to dental caries in primary molars: a before-after study.

OBJECTIVES: To evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars. MATERIALS AND METHODS: A total of 126 children aged 3-6 years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes. RESULTS: Changes from "no treatment" decided with visual inspection to "non-operative treatment" after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to "operative treatment" were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars. CONCLUSIONS: The impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces. CLINICAL RELEVANCE: The benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions?

The purpose of this study was to compare the performance of two different models of smartphone and a conventional camera with that of direct clinical examination in detecting caries lesions at different stages of progression in deciduous molars. The photographic equipment consisted of two smartphones (iPhone and Nexus 4) and a conventional macro camera setup. First, in the laboratory phase of the study, we compared the images of 20 exfoliated primary teeth having caries lesions at different stages. Then, in the clinical phase of the study, the images of 119 primary molars from fifteen children (3 to 6 years old) were used. All of the photographic images were taken using the previously described devices. In both groups, two examiners, blinded to the photographic equipment used, assessed the images independently on a computer screen, and classified them according to the International Caries Detection and Assessment System (ICDAS). The teeth were then examined directly by two other experienced examiners, and the consensus reached was considered the reference standard. Parameters of validity, such as percentage of correct answers, agreement with the reference standard, sensitivity, specificity and inter-examiner agreement (using the weighted kappa test) were calculated. The examiners performed similarly in both in vitro and in vivo studies. Inter-examiner reliability was approximately 0.7 for all the devices in the laboratory setting, and for the macro camera photography system in the clinical setting, but it was approximately 0.9 for the iPhone and Nexus images taken in vivo. With regard to the percentage of correct answers, the highest values were observed for sound and extensive caries lesions in both laboratory and clinical settings. The percentage of correct answers for initial and moderate lesions was particularly low in the clinical evaluation, irrespective of the camera devices used. Therefore, we concluded that photographic diagnosis using smartphone images is feasible and accurate for distinguishing sound tooth surfaces from extensive caries lesions; however, photographic images are not a good method for accurately detecting initial and moderate caries lesions.

Prevalence of early loss of primary molar and its impact in schoolchildren's quality of life.

BACKGROUND: Evidence regarding the impact of premature loss of primary molars on oral health-related quality of life (OHRQoL) is lacking. AIM: To evaluate the prevalence of premature loss of primary molars in schoolchildren and its impact on OHRQoL. DESIGN: We randomly selected 667 children aged 8-9 years enrolled in public and private schools from Aracaju (Brazil). The presence of untreated dental caries and early loss of primary molars were recorded, and its impacts on OHRQoL evaluated using Child Perceptions Questionnaire (CPQ8-10 ). Influence of some variables on tooth loss and OHRQoL was assessed by multilevel Poisson's regression analysis (P < 0.05). RESULTS: The prevalence for early tooth loss was 65.4% (95% confidence interval 51.1%-77.3%). Children with untreated dental caries and attending public schools presented higher prevalence of early tooth loss. Moreover, early loss of primary molars provoked negative impact on OHRQoL considering total score of CPQ8-10 and domains "oral symptoms," "functional limitations" and "emotional well-being." Children presenting early teeth loss presented significantly higher scores of CPQ8-10 , as well as females and children with dental caries in other teeth. CONCLUSIONS: The prevalence of early loss of primary molars is high, and it impacts the OHRQoL of children aged 8-9 years.