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1.
J Contemp Dent Pract ; 22(4): 365-372, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267005

RESUMO

AIM AND OBJECTIVE: This study was conducted to evaluate the accuracy of a light-induced fluorescence intraoral camera vs the visual-tactile assessment method according to the modified International caries detection and assessment system-II (ICDAS-II) criteria clinically in the detection of initial occlusal caries. MATERIALS AND METHODS: Occlusal surfaces of 260 molar and premolar teeth from 52 adult participants were examined by two calibrated observers, using two diagnostic methods. Teeth were initially assessed visually according to the criteria of the ICDAS-II, and then by fluorescence camera (Soprolife®). Inter- and intraobserver agreements were measured using Cohen's kappa test. Correlation between methods was calculated using Wilcoxon signed-rank test, and effect size for comparison between the two modalities. The sensitivity, specificity, predictive values, diagnostic accuracy, likelihood ratios (LRs), area under the receiver operating characteristic (ROC) curve (AUC), and 95% confidence interval (95% CI) of the AUC for caries detection by Soprolife® were evaluated. RESULTS: A significant positive correlation was found between the ICDAS-II and camera measurements (p-value <0.001, effect size = 0.572). The sensitivity of Soprolife® was 94.2%, specificity 84.2%, positive predictive value 87.1%, negative predictive value 92.8%, positive LR 6%, negative LR 0.07%, and the diagnostic accuracy 89.5%. AUC was 0.909 with 95% CI (0.863-0.955). There was a perfect intraobserver agreement (kappa = 1.00) for both testing modalities. There was moderate interobserver agreement (kappa = 0.520) with regards to ICDAS, while for Soprolife®, there was substantial interobserver agreement (kappa = 0.798). CONCLUSION: Soprolife® can be used as a valid and reliable assessment tool for occlusal caries detection. CLINICAL SIGNIFICANCE: Light-induced fluorescence intraoral camera is an efficient tool in the detection of initial occlusal caries.


Assuntos
Cárie Dentária , Dente , Adulto , Cárie Dentária/diagnóstico , Suscetibilidade à Cárie Dentária , Fluorescência , Humanos , Dente Molar , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
2.
Medicine (Baltimore) ; 100(25): e26435, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160434

RESUMO

ABSTRACT: The aim of this study was to evaluate the association between sociodemographic factors and noncavitated and cavitated caries lesions in Mexican schoolchildren.This cross-sectional study was conducted in 2020 on 8-to-12-year-old schoolchildren of different socioeconomic status (SES). The caries was evaluated using ICDAS II, SES was evaluated using three categories---a high, middle, or low-income level---of the CONAPO. Multinomial logistic regression analyses were performed in order to ascertain the associations between socioeconomic factors and noncavitated and cavitated caries lesions.The prevalence of noncavitated lesions was 38.0% and cavitated lesions was 43.4% in permanent dentition. In all the samples, 50.6% of schoolchildren had poor oral hygiene. About 52.5% of the mothers and 64.7% of the fathers had less than 9 years of education. Schoolchildren with a low-income level have more cavitated lesions (ICDAS II 4-6) than schoolchildren with high-income level (56.3% vs 15.8%, P = .009). The multinomial logistic regression models showed that mother's level of education <9 years and low-income level were significantly associated with cavitated caries lesions (ICDAS II 4-6), [odds ratio = 1.79 (1.17 - 2.75); P = .007], [OR = 2.21 (1.23 - 3.97); P = .008], respectively. The socioeconomic level was not associated with noncavitated caries lesions (ICDAS II 1-3).An association was found between the presence of cavitated caries lesions and the subject's mother's level of education and a low-income level. Socioeconomic factors were found to be associated with inequalities in caries distribution in the age group studied.


Assuntos
Cárie Dentária/epidemiologia , Exposição da Polpa Dentária/epidemiologia , Criança , Estudos Transversais , Cárie Dentária/complicações , Cárie Dentária/diagnóstico , Exposição da Polpa Dentária/diagnóstico , Exposição da Polpa Dentária/etiologia , Escolaridade , Feminino , Humanos , Renda , Masculino , México/epidemiologia , Mães/educação , Mães/estatística & dados numéricos , Prevalência , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Classe Social
3.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 39(3): 300-305, 2021 Jun 01.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34041879

RESUMO

OBJECTIVES: This study aimed to compare the salivary biochemical indices between caries-free individuals and those with early childhood caries (ECC), and construct a saliva-based caries diagnostic model by analyzing the correlation between salivary biochemical indices and caries severity. METHODS: A total of 120 children aged 4-6 years were selected and divided into two groups: individuals with ECC (C group, n=60) and healthy children (H group, n=60). Salivary samples were collected to compare the pH, total protein, and ion concentrations between the two groups. The correlation between the salivary biochemical indices and caries severity was examined, and an ECC diagnostic model was established. RESULTS: The NO3- concentration significantly decreased in the C group, whereas the Cl-, Br-, NH4+, and Mg2+ concentrations significantly increased in the C group (P<0.05). In addition, the salivary caries severity had a significantly negative correlation with the NO3- concentration but had a positive correlation with Br-, Cl-, and NH4+ concentrations (P<0.05). The ECC diagnostic model based on salivary biochemical indices could yield satisfactory results in terms of distinguishing the C and H groups with over 85% accuracy. CONCLUSIONS: Salivary biochemical indices can contribute to the diagnosis and risk assessment of ECC.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Criança , Pré-Escolar , Cárie Dentária/diagnóstico , Humanos , Saliva
4.
BMC Oral Health ; 21(1): 255, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980210

RESUMO

BACKGROUND: Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. METHODS: The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. RESULTS: 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959-0.966) than those combining parameters (AIC:365-393, C:0.958-0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). CONCLUSIONS: Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Criança , Cárie Dentária/diagnóstico , Testes de Atividade de Cárie Dentária , Esmalte Dentário , Humanos , Dente Decíduo
5.
J Contemp Dent Pract ; 22(1): 89-92, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34002716

RESUMO

AIM: This study aimed to evaluate the dental students' performance in ICDAS (International Caries Detection and Assessment System) coding with different levels of clinical experience. MATERIALS AND METHODS: Dental students (n = 122) in their clinical years, year 3 (n = 37), year 4 (n = 44), and year 5 (n = 41) received training (two-hour introductory lecture on ICDAS, followed by a 90 min e-learning video, and practice sessions using extracted teeth and photographs) from a calibrated expert. After training, the students examined a prevalidated set of extracted teeth and assigned scores in two sessions. The intra- and inter-examiner agreement between students was analyzed using weighted kappa statistics and a focus group discussion was conducted for qualitative feedback. RESULTS: The range of kappa values for intra-examiner agreement among the year 3, 4, and 5 students for ICDAS caries code (0.611-0.879, 0.633-0.848, and 0.645-1.000) and restoration code (0.615-0.942, 0.612-0.923, 0.653-1.000), respectively. The range of kappa values for inter-examiner agreement for year 3, 4, and 5 students with a trained expert for ICDAS caries code (0.526-0.713, 0.467-0.810, and 0.525-0.842) and restoration code (0.531-0.816, 0.682-0.842, and 0.645-0.928), respectively. CONCLUSION: The ICDAS system is a promising tool for caries detection and its implementation in the curriculum was perceived by dental students as an effective method. In general, there was moderate to substantial agreement for ICDAS caries and restoration code between students of different academic year groups and with a trained ICDAS expert. CLINICAL SIGNIFICANCE: ICDAS is a simple, logical, and evidence-based system for the detection and classification of caries. Introducing ICDAS to dental students enables them to detect caries in a reliable and reproducible manner irrespective of their past clinical experience and also significantly improves their caries detection skills.


Assuntos
Cárie Dentária , Estudantes de Odontologia , Currículo , Cárie Dentária/diagnóstico , Educação em Odontologia , Humanos , Reprodutibilidade dos Testes
6.
Oper Dent ; 46(1): 87-99, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33882139

RESUMO

CLINICAL RELEVANCE: Effective methods to control incipient caries lesions are needed. In this investigation, several methods provide encouraging results. SUMMARY: This study aimed to evaluate in situ the inhibition of incipient caries lesion progression using different treatment protocols and to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent, DIAGNOdent pen, and VistaProof fluorescence camera [FC]) in monitoring this process. The research was conducted in four phases: (1) at baseline, (2) after a first cariogenic challenge, (3) after treatment modalities, and (4) after a second cariogenic challenge. Sixteen volunteers used intraoral acrylic palatal appliances, each containing six enamel blocks (n=96). The cariogenic challenge was performed using a 20% sucrose solution over a 14-day period. The appliances were removed eight times a day and, upon removal, two drops of the solution were placed onto each enamel block. The enamel blocks were randomly assigned to three treatment groups: fluoride varnish ([FV] Duraphat; n=32), resin infiltrant ([RI] Icon; n=32), and adhesive system ([AS] Scotchbond; n=32). At the end of each phase, the surface microhardness (SMH) was measured, and two trained examiners evaluated the specimens using fluorescence-based methods. In addition, integrated mineral loss (ΔΔZ; vol%.min x µm) and lesion depth (ΔLD; µm) were evaluated using transverse microradiography. A two-way analysis of variance and a Tukey post hoc test were calculated (α=5%). Significant differences in SMH were observed according to the treatment, phases, and interaction of factors (p<0.001). Treatment with FV resulted in significantly higher SMH values in phases 3 and 4 compared to RI and AS, with the last two treatments resulting in similar values (p>0.05). The ΔΔZ value was similar for FV and AS but significantly higher for RI (p=0.016). ΔLD was not significantly different among the groups (p=0.126). Significant differences in the measurement of fluorescence for each fluorescence-based method were observed between each phase of the study (p<0.05). It can be concluded that all treatments were effective in inhibiting the in situ progression of incipient lesions, although to different degrees, with minor mineral loss changes observed for the AS and FV. Besides, all fluorescence-based methods tested, except for that using the FC device, were effective in monitoring caries lesion progression.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Cariostáticos , Cárie Dentária/diagnóstico , Cárie Dentária/terapia , Esmalte Dentário , Fluorescência , Humanos , Microrradiografia
7.
Photodiagnosis Photodyn Ther ; 34: 102252, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33711531

RESUMO

AIM: This study aimed to validate the in vivo performance of Diagnodent and Vista proof devices with ICDAS clinical criteria on incipient carious lesions in adults. METHODS: A total of 44 adult patients with 230 incipient occlusal caries took part in the present study. These patients were assessed for caries with ICDAS clinical criteria, and then they were examined with Diagnodent pen™ (DP) and Vista proof™ (VP) fluorescence devices. Sensitivity, specificity accuracy, and ICC agreement between devices with ICDAS criteria, which served as a gold standard, were evaluated. RESULTS: Regarding the caries diagnostic devices, sensitivity and specificity found 0,61 and 0,51 for DP, and 0,64 and 0,54 for VP, respectively. The different detection methods showed no differences in diagnostic capacity (Az values) each other, and ICC values with ICDAS criteria were calculated low. CONCLUSIONS: DP and VP do not contribute to incipient occlusal carious lesions' better detective ability compared with visual ICDAS clinical criteria. The DP and VP devices presented no differences in diagnostic ability and measured lesion depth concerning the visual examination.


Assuntos
Cárie Dentária , Fotoquimioterapia , Adulto , Cárie Dentária/diagnóstico , Fluorescência , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
8.
Cochrane Database Syst Rev ; 3: CD014547, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33724442

RESUMO

BACKGROUND: Caries is one of the most prevalent, preventable conditions worldwide. A wide variety of management options are available at different thresholds of disease, ranging from non-operative preventive strategies such as improved oral hygiene, reduced sugar diet, and application of topical fluoride, to minimally invasive treatments for early lesions which are limited to enamel, through to selective removal and restoration for extensive lesions. The cornerstone of caries detection is a visual and tactile dental examination, however, an increasing array of methods of caries lesion detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES: Our primary objective was to determine the diagnostic accuracy of different electrical conductance devices for the detection and diagnosis of non-cavitated coronal dental caries in different populations (children, adolescents, and adults) and when tested against different reference standards. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 26 April 2019); Embase Ovid (1980 to 26 April 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 26 April 2019); and the World Health Organization International Clinical Trials Registry Platform (to 26 April 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy studies that compared electrical conductance devices with a reference standard of histology or an enhanced visual examination. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. We included studies using previously extracted teeth or those that recruited participants with teeth believed to be sound or with early lesions limited to enamel. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information was displayed as coupled forest plots, and plotted as summary receiver operating characteristic (SROC) plots, displaying the sensitivity-specificity points for each study. Due to variability in thresholds we estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. MAIN RESULTS: We included seven studies reporting a total of 719 tooth sites or surfaces, with an overall prevalence of the target condition of 73% (528 tooth sites or surfaces). The included studies evaluated two index tests: the electronic caries monitor (ECM) (four studies, 475 tooth surfaces) and CarieScan Pro (three studies, 244 tooth surfaces). Six studies used histology as the reference standard, one used an enhanced visual examination. No study was considered to be at low risk of bias across all four domains or low concern for applicability or both. All studies were at high (five studies) or unclear (two studies) risk of bias for the patient selection domain. We judged two studies to be at unclear risk of bias for the index test domain, and one study to be at high risk of bias for the reference standard and flow and timing domains. We judged three studies to be at low concern for applicability for patient selection, and all seven studies to be of low concern for reference standard and flow and timing domains. Studies were synthesised using a hierarchical method for meta-analysis. There was variability in the results of the individual studies, with sensitivities which ranged from 0.55 to 0.98 and specificities from 0 to 1.00. These extreme values of specificity may be explained by a low number of healthy tooth surfaces in the included samples. The diagnostic odds ratio (DOR) was 15.65 (95% CI 1.43 to 171.15), and indicative of the variability in the included studies. Through meta-regression we observed no meaningful difference in accuracy according to device type or dentition. Due to the small number of studies we were unable to formally investigate other potential sources of heterogeneity. We judged the certainty of the evidence as very low, and downgraded for risk of bias due to limitations in the design and conduct of the included studies, imprecision arising from the relatively small number of surfaces studied, and inconsistency due to the variability of results. AUTHORS' CONCLUSIONS: The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ is particularly challenging. The evidence base to support the detection and diagnosis of caries with electrical conductance devices is sparse. Newer electrical conductance devices show promise and further research at the enamel caries threshold using a robust study design to minimise bias is warranted. In terms of applicability, any future studies should be carried out in a clinical setting to provide a realistic assessment within the oral cavity where plaque, staining, and restorations can be problematic.


Assuntos
Cárie Dentária/diagnóstico , Condutividade Elétrica , Adolescente , Adulto , Criança , Intervalos de Confiança , Instrumentos Odontológicos , Humanos , Estudos Prospectivos , Padrões de Referência , Sensibilidade e Especificidade
9.
Trials ; 22(1): 156, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618735

RESUMO

BACKGROUND: Despite the implementation of the preschool oral healthcare programme (POHP) for 5-6-year-old children over the past 3 decades in Malaysia, dental plaque and caries levels in this age group remain high. Among the child-level attributable factors are unhealthy self-care behaviours (poor oral hygiene and high sugary diet). In order to improve the children's oral health, an improved programme called the 'Senyuman Indah Milik Semua' Programme (SIMSP) or 'Beautiful Smile for All' programme is introduced. In this programme, a triad of dental hygienist-teacher-parent works together to improve children's oral hygiene levels compared with the existing POHP that involves dental hygienists only. The aim of this study is to compare the effect of the SIMSP versus the existing POHP on oral hygiene levels of 5-6-year-old children in the Kampar district, Perak state, Malaysia. METHODS: This study is a pragmatic, cluster-randomised, parallel-group, matched pair, controlled trial with blinded outcome assessment. Randomisation is performed using a computer-generated table with a 1:1 allocation comparing the SIMSP and the POHP involving 28 preschools in the Kampar district, Perak, Malaysia. The intervention consists of preschool visits by a group of dental therapists, in-class oral health lessons and daily toothbrushing conducted by class teacher, child home toothbrushing supervised by parents, and infographic oral health messages to parents. The control consists of the existing POHP that involves preschool visits by a group of dental therapists only. The trial lasts for 6 months. Primary outcome variable is the mean plaque score change after 6 months. To determine the feasibility of the SIMSP, a process evaluation will be conducted using the perspectives of dental therapists, teachers, and parents on the appropriateness, effectiveness, facilitators, and barriers to the SIMSP implementation as well as an audit trail to assess the trial intervention. DISCUSSION: Cluster randomisation may lead to a random effect and cluster selection bias. These factors will be accounted for when analysing the data and interpreting the outcomes. The effectiveness of the SIMSP will be evaluated by comparing the results with those of the POHP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04339647 . Registered on 5 April 2020 - Retrospectively registered.


Assuntos
Cárie Dentária , Higiene Bucal , Criança , Pré-Escolar , Atenção à Saúde , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Humanos , Malásia , Ensaios Clínicos Controlados Aleatórios como Assunto , Instituições Acadêmicas , Escovação Dentária
10.
J Dent Hyg ; 95(1): 50-56, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33627453

RESUMO

Purpose: The Michigan Caries Prevention Program (MCPP) aimed to reduce the burden of childhood dental disease in the state of Michigan by offering training programs to implement preventive oral health services during well-child medical visits. The purpose of this study was to elicit feedback from the participants of the MCPP and determine which oral health services were implemented post-training, identify implementation barriers and assess provider comfort levels in performing oral screenings and fluoride applications.Methods: A descriptive electronic survey was utilized for data collection. A 15-item survey consisting of multiple choice and Likert scale questions was sent to medical providers who had participated in the MCPP from 2015-2017 (n=1115). Descriptive statistics were used to analyze the data.Results: A total of 170 surveys were completed for a 15% response rate. The majority of the participants were physicians (82%, n=134). Nearly all participants reported performing oral screenings and fluoride varnish application post-training (93%, n=153). Participants felt more comfortable applying fluoride varnish than performing oral screenings (80%, n=121 vs 70%, n=112), respectively. Barriers included lack of time, understaffed, staff resistance, feeling that procedures were outside of their scope of practice and disinterest from parents or safety concerns. A majority (70%, n=112) reported that the MCPP training did not help to establish new relationships with community dental providers.Conclusion: Medical providers indicate that the MCPP training was beneficial and that they were willing and able to incorporate oral health screenings and fluoride varnish applications in their practice, but that they face challenges in developing relationships with dental care providers. Opportunities for dental hygienists to work in non-traditional medical-dental integration practice settings may help to increase oral health services offered to patients and improve communication between health care providers.


Assuntos
Cárie Dentária , Fluoretos , Criança , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Humanos , Michigan , Percepção
11.
Health Qual Life Outcomes ; 19(1): 46, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546712

RESUMO

BACKGROUND: The oral health related quality of life (OHRQoL) of children in Bangladesh has not yet been measured, as there is no validated OHRQoL measure for that population. The aim of this study was to cross-culturally adapt the child self-report and parental proxy report versions of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) into Bengali and test their psychometric properties: face validity, construct validity (convergent and discriminant validity) and reliability (internal consistency and test-retest reliability), among 5-9-year-old children and their parents in Bangladesh and assess associations between dental caries/sepsis and OHRQoL in this population. METHODS: The forward-backward translated Bengali SOHO-5 was piloted among 272 children and their parents to test its face validity. The questionnaire was administered to 788 children and their parents to evaluate its psychometric properties. Internal consistency of Bengali SOHO-5 was assessed using Cronbach's alpha, and test-retest reliability was assessed using Kappa. Convergent and discriminant validity were assessed through nonparametric tests. The calculation of effect sizes and standard error of measurement facilitated the assessment of minimally important difference (MID) for SOHO-5. The associations of reporting an oral impact with caries and sepsis were assessed via logistic regression models. RESULTS: Both child self-report and parental proxy report questionnaires showed good face validity. Cronbach's alpha scores were 0.79 and 0.87 for child and parental questionnaire, respectively. A weighted Kappa score of 0.85 demonstrated test-retest reliability of child questionnaire. SOHO-5 scores were significantly associated with subjective oral health outcomes and discriminated clearly between different caries severity and sepsis groups. These differences were considerably higher than the MID. After adjusting for child's age, sex, setting, maternal education and family income, the odds of reporting an oral impact were 2.25 (95% CI 1.98-2.56) and 4.44 (95% CI 3.14-6.28) times higher for each additional tooth with caries and sepsis, respectively. CONCLUSION: This study provided strong evidence supporting the validity and reliability of both versions of Bengali SOHO-5 as OHRQoL measures. Dental caries and sepsis were associated with poor OHRQoL in this population. The Bengali SOHO-5 is expected to be a useful outcome measure for research and clinical purposes in Bengali speaking child populations.


Assuntos
Cárie Dentária/diagnóstico , Saúde Bucal/normas , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Bangladesh , Pré-Escolar , Comparação Transcultural , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pais , Psicometria , Reprodutibilidade dos Testes , Tradução
12.
J Dent Res ; 100(6): 615-622, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33423574

RESUMO

Dental caries is characterized by a dysbiotic shift at the biofilm-tooth surface interface, yet comprehensive biochemical characterizations of the biofilm are scant. We used metabolomics to identify biochemical features of the supragingival biofilm associated with early childhood caries (ECC) prevalence and severity. The study's analytical sample comprised 289 children ages 3 to 5 (51% with ECC) who attended public preschools in North Carolina and were enrolled in a community-based cross-sectional study of early childhood oral health. Clinical examinations were conducted by calibrated examiners in community locations using International Caries Detection and Classification System (ICDAS) criteria. Supragingival plaque collected from the facial/buccal surfaces of all primary teeth in the upper-left quadrant was analyzed using ultra-performance liquid chromatography-tandem mass spectrometry. Associations between individual metabolites and 18 clinical traits (based on different ECC definitions and sets of tooth surfaces) were quantified using Brownian distance correlations (dCor) and linear regression modeling of log2-transformed values, applying a false discovery rate multiple testing correction. A tree-based pipeline optimization tool (TPOT)-machine learning process was used to identify the best-fitting ECC classification metabolite model. There were 503 named metabolites identified, including microbial, host, and exogenous biochemicals. Most significant ECC-metabolite associations were positive (i.e., upregulations/enrichments). The localized ECC case definition (ICDAS ≥1 caries experience within the surfaces from which plaque was collected) had the strongest correlation with the metabolome (dCor P = 8 × 10-3). Sixteen metabolites were significantly associated with ECC after multiple testing correction, including fucose (P = 3.0 × 10-6) and N-acetylneuraminate (p = 6.8 × 10-6) with higher ECC prevalence, as well as catechin (P = 4.7 × 10-6) and epicatechin (P = 2.9 × 10-6) with lower. Catechin, epicatechin, imidazole propionate, fucose, 9,10-DiHOME, and N-acetylneuraminate were among the top 15 metabolites in terms of ECC classification importance in the automated TPOT model. These supragingival biofilm metabolite findings provide novel insights in ECC biology and can serve as the basis for the development of measures of disease activity or risk assessment.


Assuntos
Cárie Dentária , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Suscetibilidade à Cárie Dentária , Humanos , Metabolômica , North Carolina/epidemiologia , Prevalência
13.
Cochrane Database Syst Rev ; 1: CD013855, 2021 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-33502759

RESUMO

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non-invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection and diagnosis is a visual and tactile dental examination, although alternative approaches are available. These include illumination-based devices that could potentially support the dental examination. There are three categories of illumination devices that exploit various methods of application and interpretation, each primarily defined by different wavelengths, optical coherence tomography (OCT), near-infrared (NIR), and fibre-optic technology, which incorporates more recently developed digital fibre optics (FOTI/DIFOTI). OBJECTIVES: To estimate the diagnostic test accuracy of different illumination tests for the detection and diagnosis of enamel caries in children or adults. We also planned to explore the following potential sources of heterogeneity: in vitro or in vivo studies with different reference standards; tooth surface (occlusal, proximal, smooth surface, or adjacent to a restoration); single or multiple sites of assessment on a tooth surface; and the prevalence of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 15 February 2019); Embase Ovid (1980 to 15 February 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 15 February 2019); and the World Health Organization International Clinical Trials Registry Platform (to 15 February 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared the use of illumination-based devices with a reference standard (histology, enhanced visual examination with or without radiographs, or operative excavation). These included prospective studies that evaluated the diagnostic accuracy of a single index test and studies that directly compared two or more index tests. Both in vitro and in vivo studies of primary and permanent teeth were eligible for inclusion. We excluded studies that explicitly recruited participants with caries into dentine or frank cavitation. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. The comparative accuracy of different illumination devices was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS: We included 24 datasets from 23 studies that evaluated 16,702 tooth surfaces. NIR was evaluated in 6 datasets (673 tooth surfaces), OCT in 10 datasets (1171 tooth surfaces), and FOTI/DIFOTI in 8 datasets (14,858 tooth surfaces). The participant selection domain had the largest number of studies judged at high risk of bias (16 studies). Conversely, for the index test, reference standard, and flow and timing domains the majority of studies were judged to be at low risk of bias (16, 12, and 16 studies respectively). Concerns regarding the applicability of the evidence were judged as high or unclear for all domains. Notably, 14 studies were judged to be of high concern for participant selection, due to selective participant recruitment, a lack of independent examiners, and the use of an in vitro study design. The summary estimate across all the included illumination devices was sensitivity 0.75 (95% confidence interval (CI) 0.62 to 0.85) and specificity 0.87 (95% CI 0.82 to 0.92), with a diagnostic odds ratio of 21.52 (95% CI 10.89 to 42.48). In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 57%, this would result in 142 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 56 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). A formal comparison of the accuracy according to device type indicated a difference in sensitivity and/or specificity (Chi2(4) = 34.17, P < 0.01). Further analysis indicated a difference in the sensitivity of the different devices (Chi2(2) = 31.24, P < 0.01) with a higher sensitivity of 0.94 (95% CI 0.88 to 0.97) for OCT compared to NIR 0.58 (95% CI 0.46 to 0.68) and FOTI/DIFOTI 0.47 (95% CI 0.35 to 0.59), but no meaningful difference in specificity (Chi2(2) = 3.47, P = 0.18). In light of these results, we planned to formally assess potential sources of heterogeneity according to device type, but due to the limited number of studies for each device type we were unable to do so. For interpretation, we presented the coupled forest plots for each device type according to the potential source of heterogeneity. We rated the certainty of the evidence as low and downgraded two levels in total due to avoidable and unavoidable study limitations in the design and conduct of studies, indirectness arising from the in vitro studies, and imprecision of the estimates. AUTHORS' CONCLUSIONS: Of the devices evaluated, OCT appears to show the most potential, with superior sensitivity to NIR and fibre-optic devices. Its benefit lies as an add-on tool to support the conventional oral examination to confirm borderline cases in cases of clinical uncertainty. OCT is not currently available to the general dental practitioner, and so further research and development are necessary. FOTI and NIR are more readily available and easy to use; however, they show limitations in their ability to detect enamel caries but may be considered successful in the identification of sound teeth. Future studies should strive to avoid research waste by ensuring that recruitment is conducted in such a way as to minimise selection bias and that studies are clearly and comprehensively reported. In terms of applicability, any future studies should be undertaken in a clinical setting that is reflective of the complexities encountered in caries assessment within the oral cavity.


Assuntos
Cárie Dentária/diagnóstico , Tecnologia de Fibra Óptica , Espectroscopia de Luz Próxima ao Infravermelho , Tomografia de Coerência Óptica , Transiluminação/métodos , Conjuntos de Dados como Assunto , Esmalte Dentário , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Padrões de Referência , Viés de Seleção , Sensibilidade e Especificidade
14.
Int J Paediatr Dent ; 31(3): 361-371, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32815217

RESUMO

AIM: This study aimed to investigate whether carbonic anhydrase VI activity (CA VIACT ), pH, and buffering capacity (BC) in saliva and biofilm could predict the number of lesion occurrence and early childhood caries (ECC). DESIGN: A cross-sectional study was performed in a sample of 44 children aged 4 to 5 years who were examined regarding their caries status (dmfs + active white spot lesions-WSL) and allocated into two groups: ECC and caries-free (CF). Saliva and biofilm were collected to determine pH, BC, and CA VIACT . Data were analyzed using the Student t test, and multiple linear regression and logistic regression analyses followed by the ROC curve. RESULTS: Children with ECC exhibited lower pH and BC in saliva and a higher CA VIACT in both saliva and biofilm. Only saliva pH could predict the dmfs + active WSL. In biofilm, if CA VIACT is increased by one pixel/µg, 0.85 ± 0.28 increase is expected in the number of active WSL. Salivary pH and CA VIACT in saliva and biofilm had the power to predict ECC occurrence. CONCLUSION: Changes in saliva pH and CA VIACT in biofilm predicted the number of lesion occurrence. Furthermore, CA VIACT in both saliva and biofilm can predict propensity for ECC.


Assuntos
Cárie Dentária , Saliva , Biofilmes , Anidrases Carbônicas , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/diagnóstico , Suscetibilidade à Cárie Dentária , Humanos , Concentração de Íons de Hidrogênio
15.
Clin Oral Investig ; 25(3): 1281-1289, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32613436

RESUMO

INTRODUCTION: The aim of this study was to experimentally investigate the potential of different light wavelengths to distinguish between healthy and carious tissue using a two-circle goniometer. MATERIALS AND METHODS: Tooth slices were prepared from extracted human teeth that were caries free (n = 15) or had occlusal caries lesions (n = 10). The tooth slices were irradiated with diode laser modules of different wavelengths (532, 650, 780 nm). The transmitted and scattered laser light was spatially measured with a detector rotating on a two-circle goniometer. The anisotropy factor and attenuation coefficients were calculated. RESULTS: Enamel was more transparent than dentin and showed wavelength-dependent attenuation. Healthy dentin showed strong light scattering at all wavelengths, independent of the tested wavelength. The calculated attenuation coefficients of carious and healthy tooth tissue differed significantly (p < 0.05; t test). In contrast to healthy enamel, carious enamel showed lower light transmission and an increase in scattering. Differences in the light attenuation of carious versus healthy dentin were less pronounced than those for enamel. Carious dentin was slightly more transparent than healthy dentin. The light of longer wavelengths showed a better penetration of all tooth structures compared with shorter wavelengths. CONCLUSION: Healthy and carious dentin and enamel exhibited distinct optical properties using laser light at different wavelengths. In dentin, changes in the optical properties caused by caries are significantly less pronounced. CLINICAL RELEVANCE: The clear distinction between healthy and carious enamel makes optical caries diagnostic systems ideal tools for early caries detection.


Assuntos
Cárie Dentária , Dente , Cárie Dentária/diagnóstico , Suscetibilidade à Cárie Dentária , Esmalte Dentário , Dentina , Humanos
16.
J Dent Res ; 100(4): 369-376, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33198554

RESUMO

Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists' mean accuracy was significantly lower at 0.71 (minimum-maximum: 0.61-0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19-0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69-0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%-97.5%: 61-65] y) and less costly (298 [244-367] euro) than assessment without AI (62 [59-64] y; 322 [257-394] euro). The ICER was -13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.


Assuntos
Suscetibilidade à Cárie Dentária , Cárie Dentária , Inteligência Artificial , Análise Custo-Benefício , Cárie Dentária/diagnóstico , Humanos , Método de Monte Carlo
17.
J Dent Res ; 100(6): 599-607, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33356775

RESUMO

As the most common chronic disease in preschool children in the United States, early childhood caries (ECC) has a profound impact on a child's quality of life, represents a tremendous human and economic burden to society, and disproportionately affects those living in poverty. Caries risk assessment (CRA) is a critical component of ECC management, yet the accuracy, consistency, reproducibility, and longitudinal validation of the available risk assessment techniques are lacking. Molecular and microbial biomarkers represent a potential source for accurate and reliable dental caries risk and onset. Next-generation nucleotide-sequencing technology has made it feasible to profile the composition of the oral microbiota. In the present study, 16S ribosomal RNA (rRNA) gene sequencing was applied to saliva samples that were collected at 6-mo intervals for 24 mo from a subset of 56 initially caries-free children from an ongoing cohort of 189 children, aged 1 to 3 y, over the 2-y study period; 36 children developed ECC and 20 remained caries free. Analyses from machine learning models of microbiota composition, across the study period, distinguished between affected and nonaffected groups at the time of their initial study visits with an area under the receiver operating characteristic curve (AUC) of 0.71 and discriminated ECC-converted from healthy controls at the visit immediately preceding ECC diagnosis with an AUC of 0.89, as assessed by nested cross-validation. Rothia mucilaginosa, Streptococcus sp., and Veillonella parvula were selected as important discriminatory features in all models and represent biomarkers of risk for ECC onset. These findings indicate that oral microbiota as profiled by high-throughput 16S rRNA gene sequencing is predictive of ECC onset.


Assuntos
Cárie Dentária , Microbiota , Pré-Escolar , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Suscetibilidade à Cárie Dentária , Humanos , Microbiota/genética , Micrococcaceae , Qualidade de Vida , RNA Ribossômico 16S/genética , Reprodutibilidade dos Testes , Veillonella
18.
Support Care Cancer ; 29(1): 135-143, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32323001

RESUMO

PURPOSE: This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. METHODS: In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. RESULTS: Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p = 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). CONCLUSION: These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.


Assuntos
Cárie Dentária/terapia , Neoplasias Pulmonares/cirurgia , Periodontite/terapia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Infecções Respiratórias/prevenção & controle , Adulto , Idoso , Cárie Dentária/diagnóstico , Empiema/tratamento farmacológico , Empiema/prevenção & controle , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/patologia , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Razão de Chances , Saúde Bucal , Pacientes , Periodontite/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecções Respiratórias/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco
19.
Clin Ter ; 171(1): e80-e86, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33346334

RESUMO

AIM: Aim of this literature overview was to analyze the diagnostic procedures of hidden caries lesions and to present a restorative protocol. METHODS: A literature overview was performed in order to evaluate hidden caries etiological hypothesis and the reported prevalence. The diagnostic procedure is performed with the aid of an intra-oral fluorescence based camera and the restorative procedure is completed with the use of a novel bisphenol-A free composite. RESULTS: Non cavitated occlusal caries lesions prevalence is high in young adults population. Diagnosis of hidden caries requires both high sensitivity and specificity. CONCLUSIONS: The novel diagnostic and restorative protocol showed to be highly effective in hidden caries assessment and restoration.


Assuntos
Cárie Dentária/diagnóstico , Cárie Dentária/terapia , Cárie Dentária/classificação , Reparação de Restauração Dentária/métodos , Humanos , Prevalência , Adulto Jovem
20.
Pediatr Dent ; 42(6): 450-461, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-33369556

RESUMO

Purpose: The purpose of this study was to create an early childhood caries (ECC) risk-screening tool that fits into the primary care provider (PCP) well-child workflow. Methods: Integrated health records were employed to develop a predictive model for infants/toddlers at ECC risk; 2,009 patients with 12-, 15-, or 18-month well-child visits and at least one dental visit were used to develop a predictive model for ECC risk at the first dental visit. Independent model validation used 880 18- to 48-month-olds at their first dental appointment after at least one well-child visit. Results: Age at the first dental visit strongly predicted caries risk (odds ratio for one-year increase in age equals 2.11; 95 percent confidence interval equals 1.80 to 2.47). Three factors predicted high-caries risk: breast feeding status, preferred language not English, and no-show rates for pediatric clinic visits greater than 20 percent. All three non-age risk factors in well-child exams prior to 18 months predicted 42 percent probability of having caries if present for the first dental visit at 18 months. If that child was not seen until four years of age for the first dental visit, the probability of high caries risk increased to 83 percent. Model performance for independent validation was very close to expected performance. Conclusions: Existing clinical documentation plus a validated predictive model enables an effective caries risk assessment within well-child visits.


Assuntos
Cárie Dentária , Criança , Pré-Escolar , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Pessoal de Saúde , Humanos , Lactente , Atenção Primária à Saúde , Fatores de Risco
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