Dental caries and oral health-related quality of life of 3-year-olds living in Lima, Peru.

BACKGROUND: Untreated dental caries negatively impacts children and their families; the implication of which is best measured through assessing quality of life. Information related to Oral Health-Related Quality of Life (OHRQoL) in Peruvian pre-school children is scarce. AIM: To investigate the relationship between dental caries and the OHRQoL of 3-year-old children. DESIGN: Randomly selected government pre-schools (n = 17), situated in three low socio-economic status districts in Lima, participated. The OHRQoL data were obtained using the Peruvian (P) ECOHIS questionnaire. Clinical examinations using the Caries Assessment Spectrum and Treatment (CAST) instrument were performed on 308 children. From which, 213 parents returned the P-ECOHIS form. ANOVA, Tamhane, and Tukey methods were used to analyse the data. RESULTS: The mean age of the children was 3.04 years. The two highest mean P-ECOHIS scores in the child section were 'child symptoms' and 'child psychology' while 'parent distress' scored highest in the parent section. The prevalence of dental caries was 64.3% (CAST scores 4-7). Including CASTcode 3 (enamel carious lesion), the dental caries prevalence was 93.4%. The mean P-ECOHIS scores for 'child symptoms', 'child functions', 'child impact', 'parent distress', and 'the sample' were statistically significantly higher for children with MaxCASTcodes 5 and 6 (dentine and pulpally involved cavities, respectively) than for those with MaxCASTcode 3. CONCLUSION: The presence of cavitated teeth with and without pulpal involvement impacts negatively on the OHRQoL of 3-year-old children.

Children's Oral Health-related Quality of Life (OHRQoL) Three Years after Implementation of Treatment Protocols for Managing Cavitated Carious Dentine Lesions.

PURPOSE: To assess children's oral health-related quality of life (OHRQoL) three years after implementation of three treatment protocols for managing cavitated carious dentine lesions in primary molars by parent proxy report with the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) and to assess the level of agreement between the children's self-reporting and the parents' reporting of the children's OHRQoL. MATERIALS AND METHODS: Schoolchildren aged 6 to 7 were included in a clinical trial that compared three treatment protocols for managing cavitated carious dentine lesions: CRT (Conventional Treatment); ART (Atraumatic Restorative Treatment) and UCT (Ultraconservative Treatment). Before treatment (baseline), the OHRQoL of 273 children was assessed by B-ECOHIS using the parents'/caregivers' proxy report. Three years later, 147 parents/caregivers filled in the questionnaire while the children, ages 9 to 10, were interviewed. The t-test and one-way ANOVA were used for statistical analysis. RESULTS: No difference was observed between treatment protocols in regard to the children's OHRQoL (p = 0.41). A significant reduction in the parent distress domain was observed when baseline and parents'/caretakers' responses after three years (p = 0.01) were compared. The level of agreement between the parents'/caregivers' and children's scores was low. Children scored lower on the impact of oral health on their quality of life than their parents/caregivers did (p < 0.0001). CONCLUSION: The use of UCT, a largely non-restorative protocol, leads to a perception of OHRQoL by parents/caregivers that is similar to the ART and CRT protocols after three years. Parent distress decreased over time. Children and parents/caregivers disagreed about children's OHRQoL.

Microcomputed Tomography Evaluation of Dentine Mineral Concentration in Primary Molars Managed by Three Treatment Protocols.

The objectives of the study were to quantify the dentine mineral concentration (DMC) in teeth restored conventionally, according to the atraumatic restorative treatment (ART) and ultraconservative (UCT) protocols (open cavities and small ART restorations), and the DMC underneath the open cavities of teeth managed by UCT versus nontreated, open cavities. We studied 50 teeth with restorations/open cavities, 39 restored teeth (9 by conventional restorative treatment [CRT], 17 by ART, and 13 by UCT) and 16 teeth with open cavities. Each restoration/open cavity was scanned using microcomputed tomography, with 3 hydroxyapatite disks with respective densities of 1.24, 1.33, and 1.57 g/cm3 as a reference. Images were reconstructed and the greyscale images were converted into DMC values. For each restoration/open cavity, 15 measurements of dentine immediately underneath and from the corresponding area in sound dentine were taken. DMC was expressed as a percentage of the DMC of sound dentine. ANOVA and the Student t test were used for statistical analysis. The mean DMC underneath restorations of the ART protocol group (98.93%) was statistically significantly higher than that of the UCT protocol group (91.98%), but not of the CRT protocol group (91.33%). On multiple surfaces, mean DMC in the axial area (94.32%) was statistically significantly higher than in the gingival area (92.80%). The mean DMC of open cavities managed by UCT protocol (89.05%) was statistically significantly higher than in nontreated open cavities (83.90%). In conclusion, a dentine-hypermineralized area underneath ART restorations was observed. Managing open cavities with a toothbrush and fluoride toothpaste (the UCT protocol) resulted in higher mineralized dentine underneath the cavity than in nontreated open cavities.

Are Clinically Successful Amalgam and ART Restorations in Primary Molars Microgap Free?

PURPOSE: To determine whether the frequency of microleakage at the margin of the tooth-restoration interface in primary molars restored with high-viscosity glass-ionomer cement (HVGIC) differs from that of primary molars restored with amalgam. MATERIALS AND METHODS: The HVGIC restorations were performed according to the ART method. A total of 19 naturally exfoliated primary molars (10 amalgam and 9 ART/HVGIC) with clinically assessed intact restorations fulfilled the inclusion criteria. SEM analyses using replicas were performed to assess the microgap presence and size of the tooth-restoration interface The depth of a microgap was measured from histological sections after infiltration of 50% (w/v) AgNO3 solution. Independent variables were restorative material, age of restoration, and number of tooth surfaces. Data analyses included Fisher's Exact version of the chi-squared test, independent t-test and one-way ANOVA. RESULTS: More ART/HVGIC than amalgam-restored teeth were gap free (p = 0.14). The mean gap size for teeth with a gap between amalgam (322.0 µm) and ART/HVGIC (201.0 µm) restorations did not differ statistically significantly. AgNO3 infiltration was not influenced by restorative material or age of restoration. Infiltration in multiple-surface was higher than in single-surface restorations (p = 0.02). CONCLUSION: The occurrence of marginal microleakage in primary molars restored by ART/HVGIC is no different from that observed in primary molars restored with amalgam. Microleakage was deeper in multiple-surface than in single-surface restorations. Despite the presence of microleakage, restoration functionality up to exfoliation is secured, reinforcing the importance of biofilm removal and behavioral education of patients.

Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability.

OBJECTIVES: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS: The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.

Correction to: The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial.

Mw. M. Mijan will defend her PhD thesis on 15th September 2017. Whilst reviewing her work in preparation to the event, we discovered a few irregularities that prompted a recheck of the database and ditto analyses. These activities have lead to a few textual changes in the publication.

Global epidemiology of dental caries and severe periodontitis - a comprehensive review.

BACKGROUND: Dental caries and periodontitis are the most common oral diseases and major causes of tooth loss. AIM: To perform a review of global prevalence and incidence of dental caries and periodontitis. METHODOLOGY: Inclusion and exclusion criteria were developed. MEDLINE database and EMBASE database were used to search for eligible publications using keywords and MeSH terms. Additionally, WHO databank was used for obtaining dental caries information and PUBMED for a search on trends of dental caries prevalence and severity. RESULTS: Over the last four decades, the prevalence and severity of dentine carious lesions among 5- and 12-year-olds have declined; the decay-component is very high, with the lowest prevalence among 12-year-olds in high-income countries, which also had the lowest prevalence among 35- to 44-year-olds; and the number of retained teeth has increased around the globe. The prevalence of periodontitis is high, with approximately 10% of the global population affected by severe periodontitis. Study heterogeneity and methodological issues hamper comparisons across studies and over time. CONCLUSION: While the prevalence of dental caries has decreased, the disease is prevalent in all age groups. The prevalence of periodontitis is high. There is insufficient evidence to conclude that the prevalence of periodontitis has changed over time.

Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases.

BACKGROUND: The non-communicable diseases dental caries and periodontal diseases pose an enormous burden on mankind. The dental biofilm is a major biological determinant common to the development of both diseases, and they share common risk factors and social determinants, important for their prevention and control. The remit of this working group was to review the current state of knowledge on epidemiology, socio-behavioural aspects as well as plaque control with regard to dental caries and periodontal diseases. METHODS: Discussions were informed by three systematic reviews on (i) the global burden of dental caries and periodontitis; (ii) socio-behavioural aspects in the prevention and control of dental caries and periodontal diseases at an individual and population level; and (iii) mechanical and chemical plaque control in the simultaneous management of gingivitis and dental caries. This consensus report is based on the outcomes of these systematic reviews and on expert opinion of the participants. RESULTS: Key findings included the following: (i) prevalence and experience of dental caries has decreased in many regions in all age groups over the last three decades; however, not all societal groups have benefitted equally from this decline; (ii) although some studies have indicated a possible decline in periodontitis prevalence, there is insufficient evidence to conclude that prevalence has changed over recent decades; (iii) because of global population growth and increased tooth retention, the number of people affected by dental caries and periodontitis has grown substantially, increasing the total burden of these diseases globally (by 37% for untreated caries and by 67% for severe periodontitis) as estimated between 1990 and 2013, with high global economic impact; (iv) there is robust evidence for an association of low socio-economic status with a higher risk of having dental caries/caries experience and also with higher prevalence of periodontitis; (v) the most important behavioural factor, affecting both dental caries and periodontal diseases, is routinely performed oral hygiene with fluoride; (vi) population-based interventions address behavioural factors to control dental caries and periodontitis through legislation (antismoking, reduced sugar content in foods and drinks), restrictions (taxes on sugar and tobacco) guidelines and campaigns; however, their efficacy remains to be evaluated; (vii) psychological approaches aimed at changing behaviour may improve the effectiveness of oral health education; (viii) different preventive strategies have proven to be effective during the course of life; (ix) management of both dental caries and gingivitis relies heavily on efficient self-performed oral hygiene, that is toothbrushing with a fluoride-containing toothpaste and interdental cleaning; (x) professional tooth cleaning, oral hygiene instruction and motivation, dietary advice and fluoride application are effective in managing dental caries and gingivitis. CONCLUSION: The prevention and control of dental caries and periodontal diseases and the prevention of ultimate tooth loss is a lifelong commitment employing population- and individual-based interventions.

Caries Assessment Spectrum and Treatment (CAST): A Novel Epidemiological Instrument.

Caries detection is fundamental to understanding the oral health status of a population and is the basis for caries diagnosis for individual patients. Although different caries detection/diagnosis criteria are available, none of them include the total spectrum of dental caries (which ranges from a sound tooth to a tooth lost due to caries) other than the Caries Assessment Spectrum and Treatment (CAST) instrument. The CAST codes and descriptions were submitted to experienced epidemiologists from across the world for obtaining face and content validity. Its construct validity and reproducibility under field conditions were tested in child and adult populations, and showed a high level of agreement between examiners. Compared to what is usually reported in the literature, CAST provides more relevant information on caries prevalence, experience, and severity. CAST is straightforward and easy to use. A manual with valuable information about how to apply CAST and report its results has been published in order to facilitate communication among researchers, oral health planners, and medical professionals. Feedback from researchers indicates that CAST is considered an asset and that reporting results after using CAST is uncomplicated. More research about the effects of CAST in different cultures and age groups is required.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis.

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Frequency of remnants of sealants left behind in pits and fissures of occlusal surfaces after 2 and 3 years.

OBJECTIVES: The null-hypothesis tested was that there was no difference in the frequency of remnants of high-viscosity glass-ionomer sealants left behind in pits and fissures of occlusal surfaces of first permanent molars and that of resin composite and glass-carbomer sealants. MATERIALS AND METHODS: Based on the results of a sealant trial, a sample of sealed teeth from which the material had apparently completely disappeared from at least one of the three sections into which the occlusal surface was divided, assessed through visible clinical examination, was also assessed from images of colour photographs and Scanning Electron Microscopy (SEM) as the reference image. The sample size consisted of 112 and 120 teeth from 59 and 98 children at evaluation years 2 and 3 respectively. Two examiners performed the assessments. Fisher's Exact Test was applied to test for the differences between the dependent variable and the sealant groups. RESULTS: The remnants of sealant material left in the deeper parts of pits and fissures were assessed from colour photograph and SEM images in five sections at year 2 and in eight sections at year 3. The assessment found no sealant group effect. CONCLUSION: The frequency of remnants of glass-ionomer sealant in pits and fissures of occlusal surfaces in first permanent molars is not higher than the frequency of glass-carbomer and resin sealants after 2 and 3 years. CLINICAL RELEVANCE: Contrary to the current assumption, there appears to be no significant difference in the frequency of remnants left behind in pits and fissures between glass-ionomer and resin sealants.

Retention Rate of Four Different Sealant Materials after Four Years.

PURPOSE: To test the hypotheses: 1) cumulative survival rates of fully and partially retained high-viscosity glass-ionomer (HVGIC) ART sealants with heat application and glass-carbomer sealants on occlusal and free-smooth surfaces are both higher than that of resin sealants; 2) cumulative survival rate of fully and partially retained high-viscosity glass-ionomer ART sealant with heat application on occlusal and free-smooth surfaces is higher than that of comparable ART sealants without heat application. MATERIALS AND METHODS: The block-randomised clinical trial covered 405 eight-year-old children. The HVGIC was Ketac Molar Easymix, the glass carbomer was GlassCarbomer and the resin sealant was Clinpro. Retention rates of sealants on occlusal and free-smooth surfaces using conventional and modified categorisation (fully and partially retained sealants vs those completely lost [at least one-third of surface re-exposed]) were the dependent variables. The Kaplan-Meier survival method was used. RESULTS: The cumulative survival rate of completely and partially retained resin sealants on occlusal (81.2%) and free-smooth (81%) surfaces after 4 years was statistically significantly higher, and that of glass-carbomer sealants (10.8% and 21.1%, respectively) was statistically significantly lower than those of the other sealant groups. There was no statistically significant difference in survival rates of completely and partially retained high-viscosity glass-ionomer ART sealants with (56% for both surfaces) or without heat application (56%) on occlusal and free-smooth surfaces (55.7% and 59.1%, respectively). CONCLUSIONS: Resin sealants had the highest and glass-carbomer sealants the lowest retention rate after 4 years. Application of heat to high-viscosity glass-ionomer ART sealants did not result in a significantly higher sealant retention rate. Use of the modified categorisation for determining sealant retention is advocated.

Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren.

PURPOSE: To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. MATERIALS AND METHODS: High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. RESULTS: Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). CONCLUSION: In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.

Cost-effectiveness, in a randomized trial, of glass-ionomer-based and resin sealant materials after 4 yr.

This study, conducted from a government program perspective, compared the incremental cost-effectiveness of oral health interventions, in particular their delivery to underserved populations in whom dental sealants constitute an important, high-yielding complement to toothbrushing in dental-caries prevention. The study data concern the relative cost-effectiveness of three sealant materials in four approaches to prevent cavitated dentine carious lesions in permanent molars in a community intervention trial among school-age children in Wuhan, China. The four approaches were high-viscosity glass-ionomer cement without heat application (HVGIC); high-viscosity glass-ionomer cement with heat application [light-emitting diode (LED) thermocured HVGIC]; glass-carbomer; and composite resin. The costs studied were: cost of sealing permanent molars; adverse event costs for restoring cavitated dentine carious lesions developing within 4 yr in study data; and projections of 1,000 sealants per group. Preventing one more cavitated dentine carious lesion cost US$105 for the study data when comparing HVGIC (n = 405) with composite resin (n = 396) and US$59 per 1,000 sealants in the projections; LED thermocured HVGIC compared with composite resin cost US$115 for one more cavitated lesion and US$52 per 1,000 sealants, respectively. Although more expensive than composite resin, LED thermocured HVGIC was identified as the most cost-effective among the sealant materials studied. Ease of application, minimal technical and infrastructure requirements, and cost-effectiveness make glass-ionomers a practicable option for governments making decisions under economic constraints.

A study on the survival of primary molars with intact and with defective restorations.

BACKGROUND: Failed restorations in primary teeth are not always re-restored. Is re-restoration not required anymore? OBJECTIVE: To compare survival rates of primary molars with intact and defective amalgam and ART restorations. METHODS: A total of 649 restored primary molars, of which 162 were assessed with defective restorations for mechanical reasons, from a cluster-randomised controlled clinical trial, were followed up over a period of 3.5 years. Restored primary molars, extracted because of dental sepsis or toothache, were considered a failure. Primary molars with defective restorations were followed up from the time they were assessed defective. Data were analysed using PHREG model with frailty correction, Wald test, t-test, and jackknife procedure. RESULTS: The survival rate of primary molars with intact restorations (96.3%) was statistically significantly higher than that of primary molars with defective restorations (75.9%) over a 3-year period (P < 0.0001). Neither the effect of treatment protocol (amalgam or ART) (P = 0.05) nor the type of surface (single or multiple) (P = 0.73) was observed with respect to the survival rate of restored primary molars. CONCLUSIONS: Survival rates for primary molars with intact and defective amalgam and ART restorations were high. The 3-year survival rate of primary molars with intact restorations was significantly higher than that of primary molars with defective restorations.

Are Carious Lesions in Previously Sealed Occlusal Surfaces Detected as well on Colour Photographs as by Visual Clinical Examination?

PURPOSE: To compare the level of agreement between carious lesion assessments according to the visual clinical examination and the colour photograph methods. MATERIALS AND METHODS: Data on the presence of enamel/dentin carious lesions in previously sealed occlusal surfaces in first molars were obtained by two trained and calibrated examiners through visual clinical examination and from colour photographs 4 years after sealing. Kappa statistics were applied to calculate agreement between assessment methods. Data analysis was performed using sign, Bowker symmetry and McNemar's tests. RESULTS: The prevalence of dentin carious lesions was very low. The kappa coefficients for detecting enamel/dentin carious lesions using the two assessment methods were 0.65 (CI: 0.56-0.74) for examiner 1 and 0.70 (CI: 0.62-0.78) for examiner 2. Examiner 2 observed more enamel/dentin carious lesions on colour photographs than did examiner 1 (p = 0.008). Sensitivity analyses did not confirm this outcome. CONCLUSIONS: There was no difference in the detection of enamel/dentin carious lesions in previously sealed occlusal surfaces using colour photographs vs visual clinical examination. The colour photograph method is therefore equivalent to the visual clinical examination in detecting enamel/dentin carious lesions. More studies are required.

Effectiveness of an oral health program for mothers and their infants.

BACKGROUND: The baby oral health program (bOHP) provides pregnant women and their future babies with oral care. AIM: To assess the bOHP effectiveness by comparing caries prevalence in infants enrolled and not enrolled in the oral health program (OHP). DESIGN: Mothers who had been invited to participate in the bOHP from 2006 to 2009 were contacted. Two groups were formed: 87 pairs of mothers and infants who effectively participated in the OHP (G1) and 107 pairs who did not (G2). Mothers and infants were given a dental examination. Socio-economic status (SES) and education level (EL) questionnaires were completed. t-tests and multivariate logistic regression were used in analyzing data. RESULTS: Statistically significant differences were observed in the mean age of mothers (G1 = 33.8 years; G2 = 35.6 years; P = 0.015) and mean decayed, missed and filled surface (DMFS) score (G1 = 24.71; G2 = 32.58; P < 0.001), not in SES (P = 0.758) and EL (P = 0.109). Mean age and mean dmfs scores of G1 and G2 children were 4.2 and 4.4 years (P = 0.068), and 0.25 and 4.12 (P < 0.001), respectively. The odds ratio (OR) for children in G2 to develop dentine lesions, as opposed to those in G1, was 48.56. CONCLUSION: The bOHP was effective in preventing caries in infants enrolled in the program.

Methods and preliminary findings of a cost-effectiveness study of glass-ionomer-based and composite resin sealant materials after 2 yr.

The cost-effectiveness of glass-carbomer, conventional high-viscosity glass-ionomer cement (HVGIC) [without or with heat (light-emitting diode (LED) thermocuring) application], and composite resin sealants were compared after 2 yr in function. Estimated net costs per sealant were obtained from data on personnel time (measured with activity sampling), transportation, materials, instruments and equipment, and restoration costs for replacing failed sealants from a community trial involving 7- to 9-yr-old Chinese children. Cost data were standardized to reflect the placement of 1,000 sealants per group. Outcomes were the differences in the number of dentine caries lesions that developed between groups. The average sealant application time ranged from 5.40 min (for composite resin) to 8.09 min (for LED thermocured HVGIC), and the average cost per sealant for 1,000 performed per group (simulation sample) ranged from $US3.73 (for composite resin) to $US7.50 (for glass-carbomer). The incremental cost-effectiveness of LED thermocured HVGIC to prevent one additional caries lesion per 1,000 sealants performed was $US1,106 compared with composite resin. Sensitivity analyses showed that differences in the cost of materials across groups had minimal impact on the overall cost. Cost and effectiveness data enhance policymakers' ability to address issues of availability, access, and compliance associated with poor oral-health outcomes, particularly when large numbers of children are excluded from care, in economies where oral health services are still developing.

Sealant retention is better assessed through colour photographs than through the replica and the visual examination methods.

The aim of this study was to test the hypothesis that the colour photograph method has a higher level of validity for assessing sealant retention than the visual clinical examination and replica methods. Sealed molars were assessed by two evaluators. The scores for the three methods were compared against consensus scores derived through assessing retention from scanning electron microscopy images (reference standard). The presence/absence (survival) of retained sealants on occlusal surfaces was determined according to the traditional and modified categorizations of retention. Sensitivity, specificity, and Youden-index scores were calculated. Sealant retention assessment scores for visual clinical examinations and for colour photographs were compared with those of the reference standard on 95 surfaces, and sealant retention assessment scores for replicas were compared with those of the reference standard on 33 surfaces. The highest mean Youden-index score for the presence/absence of sealant material was observed for the colour photograph method, followed by that for the replica method; the visual clinical examination method scored lowest. The mean Youden-index score for the survival of retained sealants was highest for the colour photograph method for both the traditional (0.882) and the modified (0.768) categories of sealant retention, whilst the visual clinical examination method had the lowest Youden-index score for these categories (0.745 and 0.063, respectively). The colour photograph method had a higher validity than the replica and the visual examination methods for assessing sealant retention.

The Caries Assessment Spectrum and Treatment (CAST) instrument: construct validation.

The Caries Assessment Spectrum and Treatment (CAST) is a newly developed epidemiological instrument. The aim of this study was to investigate its construct validity. Four calibrated examiners, using CAST codes 0-6, visually examined 109 surfaces of extracted and exfoliated teeth. These teeth were then hemisectioned, photographed, and assessed histologically by two calibrated examiners using the Downer criteria. Twenty-eight of the 109 teeth were scanned using micro-computed tomography (micro-CT) and assessed by the same examiners using the same criteria. Validation was determined through calculation of the sensitivity, specificity, and Youden index for two categories of carious lesions examined visually, with histology and micro-CT as gold standards. Interexaminer consistency was κ = 0.76: SE ± 0.05 between visual and histological assessments of teeth and was κ = 0.89: SE ± 0.08 between visual and micro-CT assessments. For the category 'healthy' vs. 'diseased' (CAST codes 0-2 vs. CAST codes 3-6), sensitivity, specificity, and Youden index values of 100%, 92.9%, and 93%, respectively, for micro-CT, and 96.6%, 86%, and 83%, respectively, for histology, were obtained. For the category 'dentine' vs. 'non-dentine lesions' (CAST codes 0-3 vs. CAST codes 4-6) sensitivity, specificity, and Youden index values of 90%, 100%, and 90%, respectively, for micro-CT, and 81.4%, 100%, and 81%, respectively, for histology, were obtained. Construct validity of the CAST instrument was obtained.