Different methods of dental caries diagnosis in an epidemiological setting

Abstract

Aim: To evaluate the performance of dental caries detection when adjunct methods are associated and their applicability in epidemiological survey of dental caries, at D3 (cavitated carious lesions at dentin layer) and D1+D3 (non cavitated and cavitated carious lesions at enamel/dentin layer) diagnostic thresholds. Methods: A total of 2189 posterior teeth from 165 12-year-old schoolchildren underwent visual examination without (CL1) and with artificial lighting (CL2), radiographic bitewing (BW), fiber-optic transillumination/FOTI (FT), DIAGNOdent TM (DD) and associations of these methods. Reproducibility was calculated by Kappa statistics and validity was calculated by sensitivity, specificity and accuracy tests. ANOVA (Scott-Knott test) was performed in order to compare the average values of DMF-S obtained by the diagnostic methods. Results: The CL2FTDDBW (D3) and CL2BW (D1+D3) exams presented the highest values for accuracy at epidemiological setting. The DMF-S index obtained for those exams was statistically different at D3 and D1+D3 thresholds. Conclusions: The association of adjunct methods increased the validity of dental caries examination in an epidemiological setting. However, the potential of CL2BW (traditional caries detection methods) or visual exam performed under a more refined diagnostic criteria must be considered in dental caries epidemiological surveys.

Longitudinal study for dental caries calibration of dentists unexperienced in epidemiological surveys

“…Although there are scientific studies that evaluate the calibration process of examiners in epidemiological caries surveys, most have evaluated examiners with previous experience. 13,[22][23][24][25] Thus, there is a gap in the literature regarding the calibration of caries. When examiners with no experience in the practice of oral health surveys are evaluated, it may not be possible to assess how effective the proposed methodology is for training new examiners.…”

“…The prevalence of cavitated caries lesions is higher on the occlusal surfaces of posterior teeth than on the smooth surfaces of anterior teeth, and performing a diagnosis can be a challenge on occlusal surfaces, considering their greater anatomical complexity. 13,23 Therefore, studies that report high values of agreement among examiners may not be portraying the actual difficulties involved in examining all the anterior and posterior tooth surfaces, and in diagnosing all the carious lesions that might be found. This difficulty may lead to an overestimation of the reported reproducibility values, hence to an erroneously reported low prevalence of the disease.…”

“…The literature is scare regarding the calibration process, when assessing how well examiners without previous experience in epidemiological surveys can diagnose caries, since most studies evaluate experienced examiners. 13,[22][23][24][25] This imbalance restricts how effectively the calibration process can be determined, because the same yardstick being used to measure the agreement level of experienced examiners should be able to determine how well the calibration methodology can measure high levels of agreement for new examiners.…”

Cirurgião-Dentista na Equipe de Saúde da Família: Perfil Profissional e Diagnóstico de Cárie

“…Nas últimas décadas, o padrão da cárie dentária veio sofrendo mudanças profundas, sendo encontrado um grande número de lesões iniciais, reduções das lesões cavitadas e predominância de atividade nas superfícies oclusais 6,7 . Diante destas mudanças, o ideal é que todos os cirurgiõesdentistas, independentemente do perfil profissional, sejam capazes de diagnosticar adequadamente a cárie dentária.…”