Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth

Bussaneli, Diego Girotto; Boldieri, Thalita; Diniz, Michele Baffi; Rivera, Luciana Monti Lima; Pinto, Luiz Gustavo Rodrigues; Cordeiro, Rita de Cássia Loiola

doi:10.1111/ipd.12148

Cited by 22 publications

(30 citation statements)

References 25 publications

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“…Though many authors have concluded stating that experience or training of the examiner need not influence the detection power of the visual examination tool, experience gained during training seems to be influencing the diagnostic decisions with ICDAS II. 27,28 Visual and enhanced visual, under magnification achieved comparable values of sensitivity and specificity for both the examiners, in our study. In our study, the ICDAS II behaved as a sensitive diagnostic method for occlusal caries diagnosis in the 0-2 codes, irrespective of the use of magnification.…”

Section: Discussionsupporting

confidence: 72%

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Sathyanarayanan¹,

Usha²,

Sudhagar³

2017

Int J Sci Rep

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INTRODUCTIONDental caries is a disease that is characterized by the localized destruction of susceptible dental hard tissue by acidic by-products from bacterial fermentation of dietary carbohydrates. The process is a dynamic interaction at the biofilm-tooth interface characterised by alternating cycles of demineralisation and remineralization. A caries/carious lesion are a detectable change in the tooth structure that results from this interaction. The changes may range from initial outer surface demineralization, at the molecular level, through subsurface demineralization producing enamel white-spot lesion formation, through macroscopic lesion cavitation, to dentine and pulpal infection, to ABSTRACT Background: Pit and fissure caries presents diagnostic challenges due to its anatomical complexity and fluoride exposure. ICDAS II is a coding system for caries detection using clinical visual inspection. It identifies carious lesions by the change in colour, texture and surface integrity. Magnification might facilitate better detection of the lesions by enhancing the visual acuity. Thus, the objective of this study is to compare the reliability and validity of ICDAS II in detection of occlusal caries, with and without magnification, by using histological standard. Methods: This single blinded, randomized study included 334 unrestored extracted human premolars and molars. Two examiners independently scored pit and fissure caries status using ICDAS II criteria without magnification and later under 6 x magnification using surgical microscope. The samples were sectioned and lesions were scored using the ERK histological criteria, under Stereo microscope. The scores of the examiners were correlated with the histological scoring. Kappa statistics and Spearman correlation coefficients were performed. Optimal sensitivity, specificity of visual and enhanced visual examination was calculated by Receiver Operating Characteristic Curve (ROC). Likelihood ratios (LR) were also calculated. Results:The kappa values for Inter examiner reproducibility of visual and enhanced visual examination under microscope were 0.638-0.694 and for histological examination it was 0.979. Intra examiner reproducibility for visual and enhanced visual examination was 0.665 -0.594. There was a strong relationship between visual, enhanced visual and histological examinations. Spearman's correlation coefficient of ICDAS-II visual and enhanced visual examination for each examiner, to ERK histological scores was 0.869-0.848. The sensitivity and LR+ for visual and enhanced visual examination was decreased as the ICDAS score was increased and specificity and LR-increased with increased ICDAS score. Conclusions: Reliability and validity of ICDAS scoring in detecting occlusal caries under magnification did not differ from clinical visual inspection.

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Section: Discussionsupporting

confidence: 72%

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Sathyanarayanan¹,

Usha²,

Sudhagar³

2017

Int J Sci Rep

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“…85 (0.65 Forest plots for meta-analysis and heterogeneity analysis of intra-and inter-examiner reproducibility when ICDAS was used for assessing caries lesion severity. Teo et al [2014] 0.84 (0.61, 1.07) Mitropoulos et al [2010] 0.51 (0.36, 0.66) Braga et al [2010] 0.91 (0.69, 1.13) Parviainen et al [2013] 0.47 (0.02, 0.92) Braga et al [2009b] 0.82 (0.62, 1.02) Achilleos et al [2013] 0.73 (0.28, 1.18) Braga et al [2009a] 0.47 (0.31, 0.63) Ozturk et al [2015] 0.37 (0.17, 0.57) Bussaneli et al [2015] 0.58 (0.17, 0.99) Jallad et al [2015] 0.72 (0.63, 0.81) Study selection was performed independently by 2 reviewers (T.G. and M.M.B.).…”

Section: Systematic Review: the Accuracy Of The Icdas In Detectingmentioning

confidence: 99%

The International Caries Detection and Assessment System – ICDAS: A Systematic Review

et al. 2018

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The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

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“…For these studies, validation was the clinical consensus among experts. Some papers considered different thresholds such as all lesions or only cavitated lesions for evaluating the students’ performance in staging caries . Regarding caries activity status, clinical consensus was used as reference standard.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding caries activity status, clinical consensus was used as reference standard. Only two studies investigated the treatment decision based on caries detection …”

Section: Resultsmentioning

confidence: 99%

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta‐analysis

Turchiello

Pedrotti

Braga

et al. 2019

Int J Paed Dentistry

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Aim To assess the undergraduate students’ performance in detecting and staging caries and assessing activity using visual inspection. Design Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta‐analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta‐regression assessed the effect of methodological variables on the outcomes. Results Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10‐0.67). The intra‐examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students’ performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students’ education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection. Conclusion Undergraduate students’ performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

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Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth

Abstract: The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

Cited by 22 publications

References 25 publications

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

The International Caries Detection and Assessment System – ICDAS: A Systematic Review

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta‐analysis

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