Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D₁ and D₃ thresholds and compared by performing McNemar test (p = 0.05). D₁ sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D₃ specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.     

Development,validity and reliability of the Orofacial Esthetic Scale — Spanish version

Purpose

To develop a Spanish version of the Orofacial Esthetic Scale (OES-Sp) and to determine its psychometric properties in dental patients.

Sealing occlusal caries lesions in adults referred for restorative treatment: 2–3 years of follow-up

The aim of this study was to assess the possibility to arrest occlusal caries lesions in adults by sealant as well as to assess the presence of radiographic progression, arrest, and regression of the sealed lesions. Seventy-two occlusal caries lesions in 52 adult patients referred to restorative treatment by senior lecturers at School of Dentistry, Copenhagen, Denmark were included. In case the patient had more than one occlusal caries lesion, randomization between sealing and restoration was made; otherwise, the lesion was sealed. In total, 60 resin sealants and 12 composite restorations were made. Follow-up period was 25–38 months (mean = 33 months). Data were analyzed using non-parametric statistics including kappa statistics. After 2–3 years, the dropout rate was 15%; two patients did not show up for control and nine previously sealed lesions were restored by the patients' general practitioners. All 12 restorations and 39 of the remaining 49 sealants were well functioning, seven (14%) sealants were repaired/replaced due to failure, and three (6%) sealed lesions were restored due to caries progression (p > 0.05). The radiographic assessment showed caries progression beneath five (10%) sealants, caries regression beneath one (2%) sealant, and unchanged depth beneath 43 (88%) sealants and all restorations (p > 0.05). The majority of the referred lesions were successfully arrested by sealants, indicating the possibility for extending the criteria for sealing occlusal caries lesions in adults. However, a longer observation period is needed for final conclusion. Extending the criteria of therapeutic sealing of occlusal caries lesions in adults will lead to increased dental health.     

Parental–Caregivers Perceptions Questionnaire (P-CPQ): translation and evaluation of psychometric properties of the French version of the questionnaire

Background

The Parental–Caregivers Perceptions Questionnaire (P-CPQ) is a measure of parental/caregivers’ perceptions of the impact of children’s oral health on quality of life. The aim of the study was evaluate the psychometric properties of the French version of the P-CPQ.

Method

The original P-CPQ was developed in English language and has 31 items divided into four sub-scales. This cross-sectional study used the translation-back translation method. The translated questionnaire was pretested on 14 parents-caregivers to obtain the final French version. The psychometric properties were tested on 142 parents/caregivers of three clinical groups of children from 8 to 10?years old without dental/facial anomalies (presumed healthy), with oral-facial clefts and with oral-dental anomalies linked to a rare disease other than cleft, approached in the waiting room of the Centre of the Hospital Rothschild in Paris, France, where the children attended treatment. Internal consistency was assessed by Cronbach’s alpha and test-retest reliability by Intra-class Correlation Coefficient (ICC). Construct validity was measured by correlations between the total scores and the global ratings of oral health and overall wellbeing, and tested using exploratory factor analysis (EFA) and the factorial structure was evaluated by the partial confirmatory factor analysis (PCFA). Discriminant validity was determined using Kruskall-Wallis test.

Results

The mean (standard deviation) P-CPQ score was 18.73(18.79). Internal consistency was confirmed by a Cronbach alpha of 0.85. The test-retest reliability revealed that the responses to items were satisfactorily stable (ICC?=?0.88). Construct validity was demonstrated by significant correlation coefficients between the total scale and the global ratings (r?=?0.54 and 0.46; p?<?0.001). Factor analysis with Principal Component Analysis extracted seven factors explaining 65.23% cumulative variance. Goodness-of-fit indices for partial confirmatory factor analysis were satisfactory for the 7-factors model of the French-PCPQ version. There were statistically significant differences between clinical groups regarding the total scale, thus demonstrating discriminant validity (p?<?0.001).

Conclusion

This French P-CPQ version showed reliability and validity comparable to the previous versions. However, the cross-cultural structure of the subscales should be further evaluated.

     

Does outpatient dental treatment have impact on the quality of life of children with early childhood caries?

Clinical Oral Investigations - To assess the impact of outpatient dental treatment on oral health-related quality of life (OHRQoL) of children and their families. This prospective observational...     

Development of the Japanese version of the Child Perceptions Questionnaire (CPQ8–10_JP)

The purpose of this study was to develop a Japanese version (_JP) of the Child Perceptions Questionnaire for 8–10-year-old children (CPQ_8–10). CPQ_8–10 was translated into Japanese by a forward–backward translation method. Its reliability was investigated among 228 elementary school children who were examined clinically for the status of dental caries, plaque accumulation, and malocclusion. Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.85. Test–retest reliability was substantial (ICCs = 0.90; 95% CI, 0.88–0.92). Regarding validity assessment, significant correlations were observed between the CPQ_8–10_JP score and the global rating of oral health (r = 0.37, p < 0.001), overall well-being (r = 0.46, p < 0.001) and presence of gingivitis (p < 0.05) but not dental caries and malocclusion. These findings suggest that CPQ_8–10_JP is satisfactorily reliable and valid for application in 8–10-year-old Japanese elementary school children.     

Caries detection and quantification with DIAGNOdent: prospects for occlusal and root caries?

A possible consequence of light absorption as the interaction of electromagnetic radiation with molecules of the tooth's hard substances is, apart from the emission of heat, fluorescence. It was demonstrated that the emission spectra of enamel, dentin, and caries look alike upon excitation with red light; however, fluorescence increases with the process of carious destruction. Based on that, the DIAGNOdent System was developed, which simultaneously injects red light into the tooth surface and detects the resulting fluorescence. Due to this design, clinical application is currently limited to accessible occlusal and smooth surfaces. For occlusal caries detection, it was shown that validity and reproducibility could be optimized over classical diagnostic tests for deep dentin lesions with seemingly intact surfaces. The detection of root caries does not play a relevant role in the directly accessible areas, but estimation of the lesion's activity and progression rate is a prerequisite for differentiated lesion management Excellent reproducibility of the laser fluorescence measurements was confirmed for this scenario. Lesions with a soft surface texture show significantly higher fluorescence values than leathery or hard lesions, and values also increase with increasing cavity depth. DIAGNOdent offers the potential to improve follow-ups and estimation of the prognosis and to support clinical management of primary carious lesions.     

Validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11–14 and Parental Perceptions Questionnaire

Objective: To examine the validity and reliability of the Swedish versions of the short-form Child Perceptions Questionnaire 11–14 (CPQ_11–14) and Parental Perceptions Questionnaire (P-CPQ) for measuring children’s oral health-related quality of life (OHRQoL).

Material and methods: The sample comprised 247 children and parents. OHRQoL was assessed by asking each child and their accompanying parent to complete the relevant questionnaire. To allow test–retest analysis, 30 children and 32 parents were asked to complete the instrument a second time within 2–4 weeks.

Results: In terms of construct validity, significant correlations were observed between CPQ scale scores and the global ratings of oral health and overall well-being for both the CPQ_11–14 and the P-CPQ. Regarding internal consistency, Cronbach’s alphas for the total scales were 0.81 and 0.77, respectively, indicating good reliability, and internal consistency for the subscales (two or four dimensions) was acceptable. Test–retest reliability was good for the CPQ_11–14 total scale (ICC 0.77) and acceptable for the P-CPQ total scale (ICC 0.63).

Conclusions: The Swedish versions of the short-form CPQ_11–14 and P-CPQ are both valid and reliable, and can be recommended for use among Swedish children aged 11–14 years for evaluation of OHRQoL.     

Agreement among dentists’ restorative treatment planning thresholds for primary occlusal caries,primary proximal caries,and existing restorations: Findings from The National Dental Practice-Based Research Network

ObjectivesThe aim of this study was to quantify the agreement among individual National Dental Practice-Based Research Network dentists’ self-reported treatment decisions for primary occlusal caries, primary proximal caries, and existing restorations.MethodsFive hypothetical clinical scenarios were presented: primary occlusal caries; primary proximal caries; and whether three existing restorations should be repaired or replaced. We quantified the probability that dentists who recommended later restorative intervention for primary caries were the same ones who recommended that existing restorations be repaired instead of replaced.ResultsDentists who recommended later restorative treatment of primary occlusal caries and proximal caries at a more-advanced stage were significantly more likely to recommend repair instead of replacement. Agreement among dentists on a threshold stage for the treatment of primary caries ranged from 40 to 68%, while that for repair or replacement of existing restorations was 36 to 43%.ConclusionsDentists who recommended repair rather than replacement of existing restorations were significantly more likely to recommend later treatment of primary caries. Conversely, dentists who recommended treatment of primary caries at an earlier stage were significantly more likely to recommend replacement of the entire restoration. Between-dentist agreement for primary caries treatment was better than between-dentist agreement for repair or replacement of existing restorations.Clinical implicationsThese findings suggest consistency in how individual dentists approach the treatment of primary caries and existing restorations. However, substantial variation was found between dentists in their treatment decisions about the same teeth.     

Efficacy of nano-hydroxyapatite on caries prevention—a systematic review and meta-analysis

Clinical Oral Investigations - The review systematically explored in vivo or in situ studies investigating the efficacy of nano-hydroxyapatite (nHA) to reduce initiation of or to remineralize...     

How to measure the effects of fluoride treatments in clinical trials? The role of caries prevalence and caries assessment

Many products that claim to have caries-preventive effects are available to the general public. Different and sometimes even contradictory claims of effectiveness are given in advertisements. Dentists would like to give good information and advice to their patients and the public with respect to the efficacy of different products. In medicine and dentistry there are guidelines which consider the ethics, design, conduct as well as the recording and reporting of clinical studies. The effects of clinical trials in subjects with a high risk for caries or in a population with a high caries prevalence are not comparable to the situation in most industrialized countries today. The sample should, therefore, include subjects with a range of prevalences and of risks for a valid assumption of efficacy. Reliable data can be obtained if a strict control of the design and management of the clinical trials is maintained over the duration of the experiment. New diagnostic methods used in the study must be validated and could lead to trials of a shorter duration. For a new fluoride product the bioavailability of the ion should be demonstrated. The results must have the necessary characteristics to be included in a meta-analysis. Thesis: The caries-preventive effect of a fluoride product cannot be accurately measured in populations with a variety of preventive products in use. On the other hand, the measured effect in populations with caries prevalence higher than those of the country where it will be used is not comparable to the real situation.     

Is the morphology and activity of the occlusal carious lesion related to the lesion progression stage?

ObjectiveTo investigate the relationship between degree of dentin demineralization with both lesion activity and morphology of the occlusal carious cavity.DesignOcclusal sites (n = 138) were identified by visual examination (Nyvad’s scores 0–6) in 67 extracted teeth which were scanned in a high energy micro-CT. After 3D reconstruction, each stack was resliced in the mesio-distal direction and tooth mineral density (MD) was measured along a path from enamel to the deepest part of dentin in the slice showing the most severe carious involvement. Each site was classified in “open” or “closed” (if cavitated) depending on the morphology of the surrounding enamel walls as measured using micro-CT and as active or inactive in enamel or dentin by a clinical scoring system.ResultsLesions showing dentin cavitation presented higher demineralization degree compared to non-cavitated, or enamel cavitated lesions. Inactive lesions presented lower demineralization degree compared to active lesions, although with a low effect size. According to the morphological aspect of the carious cavity, open enamel lesions showed lower dentin demineralization degree than closed lesion environments.ConclusionActive lesions showed higher dentin demineralization degree than inactive ones, while lesions showing closed cavitation resulted in higher dentin demineralization degree only for enamel lesions. Including those parameters in treatment decisions may help to improve prognosis and increase effectiveness of the caries diagnostic systems in the clinical setting.     

What is the relation between the presence of caries in the deciduous dentition and the chronology of the eruption of the permanent teeth?

Based on data obtained from a prospective epidemiological study in a random sample of 4468 Flemish children, accurate emergence ages for permanent teeth could be established. When data on permanent tooth emergence in different populations are compared, differences are most pronounced for premolars. Several authors hypothesised that this difference could be explained by a difference in caries experience in the primary molars. The purpose of this study was to quantify the effect of caries experience in a primary molar on the timing of emergence of its successor. The results indicate that the emergence of the premolars was accelerated by 2 to 8 months when its predecessor had been decayed and or filled but had not been extracted. Premature loss of maxillary primary molars resulted in a significant acceleration of the emergence of the premolars; this was not observed in the mandible. In conclusion, when considering permanent tooth emergence ages, caries experience in the primary dentition should be taken into account.     

Is a calcium hydroxide liner necessary in the treatment of deep caries lesions? A systematic review and meta‐analysis

The aim of this systematic review and meta‐analysis was to evaluate whether the use of calcium hydroxide (CH) liner improves the clinical success in the treatment of deep caries lesions of primary and permanent teeth. The review was reported in accordance with the PRISMA Statement. Only studies that evaluated deep carious lesions treated with and without a CH liner were included. The required outcomes had to be obtained by clinical, radiographic or laboratory evaluations. Statistical analyses were performed with the RevMan 5.2 program (The Cochrane Collaboration, Copenhagen, Denmark) for randomized clinical trials with at least 12 months of follow‐up, using fixed‐effect models at a significance level of P < 0.05. The literature search was performed in eight databases: PubMed (MEDLINE), Lilacs, IBECS, BBO, Web of Science, Scopus, SciELO and The Cochrane Library. A total of 17 studies were included (15 in primary teeth, two in permanent teeth). The overall risk difference for CH versus adhesive system in primary teeth was 0.06 [95% CI ?0.01 to 0.13], and the overall risk difference for CH versus GIC was 0.10 [95% CI ?0.01 to 0.22], with no significant differences between materials. CH liner did not influence the clinical success of treatment for deep caries lesions of primary or permanent teeth. Although the present analysis demonstrated that use of CH liner in deep caries lesions was unnecessary, the evidence was of moderate to very low quality; thus, further well‐designed, randomized and controlled clinical trials are necessary to provide stronger recommendations.