scholarly journals Influence of Examiner Experience on Clinical Performance of Visual Inspection in Detecting and Assessing the Activity Status of Caries Lesions

2013 ◽  
Vol 38 (6) ◽  
pp. 583-590 ◽  
Author(s):  
T Gimenez ◽  
DG Bittar ◽  
C Piovesan ◽  
CAB Guglielmi ◽  
KY Fujimoto ◽  
...  
Keyword(s):  
Clinical Features ◽  
Visual Inspection ◽  
Dental Treatment ◽  
Pediatric Dentistry ◽  
Dental Students ◽  
Assessment System ◽  
Caries Detection ◽  
Caries Activity ◽  
Caries Lesions ◽  
Different Levels

SUMMARYOur hypothesis was that a method of caries activity evaluation based on the clinical features of the lesions would be less time consuming but more influenced by the examiner's experience than the scoring system used in association with the International Caries Detection and Assessment System (ICDAS). Thus, the aim of this study was to evaluate the performance of three groups of examiners with different levels of experience using two different methods to assess the activity status of caries lesions by visual inspection. A cross-sectional study in a dental office setting was performed selecting 18 children, aged three to eight years, who had sought dental treatment at a dental school. Examinations to detect caries lesions were performed using visual inspection by six examiners with different levels of experience: two undergraduate dental students, two specialists in pediatric dentistry, and two graduate students. The examiners used ICDAS and two different methods to assess caries activity: using an additional score system or considering the examination of clinical features. Two benchmark examiners examined the children in a joint session, and their consensus was considered to be the reference standard. The sensitivity, specificity, and reproducibility were calculated for different thresholds: all, cavitated, and active caries lesions. Multilevel analyses were performed to compare the different methods and examiners. No differences were observed among the examiners, either in detecting all lesions and cavitated lesions or regarding the activity assessment. The methods of assessing activity status performed similarly, but the time spent on examinations was shorter for the method evaluating clinical features. In conclusion, the experience of examiners does not significantly influence the performance of visual inspection, and both methods of assessing activity status result in similar diagnostic accuracy.

scholarly journals A Hands-On Exercise on Caries Diagnostics among Dental Students—A Qualitative Study

2021 ◽  
Vol 9 (10) ◽  
pp. 113
Author(s):  
Heidi Kangas ◽  
Saujanya Karki ◽  
Tarja Tanner ◽  
Anne Laajala ◽  
Helvi Kyngäs ◽  
...  
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Learning Experience ◽  
Dental Students ◽  
Assessment System ◽  
Diagnostic Methods ◽  
Caries Detection ◽  
Caries Diagnostics ◽  
Hands On ◽  
Caries Lesions

According to current care practices, the aim is to prevent the onset of caries lesions and to stop the progression of incipient lesions. A visual lesion assessment system, International Caries Detection and Assessment System (ICDAS), has been developed to promote reliability and repeatability of assessment of different stage caries lesions. The aims of this study were to evaluate the experiences of a hands-on exercise with authentic teeth as an adjunct to lecturing among third-year dental students and to evaluate the learning process during the hands-on exercise measured by qualitative (inductive content) analysis of the given feedback. In 2018, 51 third-year dental students at the University of Oulu, Finland, participated in a hands-on exercise on caries detection, where they assessed the depth and activity of lesions in extracted teeth using the ICDAS classification. After the lecture, students evaluated the exercise, giving feedback according to five given topics, three of which were analyzed using inductive content analysis. The exercise was considered useful and necessary but, overall, also challenging. The diverse activities and materials, as well as observational methods, promoted learning. The classification of lesions, the diagnostic methods, and the fact that there was not enough time to adopt things during the exercise were found to be challenging. For developing the exercise, the students suggested that more time should be scheduled for it and there should be more individual teaching. This qualitative study showed that, despite the challenge in caries diagnostics, dental students perceive the hands-on exercise as both a communal and individual learning experience.

scholarly journals Metabolic Profile of Supragingival Plaque Exposed to Arginine and Fluoride

2019 ◽  
Vol 98 (11) ◽  
pp. 1245-1252 ◽  
Author(s):  
M.M. Nascimento ◽  
A.J. Alvarez ◽  
X. Huang ◽  
C. Browngardt ◽  
R. Jenkins ◽  
...  
Keyword(s):  
Acid Production ◽  
Metabolic Profile ◽  
Assessment System ◽  
Caries Detection ◽  
Metabolic Profiles ◽  
Ph Homeostasis ◽  
Supragingival Plaque ◽  
Plaque Ph ◽  
Oral Biofilms ◽  
Caries Lesions

Caries lesions develop when acid production from bacterial metabolism of dietary carbohydrates outweighs the various mechanisms that promote pH homeostasis, including bacterial alkali production. Therapies that provide arginine as a substrate for alkali production in supragingival oral biofilms have strong anticaries potential. The objective of this study was to investigate the metabolic profile of site-specific supragingival plaque in response to the use of arginine (Arg: 1.5% arginine, fluoride-free) or fluoride (F: 1,100 ppm F/NaF) toothpastes. Eighty-three adults of different caries status were recruited and assigned to treatment with Arg or F for 12 wk. Caries lesions were diagnosed using International Caries Detection and Assessment System II, and plaque samples were collected from caries-free and carious tooth surfaces. Taxonomic profiles were obtained by HOMINGS (Human Oral Microbe Identification using Next Generation Sequencing), and plaque metabolism was assessed by the levels of arginine catabolism via the arginine deiminase pathway (ADS), acidogenicity, and global metabolomics. Principal component analysis (PCA), partial least squares–discriminant analysis, analysis of variance, and random forest tests were used to distinguish metabolic profiles. Of the 509 active lesions diagnosed at baseline, 70 (14%) were inactive after 12 wk. Generalized linear model showed that enamel lesions were significantly more likely to become inactive compared to dentin lesions ( P < 0.0001), but no difference was found when treatment with Arg was compared to F ( P = 0.46). Arg significantly increased plaque ADS activity ( P = 0.031) and plaque pH values after incubation with glucose ( P = 0.001). F reduced plaque lactate production from endogenous sources ( P = 0.02). PCA revealed differences between the metabolic profiles of plaque treated with Arg or F. Arg significantly affected the concentrations of 16 metabolites, including phenethylamine, agmatine, and glucosamine-6-phosphate ( P < 0.05), while F affected the concentrations of 9 metabolites, including phenethylamine, N-methyl-glutamate, and agmatine ( P < 0.05). The anticaries mechanisms of action of arginine and fluoride are distinct. Arginine metabolism promotes biofilm pH homeostasis, whereas fluoride is thought to enhance resistance of tooth minerals to low pH and reduce acid production by supragingival oral biofilms.

scholarly journals Monitoring of Sound and Carious Surfaces under Sealants over 44 Months

2014 ◽  
Vol 93 (11) ◽  
pp. 1070-1075 ◽  
Author(s):  
M. Fontana ◽  
J.A. Platt ◽  
G.J. Eckert ◽  
C. González-Cabezas ◽  
K. Yoder ◽  
...  
Keyword(s):  
Assessment System ◽  
Retention Rates ◽  
Caries Detection ◽  
Major Barrier ◽  
Occlusal Surfaces ◽  
Before And After ◽  
Permanent Molars ◽  
Caries Lesions ◽  
Sealant Retention ◽  
Lesion Severity

Although there is strong evidence for the effectiveness of sealants, one major barrier in sealant utilization is the concern of sealing over active caries lesions. This study evaluated detection and monitoring of caries lesions through a clear sealant over 44 mo. Sixty-four 7- to 10-year-old children with at least 2 permanent molars with International Caries Detection and Assessment System (ICDAS) scores 0-4 (and caries less than halfway through the dentin, radiographically) were examined with ICDAS, DIAGNOdent, and quantitative light-induced fluorescence (QLF) before sealant placement and 1, 12, 24, and 44 mo (except QLF) after. Bitewing radiographs were taken yearly. DIAGNOdent and QLF were able to distinguish between baseline ICDAS before and after sealant placement. There was no significant evidence of ICDAS progression at 12 mo, but there was small evidence of minor increases at 24 and 44 mo (14% and 14%, respectively) with only 2% ICDAS ≥ 5. Additionally, there was little evidence of radiographic progression (at 12 mo = 1%, 24 mo = 3%, and 44 mo = 9%). Sealant retention rates were excellent at 12 mo = 89%, 24 mo = 78%, and 44 mo = 70%. The small risk of sealant repair increased significantly as baseline ICDAS, DIAGNOdent, and QLF values increased. However, regardless of lesion severity, sealants were 100% effective at 12 mo and 98% effective over 44 mo in managing occlusal surfaces at ICDAS 0-4 ( i.e., only 4 of 228 teeth progressed to ICDAS ≥ 5 associated with sealants in need of repair and none to halfway or more through the dentin, radiographically). This study suggests that occlusal surfaces without frank cavitation (ICDAS 0-4) that are sealed with a clear sealant can be monitored with ICDAS, QLF, or DIAGNOdent, which may aid in predicting the need for sealant repair.

scholarly journals Orange/Red Fluorescence of Active Caries by Retrospective Quantitative Light-Induced Fluorescence Image Analysis

2016 ◽  
Vol 50 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Grace Felix Gomez ◽  
George J. Eckert ◽  
Andrea Ferreira Zandona
Keyword(s):  
Image Analysis ◽  
Mixed Model ◽  
Assessment System ◽  
Caries Detection ◽  
Percentage Increase ◽  
Caries Activity ◽  
Red Fluorescence ◽  
Mixed Model Anova ◽  
Retrospective Clinical Study ◽  
Final Observation

This retrospective clinical study determined the association of caries activity and orange/red fluorescence on quantitative light-induced fluorescence (QLF) images of surfaces that progressed to cavitation, as determined by clinical visual examination. A random sample of QLF images from 565 children (5-13 years) previously enrolled in a longitudinal study was selected. Buccal, lingual and occlusal surface images obtained after professional brushing at baseline and every 4 months over a 4-year period were analyzed for red fluorescence. Surfaces that progressed (n = 224) to cavitation according to the International Caries Detection and Assessment System (ICDAS 0/1/2/3/4 to 5/6 or filling), and surfaces that did not progress (n = 486) were included. QA2 image analysis software outputs the percentage increase of the red/green components as ΔR and area of ΔR (areaΔR) at different thresholds. Mixed-model ANOVA was used to compare progressive and nonprogressive surfaces to account for correlations of red fluorescence (ΔR and areaΔR) between surfaces within a subject. The first analysis used the first observation for each surface or the first available visit if the surface was unerupted (baseline), while the second analysis used the last observation prior to cavitation for surfaces that progressed and the last observation for surfaces that did not progress (final). There was a significant (p < 0.05) association between red fluorescence and progression to cavitation at thresholds ΔR0, ΔR10, ΔR20, ΔR60, ΔR70, ΔR80, ΔR90 and ΔRmax at baseline and for ΔR0 and ΔR10 at the final observation. Quantification of orange/red fluorescence may help to identify lesions that progress to cavitation. Future studies identifying microbiological factors causing orange/ red fluorescence and its caries activity are indicated.

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

2018 ◽  
Vol 52 (5) ◽  
pp. 406-419 ◽  
Author(s):  
Kim Rud Ekstrand ◽  
Thais Gimenez ◽  
Fernanda R. Ferreira ◽  
Fausto M. Mendes ◽  
Mariana M. Braga
Keyword(s):  
Roc Curves ◽  
Diagnostic Odds Ratio ◽  
Assessment System ◽  
Caries Detection ◽  
Activity Assessment ◽  
Caries Progression ◽  
Overall Performance ◽  
Meta Analyses ◽  
Caries Lesions ◽  
Specific Search

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.

scholarly journals Dental students’ and lecturers’ perception of the degree of difficulty of caries detection associated learning topics in Brazil

2015 ◽  
Vol 12 ◽  
pp. 56 ◽  
Author(s):  
Juan Sebastian Lara ◽  
Mariana Minatel Braga ◽  
Caleb Shitsuka ◽  
Chao Lung Wen ◽  
Ana Estela Haddad
Keyword(s):  
Pediatric Dentistry ◽  
Learning Objects ◽  
Dental Students ◽  
Brown Spot ◽  
Caries Detection ◽  
Convenience Sample ◽  
Developmental Defects ◽  
Academic Level ◽  
Carious Lesions ◽  
Perceived Difficulty

Purpose: It aimed to explore the degree of difficulty of caries-detection-associated-topics perceived by dental students and lecturers as pedagogical step in the development of learning objects for e-learning. Methods: A convenience sample comprising ninety-eight subjects from different academic levels (undergraduate/graduate students and pediatric dentistry lecturers) participated. Two spreadsheets (isolated/relative) were created considering key topics in the caries detection process. The isolated evaluation intended to explore each topic in an isolated way, while the relative intended to classify, comparatively, the participants’ perceived difficulty per topic. Afterwards, data were analyzed. All values on spreadsheets were combined obtaining the subject’s final perception. Associations between the subjects’ degree of the perceived difficulty and academic level were estimated. ANOVA was used to determine differences regarding the perception among evaluated topics in distinct groups. Results: Caries histopathology and detection of proximal carious lesions were the topics perceived as the most difficult in the process of caries detection by both students and lecturers. Differentiation between an extrinsic pigmentation and a brown-spot (caries lesion) as well as differential diagnosis between caries and enamel developmental defects or non-carious lesions were considered as more difficult by undergraduates in comparison to graduates/lecturers (regression-coefficient=14.54; Standard Error=3.34; P<0.001 and 8.40, 3.31, and 0.01 respectively). Conclusion: Topics as histopathology and detection of proximal caries lesions were identified as the most difficult despite the academic level. However, some topics are differently perceived according to the group. These results are useful for developing pedagogical material, based on the students real learning needs/expectations.

scholarly journals Clinical Trial of the Canary System for Proximal Caries Detection: A Comparative Study

2021 ◽  
pp. 38-50
Author(s):  
Janja Jan ◽  
Wan Zaripah Wan Bakar ◽  
Sapna M. Mathews ◽  
E. Uzamere ◽  
Linda O. Okoye ◽  
...  
Keyword(s):  
Assessment System ◽  
Receiver Operating Curve ◽  
Caries Detection ◽  
Proximal Caries ◽  
Bitewing Radiography ◽  
Initial Caries ◽  
High Caries Risk ◽  
Icdas Ii ◽  
Risk Patients ◽  
Caries Lesions

Background: Detecting initial caries on the proximal surfaces of teeth in an intact dentition is a problem in dental practice since radiograph has been shown to have poor sensitivity with this stage of caries lesions. Hence there is need for an alternative technology. Objectives: The aim of this study was to investigate the efficacy of the Canary System (CS) to detect proximal caries in a clinical setting, comparing it with bitewing radiography (BWR).  Methodology: 33 subjects, age 18 years and above, were recruited from a mixed population of low, moderate, and high caries risk patients. BWR and the CS were used to detect proximal caries lesions in these subjects. Teeth were separated by 48 hours insertion of rubber rings, and the proximal surfaces were examined by direct visual examination using the International Caries Detection and Assessment System II (ICDAS-II) scoring system. The Sensitivity (se), specificity (sp), positive (ppv) and negative predictive (npv) values of the CS and BWR in detecting caries on proximal surfaces were calculated by evaluating each method alone against ICDAS-II system (used as bronze standard). The two methods were compared statistically using their Area Under the Receiver Operating Curve (AUC). The sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong’s method of nonparametric testing of AUC values.  Results: The se, sp, ppv and npv for the CS are 0.92, 0.78, 0.89, 0.84 respectively, and for BWR are 0.67, 0.54, 0.78, and 0.40 respectively. The AUC of the Canary System (0.77) was statistically significantly higher than the AUC of the radiography (0.53, P < .001).  Conclusions: This study demonstrated the efficacy of the Canary System in detecting proximal caries lesions to be greater than that of bitewing radiography.  Clinical Significance: The Canary System can be a valuable clinical device for detecting and monitoring proximal caries lesions in clinical practice.

scholarly journals The Role of Training for Dental Students in Scoring Caries

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zurainie Abllah
Keyword(s):  
Dental Caries ◽  
Dental Students ◽  
Assessment System ◽  
Caries Detection ◽  
Permanent Teeth ◽  
Kappa Statistics ◽  
Baseline Training ◽  
Teaching Learning ◽  
Dental Mirror

Introduction: Training of dental students is an essential part of the teaching- learning activities in order to obtain reliable results in scoring of dental caries. The objectives of this study are to examine consistency in scoring of caries over a 3-month period following baseline training, calibration and retraining. Methods: Three examiners (dental students) received baseline training/calibration by a "gold standard" examiner (lecturer). This was followed by a re-calibration and retraining 3 months later. A set of 20 extracted teeth was used for the baseline training and for the re-calibration purposes. The International Caries Detection and Assessment System (ICDAS) was used to classify the visual caries lesion severity (0-6 scale) of surface of permanent teeth. The examination utilized a clinical light, dental mirror, dental probe and air syringe. Kappa (unweighted: Kappa) statistics were used to determine inter-examiner reliability at baseline and re-calibration. Results: For caries score criteria, the baseline calibration on 20 specimens indicated an inter-rater kappa ranging from 0.37-0.69. Re-calibration on the same 20 specimens 3 months later indicated an inter-rater kappa of 0.79-0.89. Activity kappa was in the poor to good range. All examiners improved with time. Conclusions: Training contributes to the consistency and reliability of dental caries scoring among dental students.

Identifying a Potential Summary Measure for Overall Caries Level in Children Examined with the International Caries Detection and Assessment System

2017 ◽  
Vol 51 (6) ◽  
pp. 568-575 ◽  
Author(s):  
Mohamed ElSalhy ◽  
Aishah Alsumait ◽  
Hollis Lai ◽  
José Manuel Almerich-Silla ◽  
Chaiana Piovesan ◽  
...  
Keyword(s):  
Permanent Dentition ◽  
Primary Dentition ◽  
Assessment System ◽  
Mixed Dentition ◽  
Caries Detection ◽  
Strong Correlations ◽  
Summary Measure ◽  
Severity Levels ◽  
The Relationship ◽  
Caries Lesions

Objective: To identify a potential summative summary measure that reflects a patient's overall caries level in children examined with the International Caries Detection and Assessment System (ICDAS). Subjects and Methods: Participants were 1- to 15-year-old children from Kuwait, Brazil, and Spain. Children's teeth were examined using the ICDAS. Multiple measures of central tendency and dentition-specific indices were considered as potential summative measures. The relationship between the summative measures and number of caries lesions was evaluated considering degrees of caries severity using Spearman's correlation analysis. The results were generated using the Kuwaiti sample and were cross-validated using the Brazilian and Spanish samples. Results: A total of 2,808 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in primary, mixed, and permanent dentitions. The total ICDAS score of 51 buccal (B), 61B, 54 occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, and 85O surfaces in primary dentition and the total ICDAS score of 14O, 16 lingual (L), 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, and 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations with the number of caries lesions at different caries severity levels. Conclusions: Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dental stages. Total ICDAS scores of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for a patient's overall caries level with high diagnostic accuracy.

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