Erupción dentaria y actividad de caries: ¿es un factor de riesgo en adolescentes?

Resumen Objetivo: describir el comportamiento, distribución y severidad de las lesiones de caries en las superficies oclusales de los segundos molares permanentes. Relacionarlo a su etapa de erupción y presencia de actividad en el resto de la cavidad bucal. Metodología: Se realizó un estudio descriptivo en una muestra de conveniencia de 100 adolescentes, de ambos sexos, (edad promedio=13,39±0,94 años). Los padres respondieron un cuestionario sobre aspectos socioeconómicos y salud general y los adolescentes sobre dieta y hábitos de higiene. Dos examinadoras calibradas realizaron el examen clínico de acuerdo a los criterios de ICDAS II en todas las superficies erupcionadas, así como el mapeo de la cara oclusal y la etapa de erupción de los segundos molares permanentes. Resultados: la prevalencia de caries fue de un 97% y la extensión (CPOD modificado) de 8,45± 5,10. El 82% de los adolescentes con experiencia de caries presentaba lesiones activas y el 62% de los carioactivos presentaban lesiones únicamente en las caras oclusales de los segundos molares permanentes. Se observó mayor prevalencia de lesiones de caries activas en los estadíos I y II de erupción de los segundos molares permanentes, siendo los sitios más afectados la fosa central y mesial y la fosa central y distal, respectivamente. Conclusiones: La erupción activa de molares significa una etapa de riesgo para las personas que debe ser considerada al momento priorizar y establecer programas de salud bucal.

Resumo Objetivo: descrever o comportamento, distribuição e severiidade das lesões de cárie nas superfícies oclusais dos segundos molares permanentes. Relacionar com seu estágio de erupção e presença de atividade no resto da cavidade oral. Metodologia: Foi realizado um estudo descritivo em uma amostra de conveniência de 100 adolescentes, de ambos os sexos, (média de idade = 13,39 ± 0,94 anos). Os pais responderam a um questionário sobre aspectos socioeconômicos e de saúde geral e os adolescentes sobre alimentação e hábitos de higiene. Dois examinadores calibrados realizaram o exame clínico de acordo com os critérios do ICDAS II em todas as superfícies erupcionadas, além de mapear a superfície oclusal e o estágio de erupção dos segundos molares permanentes. Resultados: a prevalência de cárie foi de 97% e a extensão (CPOD modificado) de 8,45 ± 5,10. 82% dos adolescentes com experiência de cárie tinham lesões ativas e 62% dos carioativos tinham lesões apenas nas superfícies oclusais dos segundos molares permanentes. Maior prevalência de lesões de cárie ativas foi observada nos estágios I e II de erupção dos segundos molares permanentes, sendo os locais mais acometidos a fossa central e mesial e a fossa central e distal, respectivamente. Conclusões: A erupção ativa de molares representa uma etapa de risco para as pessoas que deve ser considerada na priorização e estabelecimento de programas de saúde bucal.

Abstract Objective: to describe the behavior, distribution, and severity of lesions on the occlusal surfaces of the second permanent molars. Relate it to its stage of eruption and presence of activity in the rest of oral cavity. Methodology: A descriptive study was conducted in a convenience sample of 100 adolescents of both sexes (mean age = 13.39 ± 0.94 years). The parents answered a questionnaire on socioeconomic characteristics and general health, and the adolescents, one on food and hygiene habits. Two calibrated examiners recorder caries according to ICDAS II on all the dental surfaces . They also mapped the occlusal surface and eruption stage of the second permanent molars. Results: the prevalence of caries was 97%, and the extension (modified DMFT) was 8.45 ± 5.10. Eighty-two percent of the adolescents with caries experience had active lesions, and 62% of those with caries had lesions only on the occlusal surfaces of the second permanent molars. A higher prevalence of active caries lesions was observed in eruption stages I and II of the second permanent molars. The most affected sites were the central and mesial fossa and the central and distal fossa. Conclusions: Active molar eruption entails a risk stage that should be considered when prioritizing and developing oral health programs.

Sensitivity and Specificity of Different Diagnostic Methods in Occlusal Caries Detection of Permanent Teeth Among Paediatric Patients

ABSTRACT@#Dental caries is a commonly progressive disease that proceeds through various degrees of severity that a dentist can detect. The aims of the in vivo study were to assess the accuracy of the individual model (near-infrared light transillumination [NILT] device, visual and radiographic examinations) in detecting occlusal caries, and to evaluate the performance of visual and NILT device combination for occlusal caries detection in deciding the treatment options. Fifty-two non-cavitated occlusal surfaces from 16 patients were assessed with three different diagnostic devices in random order. Identified lesions were prepared and validated. Logistic regression analysis was performed for each method. The sensitivity and specificity values for each method and the combined models were statistically measured using RStudio version 0.97.551. At the enamel level, visual detection was the most sensitive method (0.88), while NILT was the most specific (0.93). NILT scored the highest for sensitivity (0.93) at the dentine level and visual detection scored the highest for specificity (0.88). Visual detection + NILT model was significantly better (p = 0.04) compared to visual detection or NILT alone (df = 1). The visual-NILT combination is a superior model in detecting occlusal caries on permanent teeth. The model provided surplus value in caries detection hence improving the treatment decision-making in occlusal surfaces.

Stress distribution of composite resin filling in Class I cavity of molars with different cavosurface angle / 口腔疾病防治

Objective @#To analyze the effect of different cavosurface angles on the stress distribution of ClassⅠ cavity composite resin filling of molars through the three-dimensional finite element method and to provide references for the preparation of ClassⅠ cavities.@*Methods@#Three-dimensional finite element models of ClassⅠ composite resin filling of mandibular first molars with three different cavosurface angles (group A: 90°, group B: 120°, group C: 135°) were established. Polymerization shrinkage of composites was simulated with a thermal expansion approach. The mechanical behavior of the restored models in terms of stress and displacement distributions under the combined effects of polymerization shrinkage and occlusal load (600 N) was analyzed.@*Results@# For ClassⅠ cavities with the same cavity size, the total stress of the restoration model and the maximum stress of the enamel in group A were less than those in groups B and C after cavity composite resin restoration with three cavity cavosurface angles (in which the width of the enamel bevel was 1 mm in groups B and C). The maximum stress of the dentin and adhesive was similar in the three groups, the maximum stress of the composite in group C was the largest, and the maximum stress of the composite in group B was the smallest. In terms of stress distribution, the maximum stress in each restoration model was mainly concentrated in the enamel at the cavosurface, near the enamel-dentin interface and at the edge of the restoration material.@*Conclusion@#From the point of reducing the stress of residual tooth tissue, the preparation of 90° angle without enamel bevel is an ideal method for cavity preparation when composite resin is used to fill ClassⅠ cavities of molars.

Comparative Evaluation of ICDAS, WHO and Histological Examination in Detection of Occlusal Carious Lesions / Avaliação comparativa de ICDAS, OMS e Exame histológico na detecção de lesões cariosas oclusais

A detecção de lesões cariosas oclusais através de sistemas de pontuação visual está em contínua validação com a profundidade histológica do processo de desminerização da cárie. Objetivo: O presente estudo teve como objetivo comparar o Sistema Internacional de Detecção e Avaliação de Cáries (ICDAS), o Sistema da Organização Mundial da Saúde (OMS) e o exame histológico na detecção de lesões cariosas oclusais. Material e Métodos: 20 pré-molares foram avaliados por exame visual ICDAS, OMS e exame histológico usando estereomicroscópio (SM) para a detecção de cárie oclusal. As superfícies oclusais foram avaliadas por dois examinadores, e todos os dentes foram avaliados visualmente e histologicamente. Resultados: Para cada um dos três sistemas, foi realizada uma análise do coeficiente de correlação interclasses, sendo que a diferença entre os três sistemas de detecção de cárie oclusal foi mínimo. O exame visual através da OMS registrou o maior coeficiente de intercorrelação seguido pelo sistema ICDAS, em seguida, o exame histológico, respectivamente. Conclusão: OMS e ICDAS demonstraram reprodutibilidade e precisão diagnóstica quando comparado com o exame histológico para detecção de cáries oclusais (AU)

Detection of occlusal carious lesions with visual scoring systems is in a continuous validation with the histological depth of carious demineralization. Objective: The present study aimed to compare the International Caries Detection and Assessment System (ICDAS), the World Health Organization (WHO) system and histological examination in detecting occlusal carious lesions. Material and Methods: 20 premolars were evaluated by visual examination using ICDAS, WHO and histological examination using stereomicroscope (SM) for occlusal caries detection. Occlusal surfaces were evaluated by two examiners then all teeth were visually and histologically assessed. Results: For each of three systems the inter class correlation coefficient was examined, the differences between the three systems of occlusal caries detection were minimal. The visual examination through WHO recorded the higher intercorrelation coefficient followed by ICDAS system then histological examination respectively. Conclusion: WHO and ICDAS have demonstrated reproducibility and diagnostic accuracy when compared with histological examination for detecting occlusal caries. (AU)

Toma de decisiones para el tratamiento de caries oclusales en el sistema de salud público brasileño / Decision-making for the treatment of occlusal caries in the Brazilian public health system

ABSTRACT Introduction: Caries diagnosis errors have become a public health problem. Objective: Verify the consistency in terms of decision-making between Brazilian dentists from the country's public health system and the International Caries Detection and Assessment System (ICDAS), and evaluate the influence of professional experience on the management of the decay. Methods: There are 80 dentists in the public health service of Recife city, Brazil. All dentists were invited to participate in this cross-sectional study. Forty dentists agreed to answer questions about their decision-making in relation to the treatment of occlusal caries in low, moderate and high-risk caries situations. The time of clinical experience, the use of methods for the assessment of caries risk and the lesion activity were also inquired about. The T-test was applied with a significance level of 5 por ciento to compare the correlation between the International Caries Detection and Assessment System scores regarding the mean age of participants. Results: The disagreement between the dentists and the criteria used by the International Caries Detection and Assessment System for decision-making were mainly related to the sound surfaces or lesions restricted to the tooth enamel. It was thus verified that lack of consistency for the low-risk condition reached a score of 3 (32 percent), while moderate (95 percent) and high-risk (85 percent) conditions lay at a classification code of 0. The time of professional experience was not considered to have interfered with decision-making on any scale, regardless of the risk condition of the patient (p> 0.05). Conclusions: A divergence in terms of decision-making between dentists of the public health system and the International Caries Detection and Assessment System could be observed, specifically regarding sound surfaces or surfaces with lesions restricted to the tooth enamel. Furthermore, professional experience was seen as not influencing the management of caries(AU)

RESUMEN Introducción: Los errores de diagnóstico de caries se han convertido en un problema de salud pública. Objetivo: Verificar la concordancia de la toma de decisiones entre los dentistas brasileños del sistema de salud pública del país y el Sistema Internacional de Detección y Evaluación de Caries (ICDAS), así como evaluar la influencia de la experiencia profesional en el manejo de la caries. Métodos: De los 80 dentistas que existen en servicio público de salud en la ciudad de Recife, Brasil, todos fueron invitados a participar en este estudio transversal. Cuarenta dentistas acordaron responder sobre su toma de decisión en relación con el tratamiento de la caries oclusal en situaciones de caries de bajo, moderado y alto riesgo. El tiempo de experiencia clínica, el uso de métodos para la evaluación del riesgo de caries y la actividad de la lesión también fueron cuestionados. La prueba T, para un nivel de significancia del 5 por ciento, fue aplicada para comparar la correlación entre los escores del Sistema Internacional de Detección y Evaluación de Caries en relación con el promedio de edad de los participantes. Resultados: El desacuerdo entre los dentistas y los criterios utilizados por el ICDAS para la toma de decisiones se concentró en los códigos de clasificación que representan superficies sanas o lesiones restringidas al esmalte de los dientes. Se verificó así que la falta de consistencia para la condición de bajo riesgo se concentró en la puntuación de 3 (32 por ciento), mientras que las condiciones moderada (95 por ciento) y de alto riesgo (85 por ciento) se concentraron en los códigos de clasificación de 0. El factor tiempo de experiencia profesional no interfirió en la prevalencia de concordancia de la toma de decisión para cualquier escore, independientemente de la condición de riesgo del paciente (p> 0,05). Conclusiones: Se pudo observar una divergencia en cuanto a la toma de decisiones entre los dentistas del sistema de salud pública y el Sistema Internacional de Detección y Evaluación de Caries, específicamente con respecto a superficies sanas o superficies con lesiones restringidas al esmalte de los dientes. Además, la experiencia profesional no influyó en el manejo de la caries(AU)

In Vitro Comparison of ICDAS And DIAGNOdent Pen in The Diagnosis and Treatment Decisions of Non-Cavitated Occlusal Caries / Comparación In Vitro de ICDAS y DIAGNOdent Pen en el diagnóstico y decisiones de tratamiento de la caries oclusal no cavitada

Abstract The aim of this study was to compare the efficacy of the ICDAS and the DIAGNOdent Pen in the diagnosis of occlusal caries lesions without cavitation, and for basing treatment decisions on the results obtained. Eighty permanent molar teeth that were healthy and non-cavitated or that had an initial occlusal lesion were evaluated. All teeth were investigated using DIAGNOdent Pen and ICDAS by four examiners. Histological evaluation of teeth was performed using stereomicroscopy by a histologist and different experienced dentist. For evaluation of the data, weighted kappa values (kw), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR+) values of the tests were calculated. The diagnostic results obtained using the DIAGNOdent Pen were found to correlate better with the results obtained from histological sections than those obtained using ICDAS. When the treatment decisions of the observers depending on the results of ICDAS, and ICDAS and DIAGNOdent Pen combination were compared with the decisions made based on histological examinations, the decisions based on ICDAS and DIAGNOdent Pen combined (kw: 0.522) were more accurate than the ones based on ICDAS (kw: 0.415) alone. In conclution, professional experience is an effective factor in diagnosing occlusal caries lesions without cavitation with ICDAS and in making treatment decisions for them. DIAGNOdent Pen is sufficient in diagnosing occlusal caries lesions without cavitation.

Resumen El objetivo de este estudio fue comparar la eficacia de ICDAS y de DIAGNOdent Pen en el diagnóstico de lesiones de caries oclusales no cavitadas. Ochenta molares permanentes sanos y no cavitados fueron utilizados. Todos los dientes fueron investigados usando DIAGNOdent Pen e ICDAS por cuatro examinadores. La evaluación histológica de los dientes se realizó mediante estereomicroscopía por un histólogo y por un dentista con previa experiencia. Los resultados diagnósticos obtenidos con el DIAGNOdent Pen se correlacionan mejor con los resultados obtenidos a partir de las secciones histológicas cuando comparados a los obtenidos utilizando ICDAS. Las decisiones basadas en el uso combinado de ICDAS y DIAGNOdent Pen (kw: 0.522) fueron más precisas que los basados en ICDAS (kw: 0.415). En conclusión, la experiencia profesional es un factor eficaz en diagnóstico de lesiones de caries oclusal sin cavitación con ICDAS y en la toma de decisiones de tratamiento. DIAGNOdent Pen es una herramienta confiable para diagnosticar lesiones de caries oclusales sin cavitación.

Ex vivo assessment of the potency of optical coherence tomography for the detection of early occlusal caries / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to evaluate the potency of optical coherence tomography (OCT) to detect early occlusal caries compared with clinical visual examination.</p><p><b>METHODS</b>Approximately 97 sites of occlusal fissures on 77 extracted accessional human teeth were scored by three examiners using conventional visual examination and OCT. Results of histological examination on these sites obtained by polarimicroscope served as a gold standard to analyze the sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV). Results of the area under receiver operating characteristic (ROC) curve (AUC) by visual examination and OCT were also analyzed. The Spearman's rank correlation coefficient with histology and the inter-examiner reliability were compared.</p><p><b>RESULTS</b>For sites of enamel demineralization limited to the outer 1/2 of the enamel layer, the detection rate of OCT (14/25) was obviously higher than that of the clinical and visual examination (3/25). SE, SP, PPV and NPV of OCT during diagnosis of the early occlusal caries (0.83, 0.64, 0.87 and 0.57) were higher than that of the visual examination (0.79, 0.60, 0.85 and 0.50). AUC (95%CI) of OCT and the visual examination were 0.737 (0.569-0.822) and 0.696 (0.614-0.859), respectively. No statistically significant difference was observed between the results. Results of OCT correlated well with histology (r=0.559, P<0.05). The inter-examiner reliability of OCT was medium.</p><p><b>CONCLUSIONS</b>OCT can accurately detect early occlusal lesions atraumatically with high sensitivity and effectiveness. OCT exhibits the potential of auxiliary clinical diagnosis enhancing detection rate and finally implementing early diagnosis and early intervention of early occlusal lesions in clinical practice.</p>

Validation of micro-computed tomography for occlusal caries detection: an in vitro study

Conventional methods of caries detection, including the gold standard of histological examination, have certain disadvantages that must be addressed prior to validating any other diagnostic technique—current or new. Here we evaluated the validity of micro-computed tomography (micro-CT) as an alternative gold-standard technique for caries detection. Sixty teeth with suspected occlusal caries were chosen from a pool of teeth extracted for orthodontic, periodontal, or surgical reasons. Identical reference points were marked on photographs taken for teeth and were used to evaluate each method. Dimensions of caries were assessed by two calibrated examiners using the ICDAS-II visual examination system, bitewing radiographs, and micro-CT. The teeth included in the study were selected randomly from solution before all measurements. For micro-CT, the device was set to 50 kV, 800 µA, pixel size 15 µm (at 1024 × 1024 resolution), and 1° rotation step. NRecon software (SkyScan) was used to obtain reconstructed images. For each diagnostic method, results were compared with histology results using the McNemar test. Receiver operator characteristic (ROC) analysis was also performed for each method (Z-test; p < 0.05). Besides showing a high correlation with histology results, micro-CT yielded the greatest values at the D3 threshold; moreover, accuracy and area under the ROC curve (AUC) values were greatest at the D1threshold. Our results indicate that micro-CT performs as well as or better than histological examination for the purpose of comparing methods for caries detection.

In vitro quantification of occlusal caries lesion using QLF-D, ICDAS, and DIAGNOdent / 대한구강보건학회지

OBJECTIVES: To compare the QLF-D method and the ICDAS and DIAGNOdent techniques for in vitro quantification of occlusal caries and to assess the histological features of the caries. METHODS: One hundred and twenty-two extracted permanent teeth were selected, and the site of interest on the occlusal surface was examined using each detection method. The occlusal sites were classified according to the ICDAS II criteria based on the decision taken by two investigators, who have taken the ICDAS E-learning course. The examined site was then measured using the DIAGNOdent, and the peak value was recorded. In addition, by using the QLF-D, the occlusal site was photographed to obtain the DeltaFmax value. After all assessments were performed, the occlusal sites were vertically sectioned in order to assess the histological features. This was considered the gold standard. The histological criteria were graded using a 4-point scale as follows: S=sound (n=21), E1=limited enamel caries (n=27), E2=caries extending to the dento-enamel junction (n=49), D=caries involving the dentine (n=25). RESULTS: An ICDAS code between 0 and 4 was assigned to all the occlusal sites, and this revealed the QLF-D value, which was between -95 to 0. The DIAGNOdent value was between 8 and 99. The correlation values of QLF-D, ICDAS, and DIAGNOdent with the histological features were 0.68, 0.58, and 0.46, respectively (P<0.01). A highly significant correlation was observed between QLF-D and the gold standard, which showed a moderate correlation and an acceptable correlation was observed with ICDAS (r=0.75, P<0.01). A statistically significant difference was observed in the average QLF-D values of each histological grade i.e., -28.5 (S), -53.7 (E1), -68.1 (E2), and -84.4 (D). CONCLUSIONS: The QLF-D showed a significant correlation with the ICDAS and histological features. Therefore, visual inspection with QLF-D would improve the detection accuracy and ensure early diagnosis of dental caries.

Distinção entre Dois Tipos de Lesão Dentinária na Superfície Oclusal sob Esmalte sem Cavitação / Distinction between Two Types of Dentine Lesion on the Occlusal Surface without Cavitation Enamel Under

Introdução: Embora a prevalência de cárie tenha diminuído consideravelmente, as superfícies oclusais ainda representam as áreas com maior proporção de experiência dessa lesão. Por outro lado, atualmente os clínicos e a comunidade científica têm detectado uma grande ocorrência de lesões dentinárias oclusais sob esmalte aparentemente hígido. Essas lesões têm sido denominadas de cárie oculta porque se mostram clinicamente com superfície oclusal sem cavitação e com evidente manifestação em dentina, quando da execução do exame radiográfico. Objetivo: O objetivo desse trabalho é distinguir dois tipos de lesão dentinária, sob esmalte sem cavitação, apresentando uma nova denominação, cárie semioculta, para todas as lesões dentinárias sob esmalte não cavitado, porém com mudança de coloração, visível através da inspeção visual detalhada, classificando as duas entidades distintas de cárie escondida, cárie oculta e semioculta, baseando-se no método de diagnóstico. A diferenciação entre as lesões será ilustrada através de fotografias, ressaltando os aspectos clínicos de ambas as situações.Conclusão: A introdução no meio científico dessa nova denominação é bastante relevante tendo em vista que as pesquisas mostram uma taxa relativamente alta da prevalência da cárie oculta porque consideram apenas a ausência da cavitação no esmalte, sem a observação da mudança na sua configuração e coloração. Entretanto, se verifica que a maioria dessas lesões é cárie semioculta, portanto detectáveis pela inspeção visual detalhada, e que a cárie oculta, encontrada em menor percentual, não é perceptível através da inspeção visual detalhada, mas plenamente visível através da radiografia. As evidências clínicas impõem a necessidade da constante evolução e modificação de conceitos e técnicas operatórias

Introduction: Although caries prevalence has decreased considerably, the occlusal surfaces still represent areas with higher proportion of experience of this injury. Moreover, currently the clinical and scientific community have found a high occurrence of occlusal dentin lesions in apparently healthy enamel. These lesions have been called hidden caries because they show clinically the occlusal surface without cavitation and with evident manifestation in dentin when executing radiographic examination. Objective: The aim of this work is to distinguish two types of dentinlesion, no cavitation in enamel, with a new name, almost hidden caries, for all lesions in enamel dentin cavitated not, but with color change, visible through the detailed visual inspection, classifying the twoseparate entities hidden caries, hidden caries and almost hidden caries, based on the method of diagnosis. The differentiation between the lesions will be illustrated by photographs, emphasizing the clinical aspects of both situations.Conclusion: The introduction of this new in the scientific name is very relevant given that polls show a relatively high prevalence of hidden caries because they take into account only the absence of cavitation inenamel without notice of the change in shape and color . However, it appears that the majority of these injuries is almost hidden cariestherefore detectable by detailed visual inspection, and that the hidden caries, found at a lower rate is not noticeable through visual detail, but fully visible by radiography. The clinical evidence imposes the need for constant evolution and change of concepts and surgical techniques

A comparative evaluation of DIAGNOdent with visual and radiography for detection of occlusal caries: An in vitro study.

Background: The diagnosis of dental caries is fundamental to the practice of dentistry. Despite the fact that dental caries has declined considerably, it is still a problem of great importance. The reduction in caries prevalence has not occurred uniformly for all the surfaces. The greatest reduction was observed at lesions located on smooth surfaces, so that occlusal caries are most common in children. Aim: The purpose of this study is to determine the clinical efficacy of DIAGNOdent in detecting occlusal caries. Materials and Methods: A total number of 50 teeth were subjected for visual, radiographic, and DIAGNOdent examinations. All the three methods were compared to histology which is a gold standard. Results: The result obtained showed that DIAGNOdent is superior to visual and radiographic methods in diagnosing occlusal caries.