Variations in caries diagnoses and treatment recommendations and their impacts on the costs of oral health care.

OBJECTIVE: To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil made a combined visual-radiographic caries examination of 40 occlusal surfaces of extracted permanent teeth mounted on two dental mannequins and proposed treatment plans for each tooth. Histological validation then evaluated the diagnoses validity and the suitability of the treatment plans. OUTCOME MEASURES: Inter-examiner agreement was calculated by Cohen's Kappa statistics. The sensitivity and specificity of caries detection and treatment decision were calculated. The costs of dental treatment plans for public health system were calculated from a Brazilian public health service fee scale. RESULTS: Inter-examiner agreement for caries detection was moderate (kappa = 0.42) while for treatment decisions it was fair (kappa = 0.29). The sensitivity and specificity were 0.69 and 0.65 for caries detection and 0.56 and 0.65 for treatment decision respectively. Dentists overestimated the presence and depth of carious lesions and there was a tendency to treat enamel lesions using invasive therapeutic procedures. Mean treatment cost across the two cases was 32US$ (range 9-65) while the histologically validated cost was 23US$. CONCLUSION: The variability in caries detection and treatment decision negatively affected the cost of the dental treatment.

Dental status of Portuguese HIV+ patients and related variables: a multivariate analysis.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the dental status of 101 Portuguese HIV+ subjects aged 22-71 years (mean = 39) and its association with clinical, socioeconomic, and behavioral variables. MATERIALS AND METHODS: A calibrated dentist performed clinical examination and collected data on dental caries, periodontal status, dental plaque levels, prosthetic conditions, and need. The volunteers completed questionnaires on socioeconomic and behavioral variables as well as the Oral Health Impact Profile (OHIP-14) questionnaire. Univariate and multiple logistic regression (MLR) analyses were performed. RESULTS: The mean number of decayed, missing or filled teeth index (DMFT index) was 16.44, standard deviation (s.d.) = 8.42. MLR demonstrated that salaried employee and those with OHIP-14 median (=17). As regards prosthetic status, 28.8% of the examined individuals used dental prosthesis. MLR demonstrated that HIV+ with DMFT >17 or those who knew they were HIV-positive for longer than 5 years were more prone to need dental prostheses. The mean OHIP-14 index was 5.83 (s.d. = 7.79). CONCLUSIONS: The dental health status of HIV-infected Portuguese patients was unsatisfactory and related to clinical, socioeconomic, and behavioral variables.

Distribution and prevalence of dental caries in Bauru, Brazil, 1976-2006.

AIMS: To compare caries prevalence and severity, as well as the disease distribution in the permanent dentition of 12-year-old schoolchildren in Bauru, Brazil, from 1976 to 2006. METHODS: Probabilistic samples were obtained in six surveys, from 1976 to 2006, which were conducted by calibrated examiners, following the same protocol. For data analysis, the DMFT (decayed, missing and filled teeth), Significant Caries Index (SiC Index), percentage of caries-free children, Gini Coefficient and Care Index were determined. RESULTS: The means (SD) for DMFT were 9.89 (3.96), 6.98 (3.80), 4.30 (3.11), 4.29(3.44), 1.53(2.07), and 0.90(1.53) in 1976, 1984, 1990, 1995, 2001 and 2006, respectively. Except for years 1990 and 1995 and also for 2001 and 2006, there were statistically significant differences in mean DMFT among the surveys (p < 0.05). The number of caries-free children (DMFT=0), which has significantly increased over the years (p < 0.001), ranged from 0.4% in 1976 to 63.8% in 2006. The SiC Indexes were 14.34, 11.42, 7.74, 8.06, 3.89, and 2.63; the Care Index were 31.9%, 57.4%, 68.7%, 50.5%, 66.4%, and 56.3%; and the Gini Coefficients were 0.23, 0.30, 0.39, 0.43, 0.66, and 0.76 in the surveys. CONCLUSION: Dental caries experience and prevalence in 12-year-old schoolchildren have declined significantly during the last 30 years in Bauru.

Clinical evaluation of a polyacid-modified resin used as a fissure sealant: 48-month results.

PURPOSE: To evaluate the incidence of occlusal caries and the rates of retention using Variglass VLC (polyacid-modified resin) as an occlusal sealant. MATERIALS AND METHODS: The sample consisted of 185 school children (6-8 yr-old), with sound unsealed permanent first molars. Sealants were applied on the upper and lower first molars from a randomly chosen hemiarch (N=370 teeth). The follow-up was conducted at 6, 12 and 48 months examining 343 (93%), 290 (78%) and 187 (51%) teeth, respectively. RESULTS: After 48 months, total retention of the material was noted in only 5% of the teeth. The presence of sealant in 2/3 and 1/3 of the pit extension was verified in 8% and 14% of the teeth, respectively, while 73% of the sealed teeth had no sealant present on the occlusal surface. Caries incidence, measured by the presence of dental caries and restorations, was 16% representing an annual increase of 4%.

Oral health and periodontal status in Brazilian elderly.

A total of 104 elderly persons between the ages of 60 and 89 were examined at the "Geraldo de Paula Sousa" Health Center, São Paulo, State of São Paulo. The state of their oral health was very poor, insofar as 4.29 (71.5%) of the sextants were shown to be null, while 0.12 and 0.13 sextants showed deep periodontal pockets > or = 6 mm in the ages from 60-70 and more than 70 years of age, respectively. The level of knowledge about periodontal disease and dental plaque was very deficient; only about 52% of the population under study reported having visited a dentist in the last two years. We conclude that greater odontological attention is needed for the elderly age group, as there are no large-scale community service centers in Brazil for this population group.