Oral cancer calibration and diagnosis among professionals from the public health in São Paulo, Brazil.

UNLABELLED: Oral cancer is a public health problem responsible for 13% of deaths worldwide in 2008 and screening programs can be useful to detect individuals more vulnerable to the disease, improving its prognosis. OBJECTIVES: The aim of the present study was to evaluate oral cancer calibration (in lux and in vivo methodologies) and diagnosis processes performed by dental surgeons (DSs) of the public health system in São Paulo, Brazil. MATERIAL AND METHODS: Thirty-three oral cancer photographs were examined during in lux calibration, while 560 individuals were examined during in vivo calibration. Oral conditions were coded as "0 - sound tissues", "1 - buccal lesions without malignant potential" and "2 - buccal lesions with malignant potential". The final sample for oral cancer screening was composed of 336 individuals, age-range 40 years or older. RESULTS: Kappa values for interexaminer agreement were 0.67 and 0.45 for in lux and in vivo respectively. The accuracy of both methodologies was over 80%. Oral cancer screening revealed 48 healthy individuals, 273 oral lesions coded as "1" and 12 oral lesions coded as "2". CONCLUSION: In spite of the low reproducibility, the validity of the visual examination in oral cancer screening was satisfactory, showing its importance as part of preventive oral cancer programs and public health system campaigns.

Dental caries and fluorosis prevalence and their relationship with socioeconomic and behavioural variables among 12-year-old schoolchildren.

PURPOSE: To evaluate caries experience and fluorosis prevalence in 12-year-old schoolchildren in Piracicaba, Brazil in 2007 and to verify the relationship of these changes with socioeconomic and behavioural variables. MATERIALS AND METHODS: The sample consisted of 724 schoolchildren from public and private schools. A calibrated dentist performed the examination under natural light using CPI probes and mirrors. The mean number of decayed, missing and filled permanent teeth (DMFT) and the SiC (Significant Caries Index) were determined for dental caries and the Thylstrup and Fejerskov index (T-F) for fluorosis. Socioeconomic and behavioural variables were collected by means of a questionnaire. Multiple logistic regression analyses were performed to verify the relationship of caries and fluorosis with socioeconomic and behavioural variables. RESULTS: The DMFT and SiC indices were 0.85 (±1.54) and 2.52 (±1.72). Fluorosis prevalence was 29.42%. The regression models showed that children whose families earned up to four minimum wages were 2.58 times more prone to having caries than those whose families earned over four minimum wages. Furthermore, children who visited the dentist were 4.27 times more likely to have DMFT > 0. However, for fluorosis, the regression model was not significant. CONCLUSIONS: The 12-year-old schoolchildren in Piracicaba presented very low caries prevalence. Significant associations were observed between the presence of caries, monthly family income and visiting the dentist. Considering dental fluorosis, the majority of the sample presented no clinical signs of fluorosis.

Reproducibility of adjunct techniques for diagnosis of dental caries in an epidemiological situation.

PURPOSE: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. MATERIALS AND METHODS: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. RESULTS: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.89/κinter = 0.84), VE2 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.88/κinter = 0.83), BW (D3: κintra = 0.95/κinter = 0.92; D1+D3: κintra = 0.99/κinter = 0.90) and FOTI (D3: κintra = 0.97/κinter = 0.93; D1+D3: κintra = 0.87/κinter = 0.83) exams and 'fair' for the DD exam (D3: κintra = 0.36/κinter = 0.35; D1+D3: κintra = 0.30/κinter = 0.32). CONCLUSION: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys.

Validity of caries-detection methods under epidemiological setting.

PURPOSE: To evaluate the validity of the visual exam and adjunct diagnostic technologies for posterior permanent teeth under epidemiological conditions. METHODS: A probabilistic sample of 165 12-year-old schoolchildren from Piracicaba, São Paulo, Brazil, was examined by visual exam (VI1), visual exam + artificial lighting (VI2), bitewing (BW), fiber optic transillumination (FOTI), DIAGNOdent and the associations among them. The D1+D3 and D3 diagnostics criteria, under epidemiological conditions, were adopted. The sensitivity, specificity and accuracy were calculated to determine the validity of the exams. RESULTS: The most accurate diagnostic method was VI2+BW exam for all dental surfaces under both diagnostic criteria. It was concluded that the BW was the best adjunct diagnostic technology on epidemiological dental caries surveys, increasing the validity of the dental exams.