A new approach for interexaminer reliability data analysis on dental caries calibration

Objectives: a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. Methods: Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth - DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. Results: Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. Conclusion: The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

A new approach for interexaminer reliability data analysis on dental caries calibration.

OBJECTIVES: a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. METHODS: Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth - DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. RESULTS: Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. CONCLUSION: The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

Trends in caries experience and fluorosis prevalence in 11- to 12-year-old Brazilian children between 1991 and 2004.

UNLABELLED: Investigating dental caries and fluorosis prevalence over time is an important measure for monitoring trends in oral health. PURPOSE: This work aimed to describe the prevalence of dental caries and dental fluorosis of 11- to 12-year-old schoolchildren from Iracemapolis, Brazil, in 2004 (n=236) and to compare the current prevalence rates with those from previous surveys carried out in 1991 (n=200), 1995 (n=160), 1997 (n=314) and 2001 (n=244). MATERIALS AND METHODS: The schoolchildren of both genders from all public schools were examined by two calibrated dentists (Kappa > 0.81), using dental probes and buccal mirrors under natural light in an outdoor setting. Dental caries and fluorosis were measured using the DMFT and Thylstrup-Fejerskov (T-F) indexes, respectively. The variation of DMFT index over time was assessed by analysis of regression and the fluorosis prevalence (T-F>1) was compared over time by the Chi-square test at 5% significance level. RESULTS: In 2004, the mean value for DMFT was 1.2; 50% of the children were caries-free, and 15.7% presented dental fluorosis (T-F>1). A significant caries reduction (82.1%) and a significant increase (685%) of fluorosis prevalence have been observed from 1991 to 2004 (p < 0.01). CONCLUSION: The results suggest a continuous decrease of dental caries experience and an increase of dental fluorosis prevalence in 11-to 12-year-old schoolchildren from this Brazilian town as well as indicate that further epidemiological surveys should be carried out in order to monitor these trends.

Effect of different diagnostic thresholds on dental caries calibration - a 12 month evaluation.

OBJECTIVE: To analyze the reproducibility of a calibration trial, at different diagnostic thresholds of dental caries, in a 12-month evaluation. METHODS: A group of dental examiners (n = 11), who had previous experience in epidemiological surveys, participated in the study. An initial training phase (theoretical and clinical) and five calibration exercises (baseline, 3, 6, 9 and 12 months) were arranged. World Health Organization (WHO) criteria, including the active initial lesions (IL) were used. Six- to 7-year-old children took part in the study. They were selected according to past history and dental caries activity. The data were analyzed at WHO and WHO + IL diagnostic thresholds in accordance with tooth and dental surfaces. RESULTS: Excellent mean intra- and inter-examiner Kappa values were obtained for both diagnostic thresholds, in accordance with tooth and surface, during the calibration phases. However, the most relevant errors were related to the decayed component and to IL diagnosis. CONCLUSION: It was possible to use the methodology proposed in this study in epidemiological surveys when examining the mixed dentition, although new strategies to improve training in IL diagnosis and calibration are necessary.

Influence of initial carious lesions on oral health planning

The aim of this cross-sectional study was to verify the importance of including initial carious lesions (IL) in the oral health planning of a public health service. The sample comprised 692 schoolchildren at the ages of 5 (n=171), 6 (n=203), 12 (n=236) and 15 (n=82), enrolled in state schools in Iracemapolis, SP, Brazil. Clinical examination was performed, using dental mirror and CPI (Community Periodontal Index) probe, after tooth brushing and drying. Two diagnostic thresholds were used for measuring the outcome: diagnostic threshold based on cavitated lesions and diagnostic threshold based on the inclusion of IL. The mean value for dmft was 1.56 for 5-year-olds and 1.98 for 6-yearolds. The mean value for DMFT was 1.19 for the age of 12 and 2.90 for the age of 15. The dmft and DMFT indexes increased significantly for all ages (paired t test, p<0.05) when IL was included in the examinations (29.59%, 12.25%, 21.71%, 26.82% for the ages of 5, 6, 12 and 15, respectively). The inclusion of IL in surveys generated a statistically significant percent increase in caries indexes for all age groups, contributing to obtain additional information for oral health planning in public services.

Diagnóstico e decisão de tratamento das lesões de cárie proximais / Diagnosis and treatment decision of interproximal carious lesions

As lesões de cárie incipientes localizadas nas superficies proximais são, na amioria das vezes, de dificil diagnóstico durante o exame clínico convencional, que determina a utilização de recursos diagnósticos adicionais. O objetivo deste trabalho foi descrever os métodos de diagnóstico mais comumente utilizados em superfícies proximais, como a inspeção visual, o exame radiográfico, a separação interdental e a transiluminação por fibra óptica, bem como tecer considerações a respeito da decisão de tratamento para as lesões de cárie localizadas nesses sítios. A presença de perdas minerais nessa região pode ser detectadas por meio do exame radiográfico ou da transiluminação por fibra óptica (FOTI). A separação dental temporária pode fornecer informações sobre a presença ou não de cavitação clínica e das características da lesão presente na área de contato (atividade da doença). somando-se a essa informações, dados como a presença de placa bacteriana e sangramento da papila adjacente são sugestivos de atividade da doença na região. Recomenda-se que a terapêutica restauradora somente seja instituida quando as lesões de cárie proximais estiveram cavitadas e localizadas na metade interna da dentina, ou na metade externa da dentina se houver retenção de placa, dificultando o controle por parte do paciente

The short-term in situ model to evaluate the anticariogenic potential of ionomeric materials.

OBJECTIVES: Aiming to contribute to the study of mechanisms involved in the anticariogenic properties of dental materials, this study assessed the suitability of a short-term in situ model to evaluate the anticariogenic potential of ionomeric materials. METHODS: The study used a 3-phase crossover, double blind design, and in each phase eight volunteers wore palatal appliances containing four enamel blocks restored with one of the following materials: composite resin (CR-Z250) (negative control), a conventional glass ionomer cement (GIC-Ketac-Fil) or a resin-modified GIC (RM-GIC-Vitremer). The restored blocks were covered with a "test plaque" of S. mutans, placed in palatal appliances and a cariogenic challenge was made during 1 min with 20% sucrose solution. After 45 min, test plaque was collected for fluoride (F) analysis. Enamel surface microhardness was previously determined at one side of the restoration and the percentage of surface microhardness change (%SMC) in relation to baseline (other side) was calculated. F concentration in enamel was also evaluated. RESULTS: Split-plot ANOVA showed a statistically lower %SMC on enamel around the ionomeric materials than around the CR (p<0.05). This result was supported by a statistically higher F concentration in test plaque (P<0.001) and in enamel (P<0.001) restored with the ionomeric materials when compared to the CR. CONCLUSIONS: The results suggest that the short-term in situ model tested is useful for studying the anticariogenic potential of dental materials that release fluoride.

Fluoride-releasing capacity and cariostatic effect provided by sealants.

This study evaluated the effect of sealants on enamel demineralization, focusing on physical protection of the sealed enamel and fluoride protection of the adjacent unsealed enamel. Occlusal fissures with areas measuring 12 mm2 were delimited in 48 extracted molars, randomly divided into 4 groups (n =12): 1) no sealing; 2) sealing with a resin-modified glass-ionomer (Vitremer, 3M ESPE); 3) sealing with a fluoride-releasing composite sealant (Clinpro Sealant, 3M ESPE); and 4) sealing with a non-fluoridated composite sealant (Concise, 3M ESPE). A 4-mm2 window was outlined on the buccal enamel for analysis of fluoride uptake. Following treatment, groups 2, 3 and 4 were subjected to 5-days of pH-cycling, while group 1 was kept in a moist environment at 37 degrees C. Fluoride uptake was assessed by dental biopsy, and the amount of fluoride released to the cycling solutions was determined by ion analysis. Enamel demineralization around the sealants was evaluated by cross-sectional micro-hardness analysis. Group 2 showed higher levels of fluoride release (P < 0.01) and uptake by enamel (P < 0.05), and lower levels of demineralization (P < 0.05) than groups 3 and 4. Group 3 exhibited reduced demineralization on unsealed enamel and provided fluoride uptake in a distant enamel area, while group 4 did not.

Planejamento em saúde bucal na cidade de Piracicaba, SP: estudo de caso / Oral health planning in Piracicaba, SP, Brazil: case study

O objetivo deste estudo de caso foi analisar o processo de planejamento do sistema de atenção à saúde bucal na cidade de Piracicaba, SP, e descrever o perfil epidemiológico da cárie dentária na população em questão. As informações foram obtidas mediante entrevista com a Coordenadoria de Saúde Bucal e os dados epidemiológicos em documentos oficiais e artigos publicados. Até 1999 a filosofia da atenção baseava-se no atendimento da população de acordo com as necessidades de tratamento e os procedimentos preventivos restringiam-se aos escolares de 7 a 10 anos da rede pública, independente do risco de cárie. Os levantamentos epidemiológicos eram realizados esporadicamente e não havia avaliação das ações. Com a proposta de implantação do planejamento estratégico (PE), as atividades preventivas têm sido destinadas às crianças de 0 a 10 anos considerando o risco de doenças bucais; os levantamentos epidemiológicos são realizados periodicamente sendo verificado um declínio na prevalência de cárie; e as avaliações das ações em saúde ocorrem trimestralmente. Conclui-se que o PE, como uma ferramenta de gestão no serviço público, mesmo com as limitações encontradas neste estudo, possibilitou melhorar a organização, cobertura e qualidade dos serviços de atenção à saúde bucal.