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Khalaf ME, Alyahya A, Qudeimat MA. Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions. Int Dent J 2023; 73:251-258. [PMID: 35896427 PMCID: PMC10023584 DOI: 10.1016/j.identj.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
Abstract
AIM There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children. MATERIALS AND METHODS Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations. RESULTS For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001). CONCLUSIONS For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.
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Affiliation(s)
- Mai E Khalaf
- Department of General Dental Practice, Kuwait University, Kuwait
| | - Asma Alyahya
- Department of Developmental and Preventive Sciences, Kuwait University, Kuwait
| | - Muawia A Qudeimat
- Department of Developmental and Preventive Sciences, Kuwait University, Kuwait.
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Yang X, Guo J, Hu B, Li Z, Wu M, Guo H, Huang X, Liu X, Guo X, Liu P, Chen Y, Li S, Gu Y, Wu H, Xuan K, Yang P. Amyloid-Mediated Remineralization in Pit and Fissure for Caries Preventive Therapy. Adv Healthc Mater 2022; 11:e2200872. [PMID: 35869581 DOI: 10.1002/adhm.202200872] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/18/2022] [Indexed: 01/27/2023]
Abstract
The pits and fissures of teeth have high caries susceptibility, and sealing these areas is considered as an effective method to prevent caries. However, long-term caries prophylaxis cannot be maintained because of the negative effects derived from the technical sensitivity and disadvantages of sealing materials. Herein, a new strategy is proposed to occlude fossae by amyloid-mediated biomimetic remineralization. In contrast to conventional inward blocking from the outside of fossae, amyloid-mediated biomimetic mineralization delivers an amyloid-like protein nanofilm into the deepest zone of the fossae and induces the formation of remineralized enamel inside. Such assembly from lysozyme conjugated with poly (ethylene glycol) enriches the interface with strongly bonded ionsand directs in situ nucleation to achieve enamel epitaxial growth. Not only is the structure of the enamel-like crystalline hydroxyapatite layer but also its mechanical stability is similar to that of natural enamel. Furthermore, the layer shows good biocompatibility and antibacterial properties. On the basis of the findings, it is demonstrated that amyloid-like protein aggregation may provide an enamel remineralization strategy to modify the current clinically available methods of pit and fissure sealing and shows great promise in preventing caries.
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Affiliation(s)
- Xiaoxue Yang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Jing Guo
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Bowen Hu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Zihan Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Meiling Wu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Hao Guo
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Xiaoyao Huang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Xuemei Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Xiaohe Guo
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Peisheng Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Yuan Chen
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Shijie Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Yang Gu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Hong Wu
- School of Pharmacy, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Kun Xuan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Peng Yang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
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Singh A, Jain P, Khan R, Anwer MK, Ansari MJ, Aqil M, Mirza MA, Iqbal Z. Development and quality evaluation of chitosan-coated cellulose acetate phthalate-poloxamer enamel adhesive device for the treatment of dentin carious lesion. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1963722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anjali Singh
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Pooja Jain
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Rahmuddin Khan
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mohammad Javed Ansari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Mohd. Aqil
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Mohd. Aamir Mirza
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
| | - Zeenat Iqbal
- Department of Pharmaceutics, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
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Diniz M, Campos P, Souza M, Guaré R, Cardoso C, Lussi A, Bresciani E. The Evaluation of Different Treatments of Incipient Caries Lesions: An in Situ Study of Progression Using Fluorescence-based Methods. Oper Dent 2021; 46:87-99. [PMID: 33882139 DOI: 10.2341/19-268-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Effective methods to control incipient caries lesions are needed. In this investigation, several methods provide encouraging results. SUMMARY This study aimed to evaluate in situ the inhibition of incipient caries lesion progression using different treatment protocols and to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent, DIAGNOdent pen, and VistaProof fluorescence camera [FC]) in monitoring this process. The research was conducted in four phases: (1) at baseline, (2) after a first cariogenic challenge, (3) after treatment modalities, and (4) after a second cariogenic challenge. Sixteen volunteers used intraoral acrylic palatal appliances, each containing six enamel blocks (n=96). The cariogenic challenge was performed using a 20% sucrose solution over a 14-day period. The appliances were removed eight times a day and, upon removal, two drops of the solution were placed onto each enamel block. The enamel blocks were randomly assigned to three treatment groups: fluoride varnish ([FV] Duraphat; n=32), resin infiltrant ([RI] Icon; n=32), and adhesive system ([AS] Scotchbond; n=32). At the end of each phase, the surface microhardness (SMH) was measured, and two trained examiners evaluated the specimens using fluorescence-based methods. In addition, integrated mineral loss (ΔΔZ; vol%.min x μm) and lesion depth (ΔLD; μm) were evaluated using transverse microradiography. A two-way analysis of variance and a Tukey post hoc test were calculated (α=5%). Significant differences in SMH were observed according to the treatment, phases, and interaction of factors (p<0.001). Treatment with FV resulted in significantly higher SMH values in phases 3 and 4 compared to RI and AS, with the last two treatments resulting in similar values (p>0.05). The ΔΔZ value was similar for FV and AS but significantly higher for RI (p=0.016). ΔLD was not significantly different among the groups (p=0.126). Significant differences in the measurement of fluorescence for each fluorescence-based method were observed between each phase of the study (p<0.05). It can be concluded that all treatments were effective in inhibiting the in situ progression of incipient lesions, although to different degrees, with minor mineral loss changes observed for the AS and FV. Besides, all fluorescence-based methods tested, except for that using the FC device, were effective in monitoring caries lesion progression.
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Nascimento MM, Ribeiro AP, Delgado AJ, Cassiano L, Caraballo M, Roulet JF, Geraldeli S, Pereira P, Ottenga ME, Dilbone DA. Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study. Oper Dent 2020; 45:581-588. [PMID: 32516382 DOI: 10.2341/19-221-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. SUMMARY In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient's caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.
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Luong MN, Shimada Y, Araki K, Yoshiyama M, Tagami J, Sadr A. Diagnosis of Occlusal Caries with Dynamic Slicing of 3D Optical Coherence Tomography Images. SENSORS 2020; 20:s20061659. [PMID: 32192069 PMCID: PMC7146590 DOI: 10.3390/s20061659] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/20/2022]
Abstract
Detecting the extent of occlusal caries is a clinically important but challenging task required for treatment decision making. The aim of this study was to assess the diagnostic power of 3D swept-source optical coherence tomography (OCT) for evaluation of occlusal caries in comparison with X-ray radiography. Extracted human molars not exhibiting American Dental Association (ADA) criteria advanced caries were mounted in a silicone block and digital dental radiographs were captured from the buccal side. Subsequently, occlusal surfaces were scanned with a prototype Yoshida Dental OCT. Thirteen examiners evaluated the presence and extent of caries on radiographs and dynamically sliced 3D OCT video images, using a 4 level scale—0: intact; 1: enamel demineralization without cavitation; 2: enamel caries with cavitation; 3: dentin caries with or without cavitation. Sensitivity, specificity and area under operating characteristic curves (Az) were statistically analyzed (α = 0.05). Reliability analysis showed an excellent agreement among the 13 examiners for both methods. The OCT presented a significantly higher sensitivity and Az value for the detection of caries compared to radiographs (p < 0.05). Radiography showed especially low sensitivity for dentin caries (0–2 versus 3). Dynamic slicing of 3D OCT volumes is a powerful adjunct tool to visual inspection to diagnose the dentin occlusal caries in vitro.
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Affiliation(s)
- Minh N. Luong
- Department of Restorative Dentistry, University of Washington, Seattle, WA 98195, USA;
| | - Yasushi Shimada
- Department of Operative Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan;
- Correspondence: (Y.S.); (A.S.)
| | - Kazuyuki Araki
- Division of Radiology, Department of Oral Diagnostic Sciences, Showa University School of Dentistry, Tokyo 145-8515, Japan;
| | - Masahiro Yoshiyama
- Department of Operative Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8525, Japan;
| | - Junji Tagami
- Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Alireza Sadr
- Department of Restorative Dentistry, University of Washington, Seattle, WA 98195, USA;
- Correspondence: (Y.S.); (A.S.)
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El-Sharkawyi Y. Detection and Characterization of Human Teeth Caries Using 2D Correlation Raman Spectroscopy. J Biomed Phys Eng 2019; 9:167-178. [PMID: 31214522 PMCID: PMC6538916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/28/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Carious lesions are formed by a complex process of chemical interaction between dental enamel and its environment. They can cause cavities and pain, and are expensive to fix. It is hard to characterize in vivo as a result of environment factors and remineralization by ions in the oral cavity. OBJECTIVES The development of a technique that gives early diagnosis which is non-invasive, is of crucial importance for publichealth. Raman spectroscopy is a technique that can fulfil these requirements. The main goal of this work was to use Raman spectroscopy to differentiate between normal and carious human teethinvivo. The samples used in this study were collected by traditional human teeth. MATERIAL AND METHOD An in vivo Raman spectroscopy system andspecialized fiber optic probe has been designed to obtain spectra from tissue. Theseprobes are filtered to reduce the background signal from the fiber optics and the collection fiberutilizes beam steering to optimize the collection effectiv. RESULTS In order to detect any demineralization and carious versus sound pit and fissure enamel, the spectral data sets are analyzed by the proposed scheme to demonstrate the utility of generalized 2D correlation spectra. Potential applications of this 2D correlation approach are then explored. The Raman spectra in the normal tissue showed thepresence of vibrational bands in 437.87 cm-1, 581.89 cm-1, 953.89 cm-1 and 1054.73 cm-1 with smaller intensity than in the carious spectra. Image construction from the peak intensity produced chemical maps of apatite concentration. CONCLUSION Such two-dimensional correlation spectra emphasize spectral features not readily observable in conventional one-dimensional spectra.No correlation is observed in mode-to-mode intensity fluctuations indicating that the changes inmode intensities are completely independent. Theoretical calculations provide convincing evidence that the fluctuationsare not the result of diffusion, orientation or local electromagnetic field gradients but rather are the result of subtle variations ofthe excited-state lifetime, energy and geometry of the molecule and producing a signature response for carious detection.
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Affiliation(s)
- Y.H. El-Sharkawyi
- Department of Biomedical Engineering, Military Technical Collage, Cairo, Egypt
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Clinical evaluation of a surface pre-reacted glass (S-PRG) filler-containing dental sealant placed with a self-etching primer/adhesive. Eur Arch Paediatr Dent 2018; 19:431-437. [PMID: 30328064 DOI: 10.1007/s40368-018-0379-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
AIMS To clinically evaluate the retention rates and caries-prevention effect of a resin-based, non-etch and rinse, self-etch primed pit and fissure sealant containing Sealant Pre-reacted Glass Ionomer Cement (S-PRG) fillers, in comparison to a conventional resin-based sealant over an 18-month period. METHODS There were 81 children, aged 6-12 years old, who were randomly assigned to one of two sealant-groups, either the self-etch primed sealant (Beautisealant, Shofu) or the conventional etch and rinse sealant (Seal it, Spident). A total of 218 sealants of both groups were placed on first permanent molars with either sound surfaces (The International Caries Detection and Assessment System [ICDAS], code 0) or incipient enamel caries lesions (ICDAS code 1) according to the manufacturers' instructions. Each sealant restoration was independently evaluated in terms of retention and caries status at 6, 12 and 18 months. The data were statistically analysed with the Chi-squared test and z-test and the level of significance was preset at α = 0.05. RESULTS The differences between the complete retention rates of the two sealant groups were statistically significant in all periods of evaluation (p < 0.01). Survival rates of each sealant-group were comparable on sound (ICDAS 0) and enamel caries lesions (ICDAS1). Caries prevention effect of the two sealant groups was similar at the end of the evaluation period. CONCLUSIONS The clinical performance of the S-PRG filler-containing dental sealant placed with a self-etching primer was poor regarding its retention. Its significantly higher loss did not lead to more carious occlusal surfaces at the 18-month recall.
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Carvalho JC, Qvist V, Aimée NR, Mestrinho HD, Bakhshandeh A. Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service. Caries Res 2017; 52:58-70. [DOI: 10.1159/000484987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022] Open
Abstract
This study validates a case-based survey method and analyzes the extent to which Danish dental professionals apply current concepts and strategies for occlusal caries management in children, adolescents, and young adults. A case-based, precoded questionnaire consisting of 10 clinical cases/patients with 26 teeth/occlusal surfaces was developed. The cases were set up in a PowerPoint presentation and color printed as a booklet illustrating patients with different patterns of caries activity, severity, and risk. A total of 69 dental professionals participated. Content and face validity of the survey method was established using a panel of experts. The panel also assessed the reliability of the method using a test-retest procedure (κ ≥ 0.80) and acting as benchmark. Measurements of agreement between dental professional and benchmark assessments showed substantial agreement for overall caries activity and risk assessment of patients and for clinical and radiographic severity of occlusal lesions (κ = 0.61-0.67). For assessment of caries lesion activity on occlusal surfaces, the agreement was moderate (κ = 0.50). Regarding treatment decisions, dental professionals showed substantial agreement when indicating restorative treatments (κ = 0.68). Multivariate logistic regression analysis showed a significant influence of various patient-, lesion-, and participant-related variables in the assessment of caries risk, caries activity and severity, and treatment decision. In conclusion, Danish dental professionals participating in the study apply reasonably well current concepts on overall caries activity and risk assessment, clinical and radiographic severity of occlusal lesions, and, to a certain extent, assessment of caries lesion activity on occlusal surfaces. Nonoperative treatment decisions had a high priority among Danish professionals.
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Makhija SK, Robinson ME, Bader JD, Shugars DA, Litaker MS, Im HR, Rindal DB, Pihlstrom DJ, Meyerowitz C, Gordan VV, Buchberg MK, Gilbert GH. Dentists' decision strategies for suspicious occlusal caries lesions in a National Dental PBRN study. J Dent 2017; 69:83-87. [PMID: 29138112 DOI: 10.1016/j.jdent.2017.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/25/2017] [Accepted: 11/08/2017] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs. METHODS 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk. Each vignette included a patient description and a photograph of a tooth presenting the 4 cues. Dentists were asked to decide the likelihood that a suspected lesion extended into dentin. A lens model analysis was used to examine how dentists use these cues in making their decisions. RESULTS 86% of dentists had a consistent pattern of cue use that defined their decision strategy. On average, 70% of the variance in their decisions was accounted for by their use of the 4 cues. However, there was considerable variability in the individual cues used by each dentist. The percentages of dentists who used the different cues consistently were: luster (58%), color (48%), roughness (36%), and risk (35%). 14% of dentists reliably used only color, 7% used only luster, 4% used only roughness, and 1% used only risk when making SOCL decisions. CONCLUSIONS The online vignette system suggests that clinical SOCL decision strategies are highly individualized and dentists do not use all cues available to them to make these decisions. CLINICAL SIGNIFICANCE Prior to this study, there has been little evidence about how dentists use these cues (either individually or in combination) when judging the extent of caries progression. Such knowledge would be valuable when designing interventions to help dentists maximize the likelihood of appropriate treatment decisions.
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Affiliation(s)
- Sonia K Makhija
- University of Alabama at Birmingham, Birmingham, AL, United States.
| | | | - James D Bader
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel A Shugars
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mark S Litaker
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hong R Im
- Private Practice, Austin, TX, United States
| | - D Brad Rindal
- HealthPartners Institute, Minneapolis, MN, United States
| | | | - Cyril Meyerowitz
- University of Rochester, Eastman Institute for Oral Health, Rochester, NY, United States
| | | | - Meredith K Buchberg
- University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, AL, United States
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Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2017; 148:922-929. [PMID: 29055504 DOI: 10.1016/j.adaj.2017.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically. METHODS Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ2 test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster. RESULTS The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07). CONCLUSIONS Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives. PRACTICAL IMPLICATIONS Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention.
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Chiang HK, Best AM, Sarrett DC. Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry. J Evid Based Dent Pract 2017; 17:169-176. [PMID: 28865813 DOI: 10.1016/j.jebdp.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. METHODS A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. RESULTS There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. CONCLUSIONS Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice.
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Affiliation(s)
- Harmeet K Chiang
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.
| | - Al M Best
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA; Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Sarrett
- School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
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13
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Lancaster P, Brettle D, Carmichael F, Clerehugh V. In-vitro Thermal Maps to Characterize Human Dental Enamel and Dentin. Front Physiol 2017; 8:461. [PMID: 28747886 PMCID: PMC5506188 DOI: 10.3389/fphys.2017.00461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/16/2017] [Indexed: 11/13/2022] Open
Abstract
The crown of a human tooth has an outer layer of highly-mineralized tissue called enamel, beneath which is dentin, a less-mineralized tissue which forms the bulk of the tooth-crown and root. The composition and structure of enamel and dentin are different, resulting in different thermal properties. This gives an opportunity to characterize enamel and dentin from their thermal properties and to visually present the findings as a thermal map. The thermal properties of demineralized enamel and dentin may also be sufficiently different from sound tissue to be seen on a thermal map, underpinning future thermal assessment of caries. The primary aim of this novel study was to produce a thermal map of a sound, human tooth-slice to visually characterize enamel and dentin. The secondary aim was to map a human tooth-slice with demineralized enamel and dentin to consider future diagnostic potential of thermal maps for caries-detection. Two human slices of teeth, one sound and one demineralized from a natural carious lesion, were cooled on ice, then transferred to a hotplate at 30°C where the rewarming-sequence was captured by an infra-red thermal camera. Calculation of thermal diffusivity and thermal conductivity was undertaken, and two methods of data-processing used customized software to produce thermal maps from the thermal characteristic-time-to-relaxation and heat-exchange. The two types of thermal maps characterized enamel and dentin. In addition, sound and demineralized enamel and dentin were distinguishable within both maps. This supports thermal assessment of caries and requires further investigation on a whole tooth.
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Affiliation(s)
- Paula Lancaster
- Restorative Department, School of Dentistry, University of LeedsLeeds, United Kingdom
| | - David Brettle
- Department of Medical Physics and Engineering, St. James's University HospitalLeeds, United Kingdom
| | - Fiona Carmichael
- Department of Dental and Maxillofacial Radiology, Leeds Dental Institute, University of LeedsLeeds, United Kingdom
| | - Val Clerehugh
- Restorative Department, School of Dentistry, University of LeedsLeeds, United Kingdom
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Rodrigues JA, Sarti CS, Assunção CM, Arthur RA, Lussi A, Diniz MB. Evaluation of laser fluorescence in monitoring non-cavitated caries lesion progression on smooth surfaces in vitro. Lasers Med Sci 2017; 32:1793-1800. [PMID: 28669068 DOI: 10.1007/s10103-017-2262-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/11/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the performance of a pen-type laser fluorescence (LF) device (LFpen: DIAGNOdent pen) to detect and monitor the progression of caries-like lesions on smooth surfaces. Fifty-two bovine enamel blocks were submitted to three different demineralisation cycles for caries-like lesion induction using Streptococcus mutans, Lactobacillus casei and Actinomyces naeslundii. At baseline and after each cycle, the enamel blocks were analysed under Knoop surface micro-hardness (SMH) and an LFpen. One enamel block after each cycle was randomly chosen for Raman spectroscopy analysis. Cross-sectional micro-hardness (CSMH) was performed at different depths (20, 40, 60, 80 and 100 μm) in 26 enamel blocks after the second cycle and 26 enamel blocks after the third cycle. Average values of SMH (± standard deviation (SD)) were 319.3 (± 21.5), 80.5 (± 31.9), 39.8 (± 12.7), and 29.77 (± 10.34) at baseline and after the first, second and third cycles, respectively. Statistical significant difference was found among all periods (p < 0.01). The LFpen values were 4.3 (± 1.5), 7.5 (± 9.4), 7.1 (± 7.1) and 5.10 (± 3.58) at baseline and after the first, second, and third cycles, respectively, among all periods (p < 0.05). The CSMH values after the second and third cycles at 20, 40, 60, 80 and 100 μm were 182.8 (± 69.8), 226.1 (± 79.6), 247.20 (± 69.36), 262.35 (± 66.36) and 268.45 (± 65.49), and for the third cycle were 193.7 (± 73.4), 239.5 (± 81.5), 262.64 (± 82.46), 287.10 (± 78.44) and 284.79 (± 72.63) (n = 24 and 23), respectively. No correlation was observed between the LFpen and SMH values (p > 0.05). One sample of each cycle was characterised through Raman spectroscopy analysis. It can be concluded that LF was effective in detecting the first demineralisation on enamel; however, the method did not show any effect in monitoring lesion progression after three cycles of in vitro demineralisation.
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Affiliation(s)
- J A Rodrigues
- Department of Pediatric Dentistry, School of Dentistry of Rio Grande do Sul Federal University - UFRGS, Porto Alegre, RS, Brazil.
| | - C S Sarti
- Department of Pediatric Dentistry, School of Dentistry of Rio Grande do Sul Federal University - UFRGS, Porto Alegre, RS, Brazil
| | - C M Assunção
- Department of Pediatric Dentistry, School of Dentistry of Rio Grande do Sul Federal University - UFRGS, Porto Alegre, RS, Brazil
| | - R A Arthur
- Department of Public Health, School of Dentistry of Rio Grande do Sul Federal University - UFRGS, Porto Alegre, RS, Brazil
| | - A Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - M B Diniz
- Department of Pediatric Dentistry, School of Dentistry of Cruzeiro do Sul University - UNICSUL, São Paulo, SP, Brazil
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Simon JC, Kang H, Staninec M, Jang AT, Chan KH, Darling CL, Lee RC, Fried D. Near-IR and CP-OCT imaging of suspected occlusal caries lesions. Lasers Surg Med 2017; 49:215-224. [PMID: 28339115 DOI: 10.1002/lsm.22641] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Radiographic methods have poor sensitivity for occlusal lesions and by the time the lesions are radiolucent they have typically progressed deep into the dentin. New more sensitive imaging methods are needed to detect occlusal lesions. In this study, cross-polarization optical coherence tomography (CP-OCT) and near-IR imaging were used to image questionable occlusal lesions (QOC's) that were not visible on radiographs but had been scheduled for restoration on 30 test subjects. METHODS Near-IR reflectance and transillumination probes incorporating a high definition InGaAs camera and near-IR broadband light sources were used to acquire images of the lesions before restoration. The reflectance probe utilized cross-polarization and operated at wavelengths from 1,500 to 1,700 nm where there is an increase in water absorption for higher contrast. The transillumination probe was operated at 1,300 nm where the transparency of enamel is highest. Tomographic images (6 × 6 × 7 mm3 ) of the lesions were acquired using a high-speed swept-source CP-OCT system operating at 1,300 nm before and after removal of the suspected lesion. RESULTS Near-IR reflectance imaging at 1,500-1,700 nm yielded significantly higher contrast (P < 0.05) of the demineralization in the occlusal grooves compared with visible reflectance imaging. Stains in the occlusal grooves greatly reduced the lesion contrast in the visible range yielding negative values. Only half of the 26 lesions analyzed showed the characteristic surface demineralization and increased reflectivity below the dentinal-enamel junction (DEJ) in 3D OCT images indicative of penetration of the lesion into the dentin. CONCLUSION This study demonstrates that near-IR imaging methods have great potential for improving the early diagnosis of occlusal lesions. Lasers Surg. Med. 49:215-224, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jacob C Simon
- University of California, San Francisco, California 94143-0758
| | - Hobin Kang
- University of California, San Francisco, California 94143-0758
| | - Michal Staninec
- University of California, San Francisco, California 94143-0758
| | - Andrew T Jang
- University of California, San Francisco, California 94143-0758
| | - Kenneth H Chan
- University of California, San Francisco, California 94143-0758
| | | | - Robert C Lee
- University of California, San Francisco, California 94143-0758
| | - Daniel Fried
- University of California, San Francisco, California 94143-0758
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Yin W, Yang YM, Chen H, Li X, Wang Z, Cheng L, Yin QD, Fang HZ, Fei W, Mi FL, Nie MH, Hu T, Zhou XD. Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015-2016. Int J Oral Sci 2017; 9:10-15. [PMID: 28358035 PMCID: PMC5379165 DOI: 10.1038/ijos.2017.6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 02/05/2023] Open
Abstract
To investigate oral health status in the residents of Sichuan Province, southwest China, a cross-sectional study was performed using the latest Oral Health Survey Basic Methods recommended by the World Health Organization. A multistage stratified random cluster-sampling method was used to enroll participants from the following three groups: children aged 3-5 years, adolescents aged 12 years, and people aged 65-74 years. In these three groups, the mean numbers of teeth that were affected by caries were 3.28, 0.86 and 5.13, respectively, resulting in a prevalence of 63.47%, 37.20% and 83.20%, respectively. Relative to the high rate of decayed teeth, the prevalence of fillings was very low in all age groups (0.97%, 7.24% and 5.43%, respectively). In the 12-year-old adolescent group, only 3.61% had good pit and fissure sealing. In addition, the rate of dental fluorosis was 24.80%, and the Community Fluorosis Index value was 0.39. In the elder group, the community periodontal index was 2.92. The prevalence in the elderly of having lost at least one tooth was 75.54%. Additionally, 4.44% of these participants were edentulous. The incidence of dental prosthesis was 51.75%, the proportion with a removable partial denture, a fixed denture, full dentures, dental implants and an informal fixed bridge was 21.59%, 11.45%, 4.64%, 0 and 16.67%, respectively. In this study, 8.2% of the elderly participants were affected by different types of oral mucosal lesions. Among such lesions, recurrent aphthous ulcers were most prevalent (2.69%) and oral lichen planuses were second (1.6%). The conclusion presented in this survey is that oral diseases, especially dental caries and periodontal disease, are frequent and common in Sichuan province, China. Moreover, the treatment rate is very low, and primary prevention and treatment options are therefore urgently needed in this population.
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Affiliation(s)
- Wei Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ying-Ming Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hong Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xue Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhuo Wang
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Li Cheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiu-Dan Yin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hong-Zhi Fang
- The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Fei
- Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Fang-Lin Mi
- Department of Stomatology, North Sichuan Medical College, First Affiliated Hospital, Nanchong, China
| | - Min-Hai Nie
- Department of Stomatology, Southwest Medical University, Luzhou, China
| | - Tao Hu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xue-Dong Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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17
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Managing caries: the need to close the gap between the evidence base and current practice. Br Dent J 2017; 219:433-8. [PMID: 26564354 DOI: 10.1038/sj.bdj.2015.842] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.
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18
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Luz PB, Stringhini CH, Otto BR, Port ALF, Zaleski V, Oliveira RS, Pereira JT, Lussi A, Rodrigues JA. Performance of undergraduate dental students on ICDAS clinical caries detection after different learning strategies. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2015; 19:235-241. [PMID: 25495379 DOI: 10.1111/eje.12131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 06/04/2023]
Abstract
AIM This study aimed to evaluate the effect of a digital learning tool on undergraduate dental students' performance in detecting dental caries using ICDAS. METHODS An experimental digital learning tool (DLT) was created using digital photographs of sound and carious teeth. Thirty-nine students were divided into three groups (n = 13) and each assessed 12 randomly allocated patients before and after learning strategies: G1, ICDAS e-learning program; G2, ICDAS e-learning program plus DLT; G3, no learning strategy. Students (n = 32) reassessed patients 2 weeks after training. RESULTS Comparing before and after the learning strategies, any difference in the values of specificity and area under the ROC curve for all groups was found. Sensitivity was statistically significantly higher for G1 and G2. Comparing the groups, G2 showed a significant increase in sensitivity at the D2 and D3 thresholds. Spearman's correlations with the gold standard before and after the learning strategy were 0.60 and 0.61 for G1, 0.57 and 0.63 for G2, and 0.54 and 0.54 for G3, respectively. The Wilcoxon test showed a statistically significant difference between the values obtained before and after learning strategies for G1 and G2. CONCLUSIONS Use of the DLT after the ICDAS e-learning program tended to increase the sensitivity of ICDAS used by undergraduate dental students. The DLT appeared to improve dental students' ability to use ICDAS.
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Affiliation(s)
- P B Luz
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - C H Stringhini
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - B R Otto
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A L F Port
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - V Zaleski
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - R S Oliveira
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - J T Pereira
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - J A Rodrigues
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Srinivasan D, Louis CJ. Evaluation of caries in deciduous second molar and adjacent permanent molar in mixed dentition. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2015; 7:S572-5. [PMID: 26538920 PMCID: PMC4606662 DOI: 10.4103/0975-7406.163544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 04/28/2015] [Accepted: 05/22/2015] [Indexed: 12/02/2022] Open
Abstract
AIM This study was done to evaluate association of caries in deciduous second molar and adjacent permanent first molar, tooth surface more involved in permanent first molar and to assess the parental awareness regarding the eruption of permanent first molar. SUBJECTS AND METHODS Three hundred and ten children (160 boys, 150 girls) of mixed dentition aged between 6 and 11 years were included. Presence or absence of paired association of caries in primary second molar and adjacent permanent first molar, of both the jaws, were noted. Parental awareness regarding the child's dentition was asked by pointing the maxillary and mandibular permanent first molar. RESULTS Pearson Chi-square test was used. Significance was noted in both sexes between paired nonassociation of caries in mandibular primary second molar and mandibular permanent molar (P =0.01) and paired nonassociation of caries in primary maxillary second molar and maxillary permanent first molar in girls only (P =0.04). Parental awareness that permanent first molar has erupted was 24.83% and not to be exfoliated and replaced was 22.9% for both the sexes. In permanent teeth of both the sexes, the occlusal surface was more involved with caries in maxillary teeth; the buccal surface was more involved in mandibular teeth. About 10% of the sample did not have caries in both maxillary and mandibular permanent first molar. CONCLUSIONS Paired association of caries of primary second molar and permanent first molar though found in large number of cases was not significant. It is clear that parental awareness is less regarding the child's oral health. Thus, community-based awareness program has to be conducted to emphasize on pediatric oral health status and care.
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Affiliation(s)
- Daya Srinivasan
- Department of Pedodontia and Preventive Dentistry, Chettinad Dental College and Hospital, Padur, Kelambakkam, Chennai, Tamil Nadu, India
| | - C. Joe Louis
- Department of Pedodontia and Preventive Dentistry, Chettinad Dental College and Hospital, Padur, Kelambakkam, Chennai, Tamil Nadu, India
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Mejàre IA, Klingberg G, Mowafi FK, Stecksén-Blicks C, Twetman SHA, Tranæus SH. A systematic map of systematic reviews in pediatric dentistry--what do we really know? PLoS One 2015; 10:e0117537. [PMID: 25706629 PMCID: PMC4338212 DOI: 10.1371/journal.pone.0117537] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/26/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. METHODS A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. RESULTS Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. CONCLUSION There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.
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Affiliation(s)
| | - Gunilla Klingberg
- Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Frida K. Mowafi
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
| | - Christina Stecksén-Blicks
- Department of Odontology, Section for Pediatric Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Svante H. A. Twetman
- Department of Odontology, Section for Cariology, Endodontics, Pediatric Dentistry and Clinical Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofia H. Tranæus
- Swedish Council on Health Technology Assessment, Stockholm, Sweden
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Alomari QD, Qudeimat MA, Khalaf ME, Al-Tarakemah Y. The Effect of Combining Radiographs and DIAGNOdent With Visual Examination on Detection and Treatment Decisions of Noncavitated Occluso-dentinal Caries. Oper Dent 2014; 40:313-21. [PMID: 25535787 DOI: 10.2341/14-138-l] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this laboratory study was to evaluate the effectiveness of incorporating radiographic examination and DIAGNOdent with visual examination for the detection and treatment of noncavitated occluso-dentinal caries. Four examiners examined the occlusal surfaces of 160 extracted posterior teeth. Teeth were examined three times with a one-month interval in between. The first examination was visual (V), the second examination was visual with radiograph (VR), and the third examination was visual with radiograph and DIAGNOdent (VRD). Examiners were asked to detect the presence of caries (if any) and identify the extent of caries (if present; ie, enamel or dentin). The examiners were also asked to choose a treatment for each tooth. The examined teeth were later sectioned, and the presence of caries was charted as 0 = no caries, 1 = caries confined to enamel, 2 = caries in the outer dentin, and 3 = caries in the inner dentin. Sensitivity, specificity, area under the curve (Az values), rank correlation coefficient, interexaminer reproducibility, and McNemar χ(2) tests were calculated. VR had statistically higher specificity and lower sensitivity than V and VRD. The means of Az values ranged from 0.58 to 0.63, with no statistical difference between the three examinations (p>0.05). The means of the rank correlation coefficients with histology for detection of dentinal caries were 0.48, 0.23, and 0.44 using V, VR, and VRD, respectively. Interexaminer reproducibility was best for V alone. The percentages of teeth indicated for restorative treatment were 31%, 33%, and 41% using V, VR, and VRD, respectively. The percentages of teeth correctly treated according to histology were 69.4%, 70.0%, and 67.5% using V, VR, and VRD, respectively. There was no difference in the accuracy of treatment decisions between the three examination points (p>0.05). The addition of radiographs and DIAGNOdent to visual examination did not have a significant effect on the improvement of the detection or treatment decisions of examiners of noncavitated occluso-dentinal carious lesions.
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22
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Assunção IVD, Costa GDFAD, Borges BCD. Systematic review of noninvasive treatments to arrest dentin non-cavitated caries lesions. World J Clin Cases 2014; 2:137-141. [PMID: 24868513 PMCID: PMC4023307 DOI: 10.12998/wjcc.v2.i5.137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 02/16/2014] [Accepted: 03/12/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To systematically review the literature on the efficacy of noninvasive methods of arresting the progression of non-cavitated occlusal carious lesions in dentin.
METHODS: The Medline/PubMed, LILACS, SciELO and Scopus databases were searched to identify relevant publications through to November 2013. Only clinical trials evaluating the ability of noninvasive methods to arrest the progression of occlusal non-cavitated carious lesions in dentin were included. Screening, data extraction and quality assessment were conducted independently and in duplicate.
RESULTS: Of 167 citations identified, nine full text articles were screened and five were included in the analysis. All papers reported on occlusal fissure sealing using a self-curing glass ionomer (n = 1) or resin-based (n = 4) sealant. Only the use of resin-based sealant to obliterate occlusal fissures arrested the progression of non-cavitated occlusal carious lesions in dentin.
CONCLUSION: Occlusal fissure sealing with a resin-based sealant may arrest the progression of non-cavitated occlusal dentinal caries. Further clinical trials with longer follow-up times should be performed to increase scientific evidence.
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Makhija SK, Gilbert GH, Funkhouser E, Bader JD, Gordan VV, Rindal DB, Pihlstrom DJ, Qvist V. Characteristics, detection methods and treatment of questionable occlusal carious lesions: findings from the national dental practice-based research network. Caries Res 2014; 48:200-7. [PMID: 24480989 DOI: 10.1159/000354841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 08/02/2013] [Indexed: 11/19/2022] Open
Abstract
Questionable occlusal carious lesions (QOC) can be defined as an occlusal tooth surface with no cavitation and no radiographic radiolucencies, but caries is suspected due to roughness, surface opacities or staining. An earlier analysis of data from this study indicates 1/3 of patients have a QOC. The objective of this report has been to quantify the characteristics of these common lesions, the diagnostic aids used and the treatment of QOC. A total of 82 dentist and hygienist practitioner-investigators from the USA and Denmark in the National Dental Practice-Based Research Network participated. When consenting patients presented with a QOC, information was recorded about the patient, tooth, lesion and treatments. A total of 2,603 QOC from 1,732 patients were analyzed. The lesions were usually associated with a fissure, on molars, and varied from yellow to black in color. Half presented with a chalky luster and had a rough surface when examined with an explorer. There was an association between color and luster: 10% were chalky-light, 47% were shiny-dark and 42% were mixtures. A higher proportion of chalky than of shiny lesions were light (22 vs. 9%; p < 0.001). Lesions light in color were less common in adults than in pediatric patients (9 vs. 32%; p < 0.001). Lesions that were chalky and light were more common among pediatric than among adult patients (22 vs. 6%; p < 0.001). This is the first study to investigate characteristics of QOC in routine clinical practice. Clinicians commonly face this diagnostic uncertainty. Determining the characteristics of these lesions is relevant when making diagnostic and treatment decisions.
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Affiliation(s)
- S K Makhija
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Ala., USA
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Dental Caries. Oral Radiol 2014. [DOI: 10.1016/b978-0-323-09633-1.00018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Norton WE, Funkhouser E, Makhija SK, Gordan VV, Bader JD, Rindal DB, Pihlstrom DJ, Hilton TJ, Frantsve-Hawley J, Gilbert GH. Concordance between clinical practice and published evidence: findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2014; 145:22-31. [PMID: 24379327 PMCID: PMC3881267 DOI: 10.14219/jada.2013.21] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network"). METHODS Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent ("1") or inconsistent ("0") with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence. RESULTS The authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent). CONCLUSION Dentists reported a medium-range concordance between practice and published evidence. PRACTICAL IMPLICATIONS Efforts to bring research findings into routine practice are needed.
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Affiliation(s)
- Wynne E Norton
- Dr. Norton is an assistant professor, Department of Health Behavior, School of Public Health, University of Alabama at Birmingham
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Khalaf ME, Alomari QD, Ngo H, Doméjean S. Restorative treatment thresholds: factors influencing the treatment thresholds and modalities of general dentists in Kuwait. Med Princ Pract 2014; 23:357-62. [PMID: 24943861 PMCID: PMC5586903 DOI: 10.1159/000363184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/27/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making. SUBJECTS AND METHODS The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material. RESULTS For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they would intervene when lesions reached the middle third of the dentin. 146 (78.9%) said they would remove the carious tissue only in their preparation. For both approximal and occlusal lesions, the participants preferred resin composite as the material for restoration. CONCLUSIONS The respondents tended to delay restorative intervention until dentinal penetration of the caries. Resin restorative materials were used in conservatively prepared cavities. Participants chose a conservative approach for occlusal lesions but still believed in a traditional approach when it concerned approximal lesions. Experience, university dental education, and participation in continuous education courses were most significantly related to restorative treatment.
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Affiliation(s)
- Mai E. Khalaf
- Department of Restorative Sciences, Faculty of Dentistry, Health Sciences Centre, Kuwait University, Jabriya, Kuwait
- *Dr. Mai E. Khalaf, Department of Restorative Sciences, Faculty of Dentistry, Health Sciences Centre, Kuwait University, PO Box 24923, Safat, Jabriya 13110 (Kuwait), E-Mail
| | - Qasem D. Alomari
- Department of Restorative Sciences, Faculty of Dentistry, Health Sciences Centre, Kuwait University, Jabriya, Kuwait
| | - Hien Ngo
- Department of Restorative Sciences, Faculty of Dentistry, Health Sciences Centre, Kuwait University, Jabriya, Kuwait
| | - Sophie Doméjean
- CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
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The prevalence of questionable occlusal caries: findings from the Dental Practice-Based Research Network. J Am Dent Assoc 2013. [PMID: 23204090 DOI: 10.14219/jada.archive.2012.0097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study METHODS A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices. RESULTS Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively). CONCLUSIONS To the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions. CLINICAL IMPLICATIONS QOC is common in routine practice and warrants further investigation regarding how best to manage it.
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Banerjee A, Doméjean S. The contemporary approach to tooth preservation: minimum intervention (MI) caries management in general practice. Prim Dent J 2013; 2:30-37. [PMID: 24340496 DOI: 10.1308/205016813807440119] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The minimum intervention (MI) approach summarises a clinical, evidence-based rationale for the preventive and cause-related approach to oral diseases in general and to caries in particular. MI oral care with respect to the management of patients suffering from dental caries is a concept based on an updated understanding of the histopathological carious process as well as the development of diagnostic technologies and adhesive, bioactive restorative materials. A patient-centred MI care plan for use in general dental practice is described, detailing the four phases of identifying disease, controlling/preventing disease, refurbishing/repairing tooth surfaces/restorations and recall consultations.
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Affiliation(s)
- Avijit Banerjee
- King's College Dental Institute at Guy's Hospital, King's Health Partners, London
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Borges BCD, de Souza Borges J, Braz R, Montes MAJR, de Assunção Pinheiro IV. Arrest of non-cavitated dentinal occlusal caries by sealing pits and fissures: a 36-month, randomised controlled clinical trial. Int Dent J 2012; 62:251-5. [PMID: 23106838 DOI: 10.1111/j.1875-595x.2012.00117.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the progression of sealed non-cavitated dentinal occlusal caries in a randomised controlled clinical trial. MATERIALS AND METHODS Sixty teeth with non-cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations. RESULTS Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the 12-month follow-up. At the 24- and 36-month recall appointments, neither sealant loss nor caries progression were observed. CONCLUSION The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months.
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Komiyama E, Kimoto K, Arakawa H. Relationship between Duration of Fluoride Exposure in School-Based Fluoride Mouthrinsing and Effects on Prevention and Control of Dental Caries. ISRN DENTISTRY 2012; 2012:183272. [PMID: 22548183 PMCID: PMC3324891 DOI: 10.5402/2012/183272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/14/2011] [Indexed: 11/23/2022]
Abstract
The objective of this paper was to assess the effects of school-based fluoride mouthrinsing (S-FMR: weekly using 0.2% NaF solution) in two groups of school children with different periods of exposure to S-FMR in elementary school. Subjects were the S-FMR group consisted of 599 children, participated for six years. The control group consisted of 282 children, participated for less than one year in the sixth year of elementary school. From the results of the present survey, the caries reduction rate of S-FMR in the permanent teeth was 36.6% for DMFT and 42.8% for DMFS, and person rates with DMF, DMFT, DMFS, and CO (questionable caries under observation) were inhibited in both boys and girls. Girls in the control group showed clearly higher values for all parameters of dental caries because of earlier teeth eruption; however, no gender differences were observed in the S-FMR group. As caries prevalence in the first molars accounted for about 85% regardless of participation to S-FMR, and first molar caries were more common in the mandible than in the maxilla, consideration should be given to preventive measures against pit-and-fissure-caries in addition to S-FMR.
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Affiliation(s)
- Eri Komiyama
- Division of Oral Health, Department of Health Science, Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Kazunari Kimoto
- Division of Oral Health, Department of Health Science, Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
| | - Hirohisa Arakawa
- Division of Oral Health, Department of Health Science, Kanagawa Dental College, 82 Inaoka-cho, Yokosuka, Kanagawa 238-8580, Japan
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Seremidi K, Lagouvardos P, Kavvadia K. Comparative in vitro validation of VistaProof and DIAGNOdent pen for occlusal caries detection in permanent teeth. Oper Dent 2011; 37:234-45. [PMID: 22166109 DOI: 10.2341/10-326-l] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Current caries diagnostic tools are neither very accurate nor very reliable for the detection of carious lesions of different depths. Thus, the development of new devices and techniques is needed. The aim of this in vitro study was to validate a newer fluorescence device VistaProof (VP), and compare it with DIAGNOdent Pen (DP), direct visual (DV) and indirect visual methods (IDV), with respect to accuracy and reliability for the detection of occlusal caries in permanent teeth. METHODS AND MATERIALS One hundred seven sites on 41 occlusal surfaces of recently extracted premolars were selected and classified into lesion categories according to Ekstrand's clinical criteria, by direct and indirect visual examination. The fluorescence of the sites was also measured by the two devices, and the teeth were ground through the sites for histological evaluation of their lesion depth. One calibrated examiner of high reliability (intraclass correlation coefficient [ICC]>0.85) made all of the evaluations. Sensitivity, specificity, and accuracy of each detection method were estimated based on histological examination as the reference method, estimated using cutoff limits calculated on the basis of best agreement between the devices' values and histological examination. McNemar tests and receiver operating characteristic (ROC) curve analyses were used to compare the validity measures of all detection methods at α=0.05, while the ICC was used to test the reproducibility of the methods based on a second measurement one week after the first. RESULTS There was no statistically significant difference (p>0.05) between the accuracy of DP and VPs for both enamel and dentin lesions. The areas under the ROC curves (AUC) for the two devices were also found not to be different (p>0.05). The reliability of DP was statistically significantly better than VP (p<0.05). CONCLUSION The validity of both fluorescence devices were not found to be significantly different and not better than visual methods for the detection of noncavitated carious lesions.
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Affiliation(s)
- Kyriaki Seremidi
- Department of Pediatric Dentistry, School of Dentistry, University of Athens, Greece
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Bottenberg P, Ricketts DNJ, Van Loveren C, Rahiotis C, Schulte AG. Decision-making and preventive non-surgical therapy in the context of a European Core Curriculum in Cariology. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2011; 15 Suppl 1:32-39. [PMID: 22023544 DOI: 10.1111/j.1600-0579.2011.00712.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and non-surgical treatment. In particular, it will provide some background information on this part of the European core curriculum. The dentist, on graduation, must be competent at applying the principles of prevention of dental hard tissue disease processes (primary prevention) and progression when it has manifested itself (secondary prevention). The competences should apply in differing ways to patients of all ages. Goals of prevention should be clearly defined in order for outcomes to be evaluated, and a dentist should be competent at determining these outcomes. Although this concept is recognised by many academics and experts, clinical teaching, practice and health insurance coverage frequently emphasise surgical treatment. There are many reasons and obstacles that might account for this, and this paper suggests some reasons why this might be and makes suggestions for how these can be addressed in the future. One factor that is essential in the provision of a preventive, non-surgical approach is that of communication with the patient. However, this unfortunately takes less space in the dental curricula compared with technical skills aimed at restorative procedures; this weighting needs to be more equally balanced.
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Affiliation(s)
- P Bottenberg
- Department of Cariology and Restorative Dentistry, Free University of Brussels (VUB), Brussels, Belgium.
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Al-Khatrash AA, Badran YM, Alomari QD. Factors affecting the detection and treatment of occlusal caries using the International Caries Detection and Assessment System. Oper Dent 2011; 36:597-607. [PMID: 21859317 DOI: 10.2341/10-346-l] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the variability in diagnosis and treatment of occlusal caries among dental practitioners in Kuwait using the International Caries Detection and Assessment System (ICDAS) criteria. METHODS A representative random sample of 156 dentists were interviewed. After completing a survey that included information about their gender, age, years in practice, place of practice, place of dental education, and specialty, practitioners examined four separately mounted molars (I-IV) for probable occlusal caries according to the ICDAS-II visual criteria. They were then asked to answer a set of questions related to their diagnosis and treatment of each tooth. The teeth were then histologically sectioned, and two independent investigators evaluated the depth of the caries according to Hintze and Wenzel's histologic criteria. RESULTS According to the histologic examination, tooth I and III had caries into enamel, while tooth II and IV had caries into dentin. About 50% of the participants diagnosed teeth with enamel caries as sound. About 60% of the participants correctly diagnosed teeth with caries extending into dentin. A restorative treatment modality was recommended for enamel caries by approximately 50% of the participants and for dentin caries by more than 80% of the participants. Dentists with a specialty in restorative dentistry had a tendency to underdiagnose enamel caries, while general practitioners and other specialists tended to overtreat enamel caries. CONCLUSIONS There was an evident variability in the diagnosis and treatment choices of occlusal caries among dentists working in Kuwait. Among the factors studied, the specialty of the participants was the only factor that had an effect on the participants' diagnosis and treatment of occlusal caries.
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Riley JL, Gordan VV, Rouisse KM, McClelland J, Gilbert GH. Differences in male and female dentists' practice patterns regarding diagnosis and treatment of dental caries: findings from The Dental Practice-Based Research Network. J Am Dent Assoc 2011; 142:429-40. [PMID: 21454850 PMCID: PMC3079556 DOI: 10.14219/jada.archive.2011.0199] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A number of articles have addressed differences in productivity between male and female dentists, but little is known about differences between the sexes in practice patterns regarding caries management. METHODS In this study, the authors surveyed general dentists who were members of The Dental Practice-Based Research Network (DPBRN) and who practiced within the United States. The survey included questions about dentists', practices' and patients' characteristics, as well as prevention, assessment and treatment of dental caries. The authors adjusted the statistical models for differences in years since dental school graduation, practice model, full-time versus part-time status, and practice owner or employee status before making conclusions about sex differences. RESULTS Three hundred ninety-three male (84 percent) and 73 female (16 percent) dentists participated. Female dentists recommended at-home fluoride to a significantly larger number of their patients than did male dentists, whereas male dentists had a preference for using in-office fluoride treatments with pediatric patients. Female dentists also chose to use preventive therapy more often at earlier stages of dental caries. There were few differences between the sexes in terms of diagnostic methods, time spent on or charges for restorative dentistry, and busyness of the practice. CONCLUSIONS Female DPBRN dentists differ from their male counterparts in some aspects of the prevention, assessment and treatment of dental caries, even with significant covariates taken into account. PRACTICE IMPLICATIONS The practice patterns of female dentists suggest a treatment philosophy with a greater focus on caries prevention.
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Affiliation(s)
- Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Valeria V. Gordan
- Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Kathleen M. Rouisse
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | | | - Gregg H. Gilbert
- Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rindal DB, Gordan VV, Litaker MS, Bader JD, Fellows JL, Qvist V, Wallace-Dawson MC, Anderson ML, Gilbert GH, DPBRN Collaborative Group. Methods dentists use to diagnose primary caries lesions prior to restorative treatment: findings from The Dental PBRN. J Dent 2010; 38:1027-32. [PMID: 20884316 PMCID: PMC3267573 DOI: 10.1016/j.jdent.2010.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/17/2010] [Accepted: 09/20/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use. METHODS A total of 228 DPBRN dentists recorded information on 5676 consecutive restorations inserted due to primary caries lesions on 3751 patients. Practitioner-investigators placed a mean of 24.9 (SD=12.4) restorations. Lesions were categorised as posterior proximal, anterior proximal, posterior occlusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorised as clinical assessment, radiographs, and/or optical. Statistical analysis utilised generalised mixed-model ANOVA to account for the hierarchical structure of the data. RESULTS By lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p<0.0001). CONCLUSION These results - obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios - quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics.
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Spallek H, Song M, Polk DE, Bekhuis T, Frantsve-Hawley J, Aravamudhan K. Barriers to implementing evidence-based clinical guidelines: a survey of early adopters. J Evid Based Dent Pract 2010; 10:195-206. [PMID: 21093800 PMCID: PMC3011934 DOI: 10.1016/j.jebdp.2010.05.013] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 05/28/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify barriers that early-adopting dentists perceive as common and challenging when implementing recommendations from evidence-based (EB) clinical guidelines. METHOD This is a cross-sectional study. Dentists who attended the 2008 Evidence-based Dentistry Champion Conference were eligible for inclusion. Forty-three dentists (34%) responded to a 22-item questionnaire administered online. Two investigators independently coded and categorized responses to open-ended items. Descriptive statistics were computed to assess the frequency of barriers and perceived challenges. RESULTS The most common barriers to implementation were difficulty in changing current practice model, resistance and criticism from colleagues, and lack of trust in evidence or research. Barriers perceived as serious problems had to do with lack of up-to-date evidence, lack of clear answers to clinical questions, and contradictory information in the scientific literature. CONCLUSIONS Knowledge of barriers will help improve translation of biomedical research for dentists. Information in guidelines needs to be current, clear, and simplified for use at chairside; dentists' fears need to be addressed.
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Affiliation(s)
- Heiko Spallek
- Center for Dental Informatics, Department of Dental Public Health and Information Management, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Warren E, Pollicino C, Curtis B, Evans W, Sbaraini A, Schwarz E. Modeling the long-term cost-effectiveness of the caries management system in an Australian population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:750-760. [PMID: 20561314 DOI: 10.1111/j.1524-4733.2010.00759.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The Monitor Practice Program demonstrated that regular monitoring and noninvasive management of dental caries is effective in reducing the incremental DMFT (decayed, missing, and filled teeth) in patients, within the construct of a 3-year randomized clinical trial. This analysis evaluates the long-term cost-effectiveness of the preventive approach underpinning the Caries Management System, used in the general practice setting and modeled to the Australian population. METHODS An individual patient-simulation Markov model was developed to compare the long-term costs and outcomes of the Caries Management System versus standard dental care in a hypothetical sample representative of the Australian population. Eight Markov submodels were developed, representing eight molar teeth (excluding wisdom teeth), each consisting of 11 health states simulating the incidence and progression of dental caries, and future interventions such as fillings and crowns. Transition probabilities and costs assigned to health states were based on claims data from the second largest private health insurer in Australia. The economic evaluation was performed from the Australian private dental practitioner perspective. The incremental cost per DMFT avoided was calculated at three time points: 2 years, 3 years, and lifetime. Univariate sensitivity analysis was conducted to test the robustness of the results. RESULTS The incremental cost per DMFT avoided at 2 years, 3 years, and lifetime was estimated to be $1287.07, $1148.91, and $1795.06, respectively. CONCLUSION The analysis suggests that the Caries Management System is most cost-effective in patients with a high risk of dental caries.
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Affiliation(s)
- Emma Warren
- Health Economist, HERA Consulting Australia, Balmain, NSW, Australia.
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Riley JL, Gordan VV, Rindal DB, Fellows JL, Ajmo CT, Amundson C, Anderson GA, Gilbert GH. Preferences for caries prevention agents in adult patients: findings from the dental practice-based research network. Community Dent Oral Epidemiol 2010; 38:360-70. [PMID: 20560997 PMCID: PMC2933181 DOI: 10.1111/j.1600-0528.2010.00547.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Collaborators] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify factors that are significantly associated with dentists' use of specific caries preventive agents in adult patients, and whether dentists who use one preventive agent are also more likely to use certain others. METHODS Data were collected from 564 practitioners in The Dental Practice-Based Research Network, a multi-region consortium of participating practices and dental organizations. RESULTS In-office topical fluoride was the method most frequently used. Regarding at-home preventive agents, there was little difference in preference between nonprescription fluoride, prescription fluoride, or chlorhexidine rinse. Dentists who most frequently used caries prevention were also those who regularly perform caries risk assessment and individualize caries prevention at the patient level. Higher percentages of patients with dental insurance were significantly associated with more use of in-office prevention modalities. Female dentists and dentists with more-recent training were more likely to recommend preventive agents that are applied by the patient. Dentists who reported more-conservative decisions in clinical treatment scenarios were also more likely to use caries preventive agents. Groups of dentist who shared a common preference for certain preventive agents were identified. One group used preventive agents selectively, whereas the other groups predominately used either in-office or at-home fluorides. CONCLUSIONS Caries prevention is commonly used with adult patients. However, these results suggest that only a subset of dentists base preventive treatments on caries risk at the individual patient level.
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Affiliation(s)
- Joseph L. Riley
- Associate Professor, Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Valeria V. Gordan
- Professor, Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - D. Brad Rindal
- Investigator and Dental Health Provider, HealthPartners, Minneapolis, Minnesota, USA
| | - Jeffrey L. Fellows
- Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | | | - Craig Amundson
- HealthPartners Central Minnesota Clinics, St. Cloud, Minnesota, USA
| | | | - Gregg H. Gilbert
- Professor and Chair, Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Collaborators
Phil Adams, Sudhir Agarwal, Craig Ajmo, Farshad Alamdari, George Allen, Charles Allen, Norman Allen, Catharina Amaloo, Craig Amundson, John Anderson, Gerald Anderson, F Damian Anderson, Ronnie Arrington, Stanley Asensio, Stuart Atkinson, Charles Babin, Karen Baker-Curtis, John Barnes, Michael Bauer, Mary Bell, Paul Benjamin, John Bennett, Per Bergmann, Wayne Berry, William Bishop, Hildegunn Bøckman, Kathleen Boehmke, Barry Booth, Charles Borden, Dorthe Borum, Thomas Bowern, Joel Boykin, Edward Bozeman, Bobby Bramblett, John Branstetter, Stephen Brewer, Galen Brey, W Brooks, Solomon Brotman, Brett Bruce, Lisa Bruce, Niels Bruun, Gitte Bruun, Robert Burks, Paul Bussman, James Callahan, R Calvert, Kimberly Carr, James Carroll, David Cawley, Jayne Cernohous, J Chastain, Noel Childers, Kevin Cockrell, Emery Cole, Christina Congo, Robert Connor, Winton Cowles, C Cowley, James Cox, Forrest Crabtree, Patrick Crow, Benjamin Cumbus, William Davis, Neel De Vos, Rodney Dellinger, Paul Dirkes, Camille Dixon, Christopher Donald, David Dotson, Catherine Dozier-Donald, Jessica Drapcho, James Dreading, Stuart Dropkin, James Duckworth, Michael Edwards, Geir Eide, Robert Embry, Harold Emmons, Marie Eng, R Entrekin, Lene Fabricius-Bekker, Anita Fenn, William Findlay, Jerome Fiorella, Jay Fisher, Håkan Flink, Gull-Britt Fogelberg, George Ford, Johnny Foster, Patrick Foy, Ronald Friedensohn, William Fulton, J Gafford, Geoff Gaunt, Daniel Gewartowski, Seth Gibree, Jeffrey Gilbert, Roger Gill, Bennie Goggans, Gary Golden, Mark Gonsewski, Barry Goodspeed, Michelle Goodwyn, Farhad Gounili, James Gowan, Charles Graffeo, John Green, William Griffin, Asta Grinis, Paul Guidi, Martin Haedersdal, Beth Hairell Dillion, Charles Hall, Rex Hall, William Hall, William Hamilton, Anders Hansen, Charlotte Hanson, Peter Harb, Lang Harp, Forrest Harris, John Harrison, William Harrison, William Harrison, C Harvell, Greg Hawkins, J Hawkins, David Hazour, Nancy Hein, Tim Herring, Wendy Holder, Bruce Holz, Gregory Horn, Robert Howard, Alex Howell, Susan Hudak Boss, Marie Hviid, George Hydrick, Benjamin Ingram, Shanaz Iranmanesh, Gordon Isbell, Janice Jackson, Marlon Jackson, John Jennings, Hoon Ji, Hiram Johnson, Marc Johnson, Teresa Johnson, Melodie Jones, Christopher Judson, Daniel Katz, Charles Keith, H Paul Kellum, Jeffery Kendrick, Greg Kennedy, Allen Kessler, Byron Ketcham, John Keyton, David Kimmel, John King, William King, Charles King, Jimmy King, Kurtis Klotzbuecher, Bruce Knecht, George Kolos, Michael Koyfman, Sally Lamberth, Sandra Lanter, Gary Lease, Edwin Lee, Greg Liebsch, Reginald Ligon, David Long, Harrison Long, David Louis, Gary Lubel, Edgar Luna, Anton Luv, Steven Lynch, Michael Maddox, G Maitre, G Maitre, Sonia Makhija, Robert Maland, Robert Mallory, Michael Mann, Lola Marek, Rodney Marshall, James Martin, James Martin, Daniel Mathews, George Matthews, Mark Mautner, William McClanahan, Jocelyn McClelland, Jennifer McClendon, Burton McGee, Ray McLaughlin, Ben McLeod, Robert Meador, V Dale Meeks, Michael Meon, Jeffrey Meral, Noah Miller, Mark Morelock, Diana Mortensen, Thomas Moseley, Jared Murrell, Gary Myers, Claes Naesheim, Leigh Nevins, Stephen New, John Nielsen, Eva Nordh, Hugh Ogletree, B Linda Ongley, Ann Orear, Rikke Orlamundt, Bjørg Ostvoll, Jules Paderewski, Per Påhlsson, Elizabeth Palmer Hill, Randall Palmore, William Pantazes, Jerry Parker, Tyrone Parrish, Wayne Patterson, Robert Payne, Liselotte Persson, Jim Phillips, Daniel Picard, Roberto Pischek, Genesis Pittman, John Poczatek, Ted Poczatek, Lindsay Pope, Gregory Powers, Michael Precise, Joni Price, Wafa Qureshi, Vibeke Qvist, Karen Raleigh, A Redmond, Ross Rehfeld, William Richardson, Vince Riehm, Matthew Rindal, Lloyd Ritchie, Kenneth Rogers, Louis Roque, D Rosenstiel, Wes Samford, Stephen Samson, James Sanderson, Robert Sanderson, Jerome Scales, A Segrest, Manuel Serra-Jovenich, Sory Shannon, M Shaw, Sterling Shaw, Raymond Shenfield, Stephen Shepherd, Stanley Sheppard, Jerry Shiver, Alberto Silber, Frederick Smith, Frederick Smith, Harald Solem, Lotte Sørensen, Julian Sparks, Kenneth Springer, Noel Spurlock, Art Steineker, Stephanie Steinmetz, James Stephens, James Stevens, Roxanna Stewart, Lyldon Strickland, Crawford Tatum, Timothy Tatum, Charles Tatum, Else Thiesson, Lars Thoegersen, Camilla Thoegersen, Lewis Thomas, Scott Thompson, Anibal Torres, L Trehern, Raymond Tso, Russell Turner, Bill Turner, Helen Turner, Børge Vaadal, Walter Vickers, Richard Vining, Dale Vohler, Belinda Waldo, Thomas Walker, Mary Wallace, Martha Wallace, Dave Watkins, Gerald Waxman, Paul Werner, Peter Westöö, Jimmy White, Shane Whitehead, Håkan Wickholm, Matthew Wilbanks, Charles Wilkinson, Thomas Williams, David Winchester, Sonya Wintzell, Jeffrey Worley, Donald Worley, Pia Worsøe, Morten Worsøe, Clayton Wright, Wilson Wright, Hugh Wunderlich, R Wyatt, Charles Yarbrough, Robin Yardic, David Young, Patrick Foy, Brad Rindal, Merry Joee Thoele, Jeffrey Fellows, Gail Morgan, Daniel Pihlstrom, Lisa Waiwaiole, Gerald Anderson, Gregg Gilbert, Jackie Love, Sonia Makhija, Andrea Mathews, Michelle Robinson, Sherry Sutphin, Martha Wallace, Kim Jenkins, Mark Litaker, Sharina Person, Joshua Richman, Dale Williams, Valerie Winston, Pia Nörrisgaard, Liselotte Persson, Vibeke Qvist, Paul Benjamin, Valeria Gordan, Pearl Harris, Deborah McEdward, Patti Moore, Joe Riley, Manuel Serra-Jovenich, James Bader,
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Nascimento MM, Bader JD, Qvist V, Litaker MS, Williams OD, Rindal DB, Fellows JL, Gilbert GH, Gordan VV, DPBRN Collaborative Group. Concordance between preoperative and postoperative assessments of primary caries lesion depth: results from the Dental PBRN. Oper Dent 2010; 35:389-96. [PMID: 20672722 PMCID: PMC2945299 DOI: 10.2341/09-363-c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study investigated the concordance between pre- and postoperative assessments of primary caries lesion depths by dentists from The Dental Practice-Based Research Network (DPBRN; www.DentalPBRN.org). A total of 229 DPBRN dentists collected data on 8,351 consecutive restorations inserted due to primary caries in 5,810 patients. Dentists estimated the preoperative depth of caries lesions based on the diagnostic methods they typically used. The preoperative depth was then compared to the postoperative depth, which dentists determined using actual clinical observation. Both estimated and observed depths were recorded as being in the outer half (E1) or inner half (E2) of enamel, or in the outer third (D1), middle third (D2) or inner third (D3) of dentin. Most restorations were placed to treat lesions that were preoperatively assessed as extending to the D1 (53%) and D2 (25%) depths. Of the restored caries lesions, 10% were preoperatively assessed as being limited to E2 depth and 3% to E1 depth. The majority of the restored enamel lesions were located on occlusal surfaces. Preoperative estimates of caries lesion depth were more concordant with postoperative depths when the lesion was at an advanced stage: 88% concordance at the D3 depth, compared to 54% concordance at the E1 depth. DPBRN dentists can discriminate caries lesions at different depths, but the accuracy of their depth assessments was higher for dentin than for enamel lesions. In general, DPBRN dentists were more likely to underestimate than overestimate the depth of caries lesions, and the extent of underestimation was greater for enamel than for dentin lesions.
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Affiliation(s)
- Marcelle M Nascimento
- Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, FL, USA
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Riley JL, Gordan VV, Rindal DB, Fellows JL, Williams OD, Ritchie LK, Gilbert GH. General practitioners' use of caries-preventive agents in adult patients versus pediatric patients: findings from the dental practice-based research network. J Am Dent Assoc 2010; 141:679-87. [PMID: 20516100 PMCID: PMC2880818 DOI: 10.14219/jada.archive.2010.0258] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In this study, the authors tested the frequency of dentists' recommendations for and use of caries-preventive agents for children as compared with adults. METHODS The authors surveyed 467 general dentists in the Dental Practice-Based Research Network who practice within the United States and treat both pediatric and adult patients. They asked dentists to identify the percentage of their patients for whom they had administered or recommended dental sealants, in-office and at-home fluoride, chlorhexidine rinse and xylitol gum. RESULTS Dentists were less likely to provide adult patients than pediatric patients with in-office caries-preventive agents. However, the rate at which they recommended at-home preventive regimens for the two groups of patients was similar. Dentists with a conservative approach to caries treatment were the most likely to use and recommend the use of caries-preventive agents at similar rates in adults as in children. In addition, dentists in practices with a greater number of patients who had dental insurance were significantly more likely to provide in-office fluoride or sealants to adult patients than to pediatric patients. CONCLUSION General dentists use in-office caries-preventive agents more commonly with their pediatric patients than with their adult patients. PRACTICE IMPLICATIONS General dentists should consider providing additional in-office caries-preventive agents for their adult patients who are at increased risk of experiencing dental caries.
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Affiliation(s)
- Joseph L. Riley
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Valeria V. Gordan
- Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | | | - Jeffrey L. Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - O. Dale Williams
- Professor and Director of the Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Gregg H. Gilbert
- Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Collaborators
Phil Adams, Sudhir Agarwal, Craig Ajmo, Lola Akinwale, Farshad Alamdari, George Allen, Charles Allen, Norman Allen, George Allen, Catharina Amaloo, Craig Amundson, John Anderson, F Damian Anderson, Gerald Anderson, Ronnie Arrington, Stanley Asensio, Stuart Atkinson, Karen Baker-Curtis, John Barnes, Michael Bauer, Mary Bell, Paul Benjamin, Per Bergmann, Wayne Berry, William Bishop, Hildegunn Bøckman, Kathleen Boehmke, Barry Booth, Charles Borden, Dorthe Borum, Thomas Bowen, Joel Boykin, Edward Bozeman, Joni Brackett Price, Bobby Bramblett, John Branstetter, Stephen Brewer, Galen Brey, W Brooks, Solomon Brotman, Brett Bruce, Lisa Bruce, Niels Bruun, Gitte Bruun, Robert Burks, Paul Bussman, James Callahan, R Calvert, Kimberly Carr, David Cawley, Jayne Cernohous, J Chastain, Noel Childers, Kevin Cockrell, Emery Cole, Christina Congo, Robert Connor, Winton Cowles, C Cowley, James Cox, Forrest Crabtree, Patrick Crow, Benjamin Cumbus, William Davis, Neel De Vos, Rodney Dellinger, Paul Dirkes, Camille Dixon, Christopher Donald, David Dotson, Catherine Dozier-Donald, Jessica Drapcho, James Dreading, Stuart Dropkin, James Duckworth, Michael Edwards, Geir Eide, Robert Embry, Harold Emmons, Marie Eng, R Entrekin, Anita Fenn, William Findlay, Jerome Fiorella, Jay Fisher, Håkan Flink, Gull-Britt Fogelberg, George Ford, Johnny Foster, Patrick Foy, Ronald Friedensohn, William Fulton, J Gafford, Geoff Gaunt, Daniel Gewartowski, Seth Gibree, Jeffrey Gilbert, Roger Gill, Bennie Goggans, Gary Golden, Mark Gonsewski, Barry Goodspeed, Michelle Goodwyn, Farhad Gounili, James Gowan, Charles Graffeo, John Green, William Griffin, Asta Grinis, Paul Guidi, Martin Haedersdal, Beth Bairell Dillion, Charles Hall, Rex Hall, William Hall, Anders Hansen, Charlotte Hanson, Peter Harb, Forrest Harris, John Harrison, William Harrison, William Harrison, C Harvell, Greg Hawkins, J Hawkins, David Hazouri, Nancy Hein, Tim Herring, Wendy Holder, Bruce Holz, Gregory Horn, Robert Howard, Alex Howell, Susan Hudak Boss, Marie Hviid, George Hydrick, Benjamin Ingram, Shanaz Iranmanesh, Gordon Isbell, Janice Jackson, Marlon Jackson, Janice Jackson, John Jennings, Hoon Ji, Hiram Johnson, Teresa Johnson, Marc Johnson, Melodie Jones, Christopher Judson, Daniel Katz, Charles Keith, H Paul Kellum, Jeffery Kendrick, Greg Kennedy, Allen Kessler, Byron Ketcham, John Keyton, David Kimmel, William King, Charles King, Jimmy King, Kurtis Klotzbuecher, Bruce Knecht, George Kolos, Sally Lamberth, Sandra Lanter, Gary Lease, Greg Liebsch, Reginald Ligon, David Long, David Louis, Gary Lubel, Edgar Luna, Anton Luv, Steven Lynch, Michael Maddox, G Maitre, Sonia Makhija, Robert Maland, Robert Mallory, Michael Mann, Rodney Marshall, James Martin, James Martin, Daniel Mathews, George Matthews, Mark Mautner, William McClanahan, Jocelyn McClelland, Jennifer McClendon, Burton McGee, Ray McLaughlin, Ben McLeod, Robert Meador, V Dale Meeks, Michael Meon, Jeffrey Meral, B Methvin, Noah Miller, Mark Morelock, Diana Mortensen, Thomas Moseley, Jared Murrell, Gary Myers, Leigh Nevins, Stephen New, John Nielsen, Eva Nordh, Hugh Ogletree, B Linda Ongley, Ann Orear, Rikke Orlamundt, Per Påhlsson, Randall Palmore, William Pantazes, Jerry Parker, Tyrone Parrish, Wayne Patterson, Robert Payne, Liselotte Persson, Jim Phillips, Roberto Pischek, Genesis Pittman, John Poczatek, Ted Poczatek, Marvin Poland, Lindsay Pope, Michael Precise, Wafa Qureshi, Vibeke Qvist, Karen Raleigh, Stephen Ray, A Redmond, Ross Rehfeld, William Richardson, Vince Riehm, Matthew Rindal, Lloyd Ritchie, Louis Roque, Stephen Samson, Robert Sanderson, Jerome Scales, A Segrest, Manuel Serra-Jovenich, Sory Shannon, Sterling Shaw, M Shaw, Raymond Shenfield, Scott Shepherd, Jerry Shiver, Alberto Silber, Frederick Smith, Frederick Smith, Harald Solem, Lotte Sørensen, Julian Sparks, Kenneth Springer, Art Steineker, Stephanie Steinmetz, James Stephens, Roxanna Stewart, Lyldon Strickland, Crawford Tatum, Timothy Tatum, Else Thiesson, Lars Thoegersen, Camilla Thoegersen, Lewis Thomas, Scott Thompson, Anibal Torres, L Trehern, Russell Turner, Bill Turner, Helen Turner, Børge Vaadal, Walter Vickers, Richard Vining, Dale Vohler, Belinda Waldo, Thomas Walker, Mary Wallace, Martha Wallace, Jon Ward, Dave Watkins, Gerald Waxman, Paul Werner, Peter Westöö, Jimmy White, Shane Whitehead, Håkan Wickholm, Charles Wilkinson, Thomas Williams, David Winchester, Sonya Wintzell, Jeffrey Worley, Donald Worley, Pia Worsøe, Morten Worsøe, Clayton Wright, Wilson Wright, Hugh Wunderlich, R Wyatt, Charles Yarbrough, Robin Yardic, Patrick Foy, Brad Rindal, Merry Jo Thoele, Jeffrey Fellows, Gail Morgan, Daniel Pihlstrom, Lisa Waiwaiole, Gerald Anderson, Gregg Gilbert, Jackie Love, Sonia Makhjia, Andrea Mathews, Michelle Robinson, Sherry Sutphin, Martha Wallace, Kim Jenkins, Mark Litaker, Sharina Person, Joshua Richman, Dale Williams, Valerie Winston, Pia Nörrisgaard, Liselotte Persson, Vibeke Qvist, Paul Benjamin, Valeria Gordan, Pearl Harris, Deborah McEdward, Patti Moore, Joe Riley, Manuel Serra-Jovenich, James Bader,
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Oulis CJ, Berdouses ED. Fissure sealant retention and caries development after resealing on first permanent molars of children with low, moderate and high caries risk. Eur Arch Paediatr Dent 2010; 10:211-7. [PMID: 19995504 DOI: 10.1007/bf03262684] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM This was to evaluate the retention of fissure sealants (FS) and their effectiveness after resealing on caries reduction applied to first permanent molars, in a sample of children stratified according to their caries risk status in a private practice setting. METHODS The sample was 1,274 FS applied on first permanent molars (FPM) of 380 children (6 to 8 years old). Follow-up and monitoring for resealing was 3 years after FS placement, having at least one recall visit per year. Caries risk was based on baseline dmft index: low (dmft=0), moderate (dmft=1-4), high (dmft >4), with almost half of the teeth belonging to the high-risk group. All sealed teeth were evaluated and recorded for FS failure and resealing in case of partial/total loss, as well as caries development. Survival analysis using the Cox Proportional Hazards regression model was used for data evaluation. RESULTS Of the 1,274 sealed surfaces, 927 (72.8%) needed no intervention 185 (14.5%) needed only resealing and 162 (12.7%) developed caries during the study. Of 162 carious surfaces, 107/ 675 (15.9%) were from the high caries risk children, compared with 17/144 (11.8%) and 38/455 (8.3%) from the moderate and low caries risk group respectively. The highest number of failures, 4.9% and resealing were found at first recall, declining to 1.4% at the end of the study. Development of caries followed a steady rate of 6-8% per year. Cox proportional hazards model indicated, regardless if resealing or caries development was considered a failure or resealing was a success and caries development a failure, only the high dmft index appeared in both cases to significantly increase the chance (158% and 173% respectively) of FS failure and caries development compared with moderate and low dmft index. Other variables when inserted into the hazard model, such as age, sex and number of visits, either did not show a significant effect or only marginally affected FS retention, without modifying the association between caries risk and sealant failure. CONCLUSIONS Children of a high baseline caries risk status showed lower FS retention rates and higher occlusal caries prevalence following FS loss compared with those of moderate and low risk status. Resealing does not seem to dramatically change the final outcome of the higher risk group to develop more caries, necessitating other more effective measures to increase the retention of FS on these highly vulnerable areas.
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Affiliation(s)
- C J Oulis
- Dept. of Paediatric Dentistry, Dental School, University of Athens, Greece.
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Nascimento MM, Gordan VV, Qvist V, Litaker MS, Rindal DB, Williams O, Fellows JL, Ritchie LK, Mjör IA, McClelland J, Gilbert GH, For the DPBRN COLLABORATIVE GROUP. Reasons for placement of restorations on previously unrestored tooth surfaces by dentists in The Dental Practice-Based Research Network. J Am Dent Assoc 2010; 141:441-8. [PMID: 20354094 PMCID: PMC2848821 DOI: 10.14219/jada.archive.2010.0197] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The authors conducted a study to identify and quantify the reasons used by dentists in The Dental Practice-Based Research Network (DPBRN) for placing restorations on unrestored permanent tooth surfaces and the dental materials they used in doing so. METHODS A total of 229 DPBRN practitioner-investigators provided data from their practices regarding 9,890 consecutive restorations in 5,810 patients. Information the practitioner-investigators provided included their reasons for restoring the teeth, the specific teeth and surfaces they restored and the restorative materials they used. RESULTS Primary caries (85 percent of teeth, 8,351 of 9,890) and noncarious defects (15 percent, 1,479 of 9,890) were the main reasons participants gave for placing restorations. Participants placed restorations necessitated by caries most frequently on occlusal surfaces (49 percent, 4,091 of 8,351). They used amalgam for 47 percent of the molar restorations and 45 percent of the premolar restorations. They used directly placed resin-based composite (RBC) for 48 percent of the molar restorations, 50 percent of the premolar restorations and 93 percent of the anterior restorations. CONCLUSION DPBRN practitioner-investigators cited dental caries on occlusal and proximal surfaces of molar teeth as the main reasons for placing restorations on previously unrestored tooth surfaces. RBC was the material they used most commonly for occlusal and anterior restorations. Amalgam remains the material of choice to restore posterior teeth with proximal caries, although the authors noted significant differences in the use of amalgam and RBC by dentists in various regions of the DPBRN.
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Affiliation(s)
- Marcelle M. Nascimento
- Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Valeria V. Gordan
- Department of Operative Dentistry, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Vibeke Qvist
- Department of Cariology and Endodontics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mark S. Litaker
- Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - O.D. Williams
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey L. Fellows
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Lloyd K. Ritchie
- DPBRN practitioner-investigator in private practice in Pensacola, Florida, USA
| | - Ivar A. Mjör
- Department of Operative Dentistry at University of Florida, Gainesville, Florida, USA
| | - Jocelyn McClelland
- DPBRN practitioner-investigator in private practice in Alabaster, Alabama, USA
| | - Gregg H. Gilbert
- Department of General Dental Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Karlsson L. Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue. Int J Dent 2010; 2010:270729. [PMID: 20454579 PMCID: PMC2864452 DOI: 10.1155/2010/270729] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/04/2010] [Indexed: 11/21/2022] Open
Abstract
A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages.
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Affiliation(s)
- Lena Karlsson
- Division of Cariology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
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Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: an in vitro study. Eur Arch Paediatr Dent 2010; 11:26-31. [PMID: 20129030 DOI: 10.1007/bf03262706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent. METHODS A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance. RESULTS According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842). CONCLUSIONS Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.
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Donovan TE, Anderson M, Becker W, Cagna DR, Hilton TJ, Rouse J. Annual review of selected scientific literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2009; 102:10-45. [DOI: 10.1016/s0022-3913(09)60095-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Balevi B. The management of incipient or suspicious occlusal caries: a decision-tree analysis. Community Dent Oral Epidemiol 2009; 36:392-400. [PMID: 18924255 DOI: 10.1111/j.1600-0528.2007.00419.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To perform a comprehensive decision-tree analysis for the management of the suspicious/incipient occlusal lesion on a molar tooth. METHODS A quantitative decision tree was constructed to assess the expected utility value of three global strategies to dentally manage the incipient or suspicious occlusal carious lesion. RESULT A preventive strategy offered an optimal expected utility value (0.98 utile) compared with the other two strategies of visual inspection (0.84 utile) or referring to one of four diagnostic tests (0.74-0.82 utile). CONCLUSION Although the general conclusion of this analysis agrees with current recommendations, this analysis offers a more complete mathematical model that provides a unified value for each strategy (i.e. expected utility value) thus allowing for complex quantitative comparison between strategies. This paper provides a specific example of how decision-tree analysis can be a powerful tool in guiding dental practice.
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Affiliation(s)
- Ben Balevi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Galloway SS, Easley J. Establishing a scientific basis for equine clinical dentistry. Vet J 2008; 178:307-10. [DOI: 10.1016/j.tvjl.2008.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
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Clinical Decision Support Chairside Tools for Evidence-Based Dental Practice. J Evid Based Dent Pract 2008; 8:119-32. [DOI: 10.1016/j.jebdp.2008.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Frantsve-Hawley J, Meyer DM. The evidence-based dentistry champions: a grassroots approach to the implementation of EBD. J Evid Based Dent Pract 2008; 8:64-9. [PMID: 18492572 DOI: 10.1016/j.jebdp.2008.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In order for evidence-based dentistry (EBD) to become part of decision making in practice, the most current and comprehensive research findings must be translated into practice. The use of Champions, influential individuals to support the transfer of knowledge among their peers, is one effective approach used by others in the health care field to successfully implement science research into clinical care. With the success of Champions in other health care areas, the American Dental Association (ADA) and the Journal of Evidence-Based Dental Practice, through an educational grant from Procter and Gamble, have launched a novel program to develop Evidence-Based Dentistry Champions. The EBD Champion program is developing a network of oral health care workers who will disseminate information about the application of an evidence-based approach to dental care and will serve as resources and mentors to their colleagues. The primary mechanism for developing the network of EBD Champions is through 3 annual EBD Champion Conferences, the first of which will be held at the ADA Headquarters in Chicago, IL, on May 2 and 3, 2008. The EBD Champion will serve as a resource to the practitioners in their communities, providing a grassroots approach to facilitating the implementation of an evidence-based approach to providing dental care.
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Affiliation(s)
- Julie Frantsve-Hawley
- Research Institute and Center for Evidence-Based Dentistry; American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60614, USA.
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Donovan TE, Becker W, Brodine AH, Burgess JO, Cronin RJ, Summitt JB. Annual review of selected dental literature: Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2007; 98:36-67. [PMID: 17631173 DOI: 10.1016/s0022-3913(07)60036-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Terence E Donovan
- Department of Operative Dentistry, University of North Carolina, School of Dentistry, Chapel Hill, NC 27599-7450, USA.
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