Use of the International Caries Detection and Assessment System Two-Digit Coding Method by Predoctoral Dental Students at Philipps University of Marburg, Germany

[Assessment of carious dental lesions and treatment options: comparison of the knowledge of dental students and orthodontic assistants]

In order to optimize dental education, established procedures for caries diagnosis and therapy, such as the International Caries Classification and Management System (ICCMS), should be integrated into the curriculum. In preparation, the level of knowledge of dental students on caries detection and management was surveyed in order to specifically address deficits in dental teaching. In addition, the data were compared with the knowledge of clinically experienced dentists. The results are presented in this report and possible consequences for dental teaching are discussed.Twenty-six sixth semester dental students and six assistant dentists at the Department of Orthodontics (Philipps University of Marburg, Germany) were available for the written survey during the winter semester 2018/2019. For 12 anonymized orthodontic patient cases, the clinical findings, caries risk, and adequate treatment were to be determined for each defined tooth. The consensus decision of two experienced dentists served as the reference value. As a result, agreement with the reference ranged from 40.7% to 51.3% for students and from 56.9% to 75.0% for assistant dentists. The extent of caries and the resulting necessary treatment were mostly underestimated.In addition to theoretical knowledge, clinical experience is another prerequisite for adequate caries diagnosis and its management. The underestimation of caries extent and necessary treatment should be taken into account when teaching content. Procedures such as the ICCMS should be integrated into the dental curriculum at an early stage, so that orthodontic patients can also receive effective care.

Knowledge of undergraduate dental students regarding management of caries lesions

Objectives

Understanding of lifelong control of disease processes associated with caries and its management is an essential part of dental education. This study evaluated the dental students’ knowledge of caries diagnosis and management using the International Caries Classification and Management System (ICCMS).

Methods

A survey was conducted among undergraduate dental students at two dental schools, attending the sixth (centre 1) and seventh semester (centre 2), respectively. Medical histories, clinical images and radiographs of 12 patients were compiled as anonymous cases. For each case, a specific lesion was to be assessed. In addition, the students should determine the patient’s caries risk and select a treatment option. An expert report (consensus decision) was used as the reference standard. For statistical analysis, kappa statistics and binomial tests were used.

Results

A total of 46 students participated in this study. The percentage of agreement of responses to the reference was: centre 1: 40.7–51.3%, centre 2: 57.9–67.9%. The corresponding Kappa values were: centre 1: 0.073–0.175, centre 2: 0.315–0.432. Overall, students tended to underestimate the codes compared to the reference standard (p < 0.001).

Conclusion

Introducing systematic content about caries diagnosis and management such as ICDAS and ICCMS in the learning objectives of undergraduate dental students can be proposed. However, in order to improve diagnosis and enable a more reliable choice of treatment options, attention should also be given to the way they are didactically taught.

Agreement of Bioluminescence Measurements and Visual Assessment in Monitoring Occlusal Surfaces of Permanent Teeth

Background: Caries lesion activity is typically assessed by visual–tactile criteria. Regular monitoring is required to detect the transition of lesions and to ensure that the initial assessment was valid. This clinical study aimed to evaluate the agreement of bioluminescence measurements (Calcivis imaging system, Cis) with visual examination to assess caries lesion activity and to monitor occlusal surfaces. Methods: The occlusal surfaces of ninety-one permanent posterior teeth were assessed for the presence or absence of active caries lesions with ICCMS criteria and Cis measurements at three visit times: baseline (t1) and six months (t2) and 12 months (t3) after baseline. Results: At the baseline visit, 70% of the included occlusal sites were assessed visually as active lesions (ICCMS codes 1 and 2). At t3, 64.8% of the sites showed signs of an active lesion. The percentage agreements between the visual and Cis methods were 87.8% (t1), 89.9% (t2) and 88.6% (t3). The corresponding κ-values were 0.71 (95% CI 0.52;0.87), 0.75 (95% CI 0.59;0.89) and 0.77 (95% CI 0.61;0.90), respectively. No significant difference between the visual and bioluminescence systems was found at any visit (p > 0.05). The results based on cluster randomization (generalized estimation equations) showed no significant differences between the visual and Cis findings for all visits (p = 0.108, Wald Χ² with 1 df = 2.587). Conclusion: The bioluminescence system demonstrated substantial agreement for the activity assessment of occlusal lesions compared to the findings obtained by visual assessment over twelve months.

Assessment of caries on the first permanent molars in a group of seven- to thirteen-year-old schoolchildren: Comparison of DMF and ICDAS systems

OBJECTIVES

The objective of this study was to compare ICDAS and DMFT/S in the evaluation of caries status of the first permanent molar in 200 children aged 7 to 13 years.

METHODS

This was a cross-sectional design study. Participants were selected from two private schools in Lebanon. The examinations were performed by two trained and calibrated examiners using a dental mirror and a WHO probe. The number of decayed (D), missing (M) and filled (F) teeth was recorded in DMFT/S form, and the numbers related to D, M and F were then added to record the DMFT/S value (D1MFT/S, D2MFT/S and D3MFT/S). In the ICDAS, the assessment of caries associated with restorations and sealant was recorded. Student t tests/and Mann-Whitney tests were used to compare the continuous variables. Chi-square tests and Fisher exact tests were used to compare the categorical variables.

RESULTS

The average age of the participants was 9.21 ± 1.927 (7-13 years old). No significant difference was found between the mean time to score DMFT, DMFS and ICDAS indices (-p-value > 0.05). The prevalence of caries with D1MFS, D2MFS and D3MFS was 80.5%, 54% and 30.5%, respectively. However, the prevalence of caries with ICDAS II was 77.5%.

CONCLUSION

The DMF index is an international user-friendly system that shows the carious history of teeth. However, the ICDAS assesses the different stages of caries and describes the restorative status of the tooth, promoting new preventive approaches and curative needs. More studies should be done to confirm these findings.

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis

AIM

To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection.

DESIGN

Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes.

RESULTS

Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection.

CONCLUSION

Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

Histologic validation of ICDAS-II and polarization sensitive optical coherence tomography to detect smooth surface early carious lesions

AIM

This in vitro study aimed to histologically validate and compare the methods for detection of smooth surface early carious lesions (ECLs) that is, International caries detection and assessment system for the smooth surface (ICDAS-II-SSC), Polarization sensitive optical coherence tomography (PS-OCT), and radiography.

METHODOLOGY

PS-OCT images for scores 0-3 of ICDAS-II-SSC were standardized according to ECLs' depth. Preliminary PS-OCT images for ICDAS-II-SSC score-2 of pigmented ECLs showed reduced lesion depth and therefore were dichotomized into scores 2 and 2p for white and pigmented lesions (ICDAS-II-SSCm). ECLs on one hundred freshly extracted teeth were scored by three examiners for ICDAS-II-SSCm, PS-OCT, radiography, and histology.

RESULTS

Compared to histology, ICDAS-II-SSCm showed a strong positive correlation followed by PS-OCT and radiographic evaluation. ICDAS-II-SSCm had a strong positive correlation with PS-OCT, while both variables had a weak positive correlation with radiography. PS-OCT detected the activity of ECLs by directly relating the image depth of ECLs to their mineral volume content.

CONCLUSION

The current scope of ICDAS-II should be reviewed since the pigmentation can be misinterpreted as an active lesion. Till then, ICDAS-II-SSC is an effective visual method for early caries detection. PS-OCT has the potential to become a probe with the proper algorithm for diagnostic purposes.

Impact of a Tutored Theoretical-Practical Training to Develop Undergraduate Students' Skills for the Detection of Caries Lesions: Study Protocol for a Multicenter Controlled Randomized Study

BACKGROUND

Tutored laboratorial activities could be a manner of improving the competency development of students. However, its impact over conventional theoretical classes has not yet been tested. Additionally, different university contexts could influence this issue and should be explored.

OBJECTIVE

To assess the impact of a tutored theoretical-practical training for teaching undergraduate students to detect caries lesions as compared with theoretical teaching activities. The impact of these teaching/learning activities will be assessed in terms of efficacy, cost/benefit, retention of knowledge/acquired competences, and student acceptability.

METHODS

Sixteen centers (7 centers from Brazil and 9 centers from other countries throughout the world) are involved in the inclusion of subjects for this protocol. A randomized controlled study with parallel groups will be conducted. One group (control) will be exposed to a 60- to 90-minute conventional theoretical class and the other group (test) will be exposed to the same theoretical class and also a 90-minute laboratory class, including exercises and discussions based on the evaluation of a pool of images and extracted teeth. The mentioned outcomes will be evaluated immediately after the teaching activities and also in medium- and long-term analyses. To compare the long-term outcomes, students who enrolled in the university before the participating students will be interviewed for data collection and these data will be used as a control and compared with the trained group. This stage will be a nonrandomized phase of this study, nested in the main study. Appropriate statistical analysis will be performed according to the aims of this study. Variables related to the centers will also be analyzed and used to model adjustment as possible sources of variability among results.

RESULTS

This ongoing study is funded by a Brazilian national funding agency (CNPq- 400736/2014-4). We expect that the tutored theoretical-practical training will improve the undergraduate students' performance in the detection of caries lesions and subsequent treatment decisions, mainly in terms of long-term retention of knowledge. Our hypothesis is that tutored theoretical-practical training is a more cost-effective option for teaching undergraduate students to detect caries lesions.

CONCLUSIONS

If our hypothesis is confirmed, the use of laboratory training in conjunction with theoretical classes could be used as an educational strategy in Cariology to improve the development of undergraduate students' skills in the detection of caries lesions and clinical decision-making.

Clinical performance of the near-infrared imaging system VistaCam iX Proxi for detection of approximal enamel lesions

OBJECTIVES/AIMS

Apart from the visual detection of caries, X-rays can be taken for detection of approximal lesions. The Proxi head of VistaCam iX intraoral camera system uses near-infrared light (NIR) to enable caries detection in approximal surfaces. The aim of this study was to evaluate the performance of the NIR for the detection of approximal enamel lesions by comparison with radiographic findings.

MATERIALS AND METHODS

One hundred ninety-three approximal surfaces from 18 patients were examined visually and using digital radiographs for presence or absence of enamel lesions. Then digital images of each surface were produced using the near-infrared light. Correlation between methods was assessed using Spearman's rank correlation coefficient (rs). Agreement between radiographic and NIR findings was calculated using the kappa coefficient. McNemar's test was used to analyse differences between the radiographic and NIR findings (α=0.05).

RESULTS

Moderate correlation was found between all detection methods (rs=0.33-0.50, P<0.0001). Agreement between the radiographic and NIR findings was moderate (κ=0.50, 95% CI=0.37-0.62) for the distinction between sound surfaces and enamel caries. No significant differences were found between the findings (P=0.07).

CONCLUSION

Radiographs and NIR were found to be comparable for the detection of enamel lesions in permanent teeth.

Use of a fluorescence-based camera for monitoring occlusal surfaces of primary and permanent teeth

BACKGROUND

Sound teeth and incipient lesions require regular monitoring to detect possible progression of caries early on.

AIM

To evaluate the ability of the VistaProof (VP) fluorescence-based camera for monitoring occlusal surfaces.

DESIGN

A total of 419 posterior teeth (205 primary molars, 145 permanent molars, and 69 premolars) of 35 patients were examined (average age: 9.1 years). The occlusal surfaces were classified visually according to the criteria of the International Caries Detection and Assessment System (ICDAS). VP measurements were performed at baseline (t1), and the examinations were repeated after six (t2) and twelve month (t3). Correlation between methods was calculated using Spearman's rank correlation coefficient (r_s ). Wilcoxon test was used to monitor whether VP identified changes as well as ICDAS (α = 0.05).

RESULTS

Correlations between ICDAS and VP were significantly positive (r_s : 0.66-0.73, P < 0.001). No significant differences were found between all times for the ICDAS findings. Significant differences for the VP were ascertained for t1/t2 (P = 0.03). Results based on cluster randomization showed significant differences between ICDAS and VistaProof concerning the absence/presence of changes in the finding (P < 0.0005).

CONCLUSION

Correlation between ICDAS and VP was strong. The VP supported the findings of visual examination for monitoring occlusal surfaces, although not all changes could be detected with respect to the visual findings.

SOPROLIFE system: an accurate diagnostic enhancer

Objectives. The aim of this study was to evaluate a light-emitting diode fluorescence tool, the SOPROLIFE light-induced fluorescence evaluator, and compare it to the international caries detection and assessment system-II (ICDAS-II) in the detection of occlusal caries. Methods. A total of 219 permanent posterior teeth in 21 subjects, with age ranging from 15 to 65 years, were examined. An intraclass correlation coefficient (ICC) was computed to assess the reliability between the two diagnostic methods. Results. The results showed a high reliability between the two methods (ICC = 0.92; IC = 0.901–0.940; P < 0.001). The SOPROLIFE blue fluorescence mode had a high sensitivity (87%) and a high specificity (99%) when compared to ICDAS-II. Conclusion. Compared to the most used visual method in the diagnosis of occlusal caries lesions, the finding from this study suggests that SOPROLIFE can be used as a reproducible and reliable assessment tool. At a cut-off point, categorizing noncarious lesions and visual change in enamel, SOPROLIFE shows a high sensitivity and specificity. We can conclude that financially ICDAS is better than SOPROLIFE. However SOPROLIFE is easier for clinicians since it is a simple evaluation of images. Finally in terms of efficiency SOPROLIFE is not superior to ICDAS but tends to be equivalent with the same advantages.

Evaluating performance of dental caries detection methods among third-year dental students

Background

Reliable caries detection is a cornerstone in the modern caries treatment schema. This study aimed to evaluate adopting traditional and new caries detection methods by third-year dental students.

Methods

Fifty-seven students were given lectures on caries detection, after which they evaluated 27 extracted carious teeth using traditional clinical assessment (CE), Nyvad’s, and ICDAS methods. On three teeth they also performed DIAGNOdent pen® (LF) scanning. Histological scores of the sectioned teeth (ICDAS, LF) and activity estimations of the lesions by the supervisors were used as golden standards (Nyvad, CE). For the ICDAS method , sensitivity and specificity were calculated using dentine caries (D3) as a cut-off point. Mean ICC and kappa values were calculated to evaluate interexaminer agreement for all lesions and methods. Spearman’s correlation coefficient evaluated LF scanning.

Results

ICDAS method presented good sensitivity (0.78) and specificity (0.87). The inter-examiner agreement for different methods was fair or good (CE ICC = 0.69, κ = 0.53; Nyvad’s method ICC = 0.68, κ = 0.48, ICDAS ICC = 0.66, κ = 0.47). Variation in LF values was the greatest with lesions extending to middle third of dentin. In that case, the Spearman’s correlation coefficient was also the weakest.

Conclusions

To follow the guidelines by the European Core Curriculum on Cariology, the third year dental students are introduced to methods for detecting lesion depth and assessing lesion activity as well as using new caries detection methods. Their performance in estimating lesion depth is good, and fair to good in estimating lesion activity even after basic training only.