1
|
Khallaf YS, Hafez S, Shaalan OO. Evaluation of ICCMS versus CAMBRA Caries Risk Assessment Models Acquisition on Treatment Plan in Young Adult Population: A Randomized Clinical Trial. Clin Cosmet Investig Dent 2021; 13:293-304. [PMID: 34290532 PMCID: PMC8289689 DOI: 10.2147/ccide.s318313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the difference between ICCMS and CAMBRA models on treatment plan of young adults. SETTINGS AND DESIGN A total of 104 young adult patients were randomly divided into two groups, either ICCMS or CAMBRA. PATIENTS AND METHODS Patients were examined according to the criteria of the ICDAS-II and caries risk was analyzed according to CAMBRA and divided into two equal groups according to treatment protocol. Caries incidence was assessed according to ICDAS-II criteria after 6 and 12 months. Statistical analysis used Chi-square test. A value of P ≤ 0.05 was considered statistically significant. Relative risk (RR) was used to determine the clinical significance. RESULTS The current study has revealed no statistically significant difference between both caries risk assessment models tested at baseline (P = 0.317), 6 months (P = 0.164) and 1 year (P = 0.287). Intra-group assessment of CAMBRA group showed a statistically significant difference in ICDAS scores (P = 0.002) after 12 months in high- and moderate-risk groups while low-risk group did not show statistically significant difference in ICDAS scores between different follow-up periods (P = 0.593) and (P = 1.000), respectively. ICCMS groups did not show statistically significant differences in any group along follow-up periods. CONCLUSION ICCMS and CAMBRA were equivalent in preventing new decay. The ICCMS treatment plan is a safe approach and its preventive products are available over the counter. However, it is more complicated than CAMBRA. While CAMBRA is simpler, it is less comprehensive, some of its products are not available over the counter worldwide (e.g. Duraphat 5000 ppm) and some of them may be accompanied by several side effects (e.g. chlorhexidine mouthwash), which may weaken its management protocol.
Collapse
Affiliation(s)
- Yomna Sayed Khallaf
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Shereen Hafez
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Omar Osama Shaalan
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
2
|
Abstract
Despite evidence strongly supporting use of non-invasive or minimally invasive procedures in caries management, there is still a large gap between evidence-based recommendations and application of these concepts in practice, with the practice of dentistry still largely dominated by invasive procedures in the US. This paper describes efforts in education and clinical practice in the US in the last decade to promote evidence-based cariology strategies, which support a minimum intervention dentistry (MID) philosophy. These include, for example: a competency-based core cariology curriculum framework which has been developed and disseminated. National education accreditation standards supporting caries management are likely to soon be changed to support assessment of best evidence in cariology. There are several ongoing efforts by organised dentistry and other groups involving dental educators, researchers and clinical practitioners to promote cariology concepts in practice, such as the development of evidence-based clinical practice guidelines for caries management by the American Dental Association. Within each of these strategies there are challenges, but also opportunities to expand the implementation of MID in the US, which create optimism for future improvements over time.
Collapse
|
3
|
Rechmann P, Chaffee BW, Rechmann BMT, Featherstone JDB. Changes in Caries Risk in a Practice-Based Randomized Controlled Trial. Adv Dent Res 2018; 29:15-23. [PMID: 29355409 DOI: 10.1177/0022034517737022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To demonstrate that Caries Management by Risk Assessment (CAMBRA) can be successfully implemented in dental practice, 30 dentists were recruited to perform a 2-y CAMBRA trial. Twenty-one dentists (18 private practices, 3 community clinics) participated in a randomized, controlled, parallel-arm, double-blind clinical trial with individual-level assignment of 460 participants to standard of care (control) versus active CAMBRA treatment (intervention). Control or active antimicrobial and remineralizing agents were dispensed at baseline and 6-, 12-, 18-, and 24-mo recall visits according to risk level and assigned treatment arm. Primary outcome measure was dentist-determined caries risk level at recall. Among initially high-risk participants, secondary outcomes were recorded disease indicators. Generalized estimating equations were used to fit log-linear models for each outcome while accounting for repeated measurements. At 24 mo, follow-up rates were 34.3% for high-risk participants (32.1% intervention, 37.1% control) and 44.2% for low-risk participants (38.7% intervention, 49.5% control). Among 242 participants classified as high caries risk at baseline (137 intervention, 105 control), a lower percentage of participants remained at high risk in the intervention group (statistically significant at all time points). At 24 mo, 25% in the intervention group and 54% in the control group remained at high risk ( P = 0.003). Among 192 participants initially classified as low risk (93 intervention, 99 control), most participants remained at low risk. At 24 mo, 89% in the intervention group and 71% in the control group were low caries risk ( P = 0.18). The percentage of initially high-risk participants with recorded disease indicators decreased over time in both intervention and control groups, being always lower for the intervention group (statistically significant at the 12- and 18-mo time point). In this practice-based clinical trial, a significantly greater percentage of high-caries-risk participants were classified at a lower risk level after CAMBRA preventive therapies were provided. Most participants initially assessed at low caries risk stayed at low risk (ClinicalTrials.gov NCT01176396).
Collapse
Affiliation(s)
- P Rechmann
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
| | - B W Chaffee
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
| | - B M T Rechmann
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
| | - J D B Featherstone
- 1 Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
| |
Collapse
|
4
|
Young DA, Alvear Fa B, Rogers N, Rechmann P. The Effect of Calibration on Caries Risk Assessment Performance by Students and Clinical Faculty. J Dent Educ 2017; 81:667-674. [PMID: 28572412 DOI: 10.21815/jde.017.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/09/2017] [Indexed: 11/20/2022]
Abstract
Caries management requires a complete oral examination and an accurate caries risk assessment (CRA). Performing Caries Management by Risk Assessment (CAMBRA) is inefficient when the caries risk level assignment is incorrect. The aim of this study was to evaluate the ability of faculty members and students at one U.S. dental school to correctly assign caries risk levels for 22 CRA cases, followed by calibration with guidelines on how to use the CRA form and a post-calibration test two months after calibration. Inter-examiner reliability to a gold standard (consensus of three experts) was assessed as poor, fair, moderate, good, and very good. Of the 162 students and 125 faculty members invited to participate, 13 students and 20 faculty members returned pre-calibration tests, for response rates of 8% and 16%, respectively. On the post-calibration test, eight students and 13 faculty members participated for response rates of 5% and 10%, respectively. Without guidelines and calibration, both faculty members and students when evaluated as one group performed only poor to fair in assigning correct caries risk levels. After calibration, levels improved to good and very good agreements with the gold standard. When faculty and students were evaluated separately, in the pre-calibration test they correctly assigned the caries risk level on average in only one-quarter of the cases (students 24.1%±13.3%; faculty 23.6%±17.5%). After calibration, both groups significantly improved their correct assignment rate. Faculty members (73.8% correct assignments) showed even significantly higher correct assignment rates than students (47.7% correct assignments). These findings suggest that calibration with a specific set of guidelines improved CRA outcomes for both the faculty members and students. Improved guidelines on how to use a CRA form should lead to improved caries risk assessment and proper treatment strategy for patients.
Collapse
Affiliation(s)
- Douglas A Young
- Dr. Young is Professor, Department of Dental Practice, Arthur A. Dugoni School of Dentistry, University of the Pacific; Dr. Fa is Assistant Professor, Department of Integrated Reconstructive Dental Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific; Mr. Rogers is Administrative Lead for Personalized Instructional Programs, Department of Academic Affairs, Arthur A. Dugoni School of Dentistry, University of the Pacific; and Dr. Rechmann is Professor and Director of Clinical Sciences Research Group, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco.
| | - Bernadette Alvear Fa
- Dr. Young is Professor, Department of Dental Practice, Arthur A. Dugoni School of Dentistry, University of the Pacific; Dr. Fa is Assistant Professor, Department of Integrated Reconstructive Dental Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific; Mr. Rogers is Administrative Lead for Personalized Instructional Programs, Department of Academic Affairs, Arthur A. Dugoni School of Dentistry, University of the Pacific; and Dr. Rechmann is Professor and Director of Clinical Sciences Research Group, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco
| | - Nicholas Rogers
- Dr. Young is Professor, Department of Dental Practice, Arthur A. Dugoni School of Dentistry, University of the Pacific; Dr. Fa is Assistant Professor, Department of Integrated Reconstructive Dental Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific; Mr. Rogers is Administrative Lead for Personalized Instructional Programs, Department of Academic Affairs, Arthur A. Dugoni School of Dentistry, University of the Pacific; and Dr. Rechmann is Professor and Director of Clinical Sciences Research Group, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco
| | - Peter Rechmann
- Dr. Young is Professor, Department of Dental Practice, Arthur A. Dugoni School of Dentistry, University of the Pacific; Dr. Fa is Assistant Professor, Department of Integrated Reconstructive Dental Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific; Mr. Rogers is Administrative Lead for Personalized Instructional Programs, Department of Academic Affairs, Arthur A. Dugoni School of Dentistry, University of the Pacific; and Dr. Rechmann is Professor and Director of Clinical Sciences Research Group, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco
| |
Collapse
|
5
|
Sutton JC, Fay RM, Huynh CP, Johnson CD, Zhu L, Quock RL. Dental Faculty Accuracy When Using Diagnostic Codes: A Pilot Study. J Dent Educ 2017; 81:554-560. [PMID: 28461632 DOI: 10.21815/jde.016.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
Abstract
The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.
Collapse
Affiliation(s)
- Jeanne C Sutton
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Rose-Marie Fay
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Carolyn P Huynh
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Cleverick D Johnson
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Liang Zhu
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston
| | - Ryan L Quock
- Dr. Sutton is Associate Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Fay is Assistant Professor, Department of General Practice and Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Huynh is Associate Professor, Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry at Houston; Dr. Johnson is Professor, Department of General Practice & Dental Public Health, University of Texas School of Dentistry at Houston; Dr. Zhu is Associate Professor, Biostatistics and Epidemiology Research Design Core, Center for Clinical and Translational Sciences, and Department of Internal Medicine, University of Texas McGovern Medical School; and Dr. Quock is Professor and Vice-Chair, Department of Restorative Dentistry and Prosthodontics, University of Texas School of Dentistry at Houston.
| |
Collapse
|
6
|
Oh HY, Jung HI, Lee JW, de Jong EDJ, Kim BI. Improving the competency of dental hygiene students in detecting dental restorations using quantitative light-induced fluorescence technology. Photodiagnosis Photodyn Ther 2017; 17:245-249. [DOI: 10.1016/j.pdpdt.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/25/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
|
7
|
Goolsby SP, Young DA, Chiang HK, Carrico CK, Jackson LV, Rechmann P. The Effects of Faculty Calibration on Caries Risk Assessment and Quality Assurance. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.11.tb06214.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Susie P. Goolsby
- Department of General Practice and Department of Admissions; School of Dentistry; Virginia Commonwealth University
| | - Douglas A. Young
- Department of Dental Practice; Arthur A. Dugoni School of Dentistry; University of the Pacific
| | - Harmeet K. Chiang
- Department of General Practice; School of Dentistry; Virginia Commonwealth University
| | - Caroline K. Carrico
- Department of Periodontics; School of Dentistry; Virginia Commonwealth University
| | - Leonard V. Jackson
- Department of General Practice and Department of Admissions; School of Dentistry; Virginia Commonwealth University
| | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences; School of Dentistry; University of California; San Francisco
| |
Collapse
|
8
|
Metz MJ, Metz CJ, Durski MT, Aiken SA, Mayfield TG, Lin WS. A Training Program Using an Audience Response System to Calibrate Dental Faculty Members Assessing Student Clinical Competence. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.9.tb06193.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michael J. Metz
- Department of General Dentistry and Oral Medicine; University of Louisville School of Dentistry
| | - Cynthia J. Metz
- Department of Physiology and Biophysics; University of Louisville School of Medicine
| | - Marcelo T. Durski
- Department of General Dentistry and Oral Medicine; University of Louisville School of Dentistry
| | | | - Theresa G. Mayfield
- Department of General Dentistry and Oral Medicine; University of Louisville School of Dentistry
| | - Wei-Shao Lin
- Department of Oral Health and Rehabilitation; University of Louisville School of Dentistry
| |
Collapse
|
9
|
Fontana M, Guzmán-Armstrong S, Schenkel AB, Allen KL, Featherstone J, Goolsby S, Kanjirath P, Kolker J, Martignon S, Pitts N, Schulte A, Slayton RL, Young D, Wolff M. Development of a Core Curriculum Framework in Cariology for U.S. Dental Schools. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.6.tb06133.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | | | - Susie Goolsby
- School of Dentistry; Virginia Commonwealth University
| | | | - Justine Kolker
- College of Dentistry and Dental Clinics; University of Iowa
| | | | | | - Andreas Schulte
- Department for Special Care Dentistry; Dental School; University of Witten/Herdecke; Witten Germany
| | | | - Douglas Young
- Arthur A. Dugoni School of Dentistry; University of the Pacific
| | - Mark Wolff
- College of Dentistry; New York University
| |
Collapse
|