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Kang S, Shon B, Park EY, Jeong S, Kim EK. Diagnostic accuracy of dental caries detection using ensemble techniques in deep learning with intraoral camera images. PLoS One 2024; 19:e0310004. [PMID: 39241044 PMCID: PMC11379315 DOI: 10.1371/journal.pone.0310004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 08/22/2024] [Indexed: 09/08/2024] Open
Abstract
Camera image-based deep learning (DL) techniques have achieved promising results in dental caries screening. To apply the intraoral camera image-based DL technique for dental caries detection and assess its diagnostic performance, we employed the ensemble technique in the image classification task. 2,682 intraoral camera images were used as the dataset for image classification according to dental caries presence and caries-lesion localization using DL models such as ResNet-50, Inception-v3, Inception-ResNet-v2, and Faster R-convolutional neural network according to diagnostic study design. 534 participants whose mean age [SD] was 47.67 [±13.94] years were enrolled. The dataset was divided into training (56.0%), validation (14.0%), and test subset (30.0%) annotated by one experienced dentist as a reference standard about dental caries detection and lesion location. The confusion matrix, area under the receiver operating characteristic curve (AUROC), and average precision (AP) were evaluated for performance analysis. In the end-to-end dental caries image classification, the ensemble DL models had consistently improved performance, in which as the best results, the ensemble model of Inception-ResNet-v2 achieved 0.94 of AUROC and 0.97 of AP. On the other hand, the explainable model achieved 0.91 of AUROC and 0.96 of AP after the ensemble application. For dental caries classification using intraoral camera images, the application of ensemble techniques exhibited consistently improved performance regardless of the DL models. Furthermore, the trial to create an explainable DL model based on carious lesion detection yielded favorable results.
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Affiliation(s)
- Sohee Kang
- Department of Dentistry, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Byungeun Shon
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, South Korea
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Eun Young Park
- Department of Dentistry, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Sungmoon Jeong
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, South Korea
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Eun-Kyong Kim
- Department of Dental Hygiene, College of Science and Technology, Kyungpook National University, Sangju, South Korea
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Ashtiani GH, Sabbagh S, Moradi S, Azimi S, Ravaghi V. Diagnostic accuracy of tele-dentistry in screening children for dental caries by community health workers in a lower-middle-income country. Int J Paediatr Dent 2024; 34:567-575. [PMID: 38196024 DOI: 10.1111/ipd.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Tele-dentistry can be useful for dental caries screening of children, especially in lower-middle-income countries (LMICs). AIM To evaluate the diagnostic accuracy of mobile phone photographs taken by a community health worker (CHW) for caries detection in Iran. DESIGN Children aged 6-12 years were visually examined by a paediatric dentist. Following dental examinations, intraoral photographs were taken by a trained CHW. Two remote dentists assessed intraoral photographs for dental caries. Diagnostic accuracy of tele-dentistry for caries detection was evaluated. In addition, the questionnaire about oral health and parents' views towards tele-dentistry was prepared. RESULTS One hundred thirty-one children aged 8.74 ± 1.62 years participated. The caries prevalence was 30% for the whole dentition. Tele-dentistry demonstrated high accuracy, with a sensitivity exceeding 80% and specificity exceeding 90%. The inter-rater reliability for remote dentists' assessments to the gold standard dental examination ranged from substantial to almost perfect (kappa: 75%-93%). Additionally, 80% of parents whose children participated in this study had positive views towards tele-dentistry. CONCLUSION Tele-dentistry was shown to be an alternative approach to clinical examinations for caries detection among school children. Employing non-dental care professionals in tele-dentistry has been emerged as a reliable and cost-effective approach, especially in LMICs.
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Affiliation(s)
- Gelareh Haghi Ashtiani
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sedigheh Sabbagh
- Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Moradi
- Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
| | - Somayyeh Azimi
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Vahid Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
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Muacevic A, Adler JR, Bains R, Singh A, Manar M, Kumar A. The Efficacy of Dental Caries Telediagnosis Using Smartphone: A Diagnostic Study in Geriatric Patients. Cureus 2023; 15:e33256. [PMID: 36741615 PMCID: PMC9891317 DOI: 10.7759/cureus.33256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
Background and aim The major barrier to oral health care for geriatrics is access to dental care. Teledentistry is the field of dentistry that uses telecommunication with digital imaging for the exchange of valid information for diagnosis, treatment, and continuing dental education, enabling some means of approach to oral health care. This study aimed to assess the accuracy of diagnosing dental caries in the older age group by examining intraoral photographs taken by smartphone camera compared with standard clinical dental examination. Methods and material A calibrated dentist examined 18 patients aged 60-75 for six variables: sound tooth, decayed tooth, filled tooth with and without caries, missing tooth, and the presence of prosthesis. Intraoral photographs of each patient were taken using a smartphone. The photographs were then sent to six different examiners through WhatsApp. The accuracy of the diagnosis was measured by applying Cohen's kappa, sensitivity, and specificity. Fleiss' kappa was used to measure the agreement index using the software R (R Foundation for Statistical Computing, Vienna, Austria) version 4.2.1. Results The overall agreement between the tele-examiners and the control was measured, with the kappa scores ranging from 0.897 to 0.921, and the mean kappa score was 0.909. There was high specificity and sensitivity in the value observed. The agreement index, measured through Fleiss' kappa for six teeth conditions, reported the perfect agreement (0.867) among six examiners. Conclusions Under the limitations of the study, teledentistry using a mobile phone has acceptable accuracy for diagnosing caries in the older age group compared to a standard clinical dental examination.
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Near-Infrared Transillumination for Occlusal Carious Lesion Detection: A Retrospective Reliability Study. Diagnostics (Basel) 2022; 13:diagnostics13010036. [PMID: 36611328 PMCID: PMC9818492 DOI: 10.3390/diagnostics13010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to assess the reliability of three diagnostic methods (near-infrared transillumination (NIRT), bitewing radiographs (BW), and clinical images (CI)) to detect occlusal carious lesions in a low caries risk population. This retrospective analysis included one hundred and eighty-eight occlusal surfaces, scored as sound surface, early lesion, or distinct lesion. We evaluated the agreement between and within the methods over time. Kappa statistics tested the correlation between the methods. Examiners detected occlusal early lesions more frequently with visual examination and NIRT and the same lesions were confirmed on the 2-year follow-up. Within the limitations of this study, we were able to establish that early occlusal lesions can be detected and monitored over time using NIRT and visual exam, while BW scores showed mostly sound surfaces at both examinations. NIRT combined with clinical examination can be considered appropriate to detect and monitor early enamel caries on the occlusal surface in low caries-risk populations.
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Chiu S, Lee Y, Liu M, Chen H, Ye H, Liu Y. Evaluation of the marginal adaptation and gingival status of full-crown restorations using an intraoral camera. BMC Oral Health 2022; 22:517. [PMID: 36403015 PMCID: PMC9675266 DOI: 10.1186/s12903-022-02587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to compare the usefulness of intraoral photographs, acquired with a household intraoral camera operating in conventional, calibrated, and polarized modes, with clinical examinations for assessing the marginal adaptation and gingival status of full-crown restorations. Methods Clinical examinations were performed by a prosthodontist who classified the marginal adaptation of full-crown restorations according to FDI World Dental Federation criteria, and a periodontal expert who classified gingival status according to the Modified Gingival Index (MGI). The margins and gingival status of the conventional, calibration, and polarization groups of full-crown restorations were independently assessed by three evaluators who obtained photographs using an intraoral camera. Cases where at least two of three assessors were in agreement were analyzed using Cohen’s kappa coefficient and the chi-square test, and the sensitivity and specificity were calculated. Results The conventional, calibration, and polarization groups differed significantly in marginal and gingival status of full-crown restorations. In the calibration group, there was good agreement between the camera-based and oral clinical examinations in terms of the gingival status of full-crown restorations (kappa = 0.945), with 100% sensitivity and 91.67% specificity; this was also the case in the polarization group with respect to the margins of full-crown restorations (kappa = 0.917, sensitivity = 97.22%, specificity = 94.44%). Conclusions An intraoral camera with black and white calibrated images is useful to assess the gingival status of full-crown restorations. Polarization mode can be used to assess the marginal adaptation of full-crown restorations. The camera is a feasible and valid diagnostic aid.
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Affiliation(s)
- Shuting Chiu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yeh Lee
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Min Liu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Hu Chen
- grid.11135.370000 0001 2256 9319Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Hongqiang Ye
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yunsong Liu
- grid.11135.370000 0001 2256 9319Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081 People’s Republic of China
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Goodwin M, Emsley R, Kelly MP, Sutton M, Tickle M, Walsh T, Whittaker W, Pretty IA. Evaluation of water fluoridation scheme in Cumbria: the CATFISH prospective longitudinal cohort study. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/shmx1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Water fluoridation was introduced in the UK against a background of high dental decay within the population. Levels of decay have dramatically reduced over the last 40 years following widespread use of fluoride toothpaste.
Objective
The aim of the CATFISH (Cumbrian Assessment of Teeth a Fluoride Intervention Study for Health) study was to address the question of whether or not the addition of fluoride to community drinking water, in a contemporary population, lead to a reduction in the number of children with caries and, if so, is this reduction cost-effective?
Design
A longitudinal prospective cohort design was used in two distinct recruited populations: (1) a birth cohort to assess systemic and topical effects of water fluoridation and (2) an older school cohort to assess the topical effects of drinking fluoridated water.
Setting
The study was conducted in Cumbria, UK. Broadly, the intervention group (i.e. individuals receiving fluoridated drinking water) were from the west of Cumbria and the control group were from the east of Cumbria.
Participants
Children who were lifetime residents of Cumbria were recruited. For the birth cohort, children were recruited at birth (2014–15), and followed until age 5 years. For the older school cohort, children were recruited at age 5 years (2013–14) and followed until the age of 11 years.
Intervention
The provision of a ‘reintroduced fluoridated water scheme’.
Main outcome measures
The primary outcome measure was the presence or absence of decay into dentine in the primary teeth (birth cohort) and permanent teeth (older school cohort). The cost per quality-adjusted life-year was also assessed.
Results
In the birth cohort (n = 1444), 17.4% of children in the intervention group had decay into dentine, compared with 21.4% of children in the control group. The evidence, after adjusting for deprivation, age and sex, with an adjusted odds ratio of 0.74 (95% confidence interval 0.56 to 0.98), suggested that water fluoridation was likely to have a modest beneficial effect. There was insufficient evidence of difference in the presence of decay in children in the older school cohort (n = 1192), with 19.1% of children in the intervention group having decay into dentine, compared with 21.9% of children in the control group (adjusted odds ratio 0.80, 95% confidence interval 0.58 to 1.09). The intervention was found to be likely to be cost-effective for both the birth cohort and the older school cohort at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. There was no significant difference in the performance of water fluoridation on caries experience across deprivation quintiles.
Conclusions
The prevalence of caries and the impact of water fluoridation was much smaller than previous studies have reported. The intervention was effective in the birth cohort group; however, the importance of the modest absolute reduction in caries (into dentine) needs to be considered against the use of other dental caries preventative measures. Longer-term follow-up will be required to fully understand the balance of benefits and potential risks (e.g. fluorosis) of water fluoridation in contemporary low-caries populations.
Limitations
The low response rates to the questionnaires reduced their value for generalisations. The observed numbers of children with decay and the postulated differences between the groups were far smaller than anticipated and, consequently, the power of the study was affected (i.e. increasing the uncertainty indicated in the confidence intervals).
Study registration
This study is registered as Integrated Research Application System 131824 and 149278.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michaela Goodwin
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Michael P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Sutton
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - William Whittaker
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Ciardo A, Sonnenschein SK, Simon MM, Ruetters M, Spindler M, Ziegler P, Reccius I, Spies AN, Kykal J, Baumann EM, Fackler S, Büsch C, Kim TS. Remote assessment of DMFT and number of implants with intraoral digital photography in an elderly patient population – a comparative study. PLoS One 2022; 17:e0268360. [PMID: 35580131 PMCID: PMC9113588 DOI: 10.1371/journal.pone.0268360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives
This comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters’ clinical experience influence the agreement.
Methods
Fifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet’s AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated.
Results
Compared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for “Decayed” were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for “Missing” and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for “Filled”. IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet’s AC1 using the mode of the blinded raters’ assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement.
Conclusions
Assessment of “Decayed”, “Missing” and IMPL by IODP showed almost perfect agreement, whereas of “Filled” and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.
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Affiliation(s)
- Antonio Ciardo
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
- * E-mail:
| | - Sarah K. Sonnenschein
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marlinde M. Simon
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Maurice Ruetters
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcia Spindler
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Ziegler
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingvi Reccius
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander-Nicolaus Spies
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Kykal
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Prosthetic Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva-Marie Baumann
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Prosthetic Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Susanne Fackler
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg University Hospital, Heidelberg, Germany
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Thomas N, Kay E, Witton R, Quinn C. Comparison of a full arch digital photographic assessment of caries prevalence in 5-year-old children to an established visual assessment method: a cross-sectional study. BDJ Open 2021; 7:32. [PMID: 34433801 PMCID: PMC8387399 DOI: 10.1038/s41405-021-00087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Digital epidemiology in dental disease screening has a number of advantages which warrant further exploration. Aim This study aimed to test the examination accuracy of digital images to evaluate child oral health by comparing the new method to a gold standard method. It also investigated the levels of diagnostic accuracy between different examiners, including dental care professionals and a lay examiner, when quantifying dental disease using images. Methods A calibrated dental examiner inspected forty 5-year-olds. In addition, three sets of digital images were taken per child. These images were assessed by six examiners. Sensitivity and specificity of caries diagnosis and inter-examiner reliability were calculated to compare the caries scores derived from examination of the images to those of the gold standard examinations. Results The mean values for sensitivity and specificity scores were 48.0% and 99.1%, respectively. The mean value for kappa showed moderate agreement between 0.43 and 0.73 (0.57). Mean values for agreement using intra-class coefficients were excellent (0.78) and good (0.73) for dt and dmft, respectively. No statistical difference in the validity of the caries scores was shown between the different image assessors. Conclusions These data demonstrate the feasibility of using digital images to screen child oral health and for nondental professionals to be recruited to carry out digital epidemiology for the oral health surveillance of children.
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Affiliation(s)
- Nicole Thomas
- Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Elizabeth Kay
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Robert Witton
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Cath Quinn
- Faculty of Health, University of Plymouth, Plymouth, UK
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Duong DL, Kabir MH, Kuo RF. Automated caries detection with smartphone color photography using machine learning. Health Informatics J 2021; 27:14604582211007530. [PMID: 33863251 DOI: 10.1177/14604582211007530] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Untreated caries is significant problem that affected billion people over the world. Therefore, the appropriate method and accuracy of caries detection in clinical decision-making in dental practices as well as in oral epidemiology or caries research, are required urgently. The aim of this study was to introduce a computational algorithm that can automate recognize carious lesions on tooth occlusal surfaces in smartphone images according to International Caries Detection and Assessment System (ICDAS). From a group of extracted teeth, 620 unrestored molars/premolars were photographed using smartphone. The obtained images were evaluated for caries diagnosis with the ICDAS II codes, and were labeled into three classes: "No Surface Change" (NSC); "Visually Non-Cavitated" (VNC); "Cavitated" (C). Then, a two steps detection scheme using Support Vector Machine (SVM) has been proposed: "C versus (VNC + NSC)" classification, and "VNC versus NSC" classification. The accuracy, sensitivity, and specificity of best model were 92.37%, 88.1%, and 96.6% for "C versus (VNC + NSC)," whereas they were 83.33%, 82.2%, and 66.7% for "VNC versus NSC." Although the proposed SVM system required further improvement and verification, with the data only imaged from the smartphone, it performed an auspicious potential for clinical diagnostics with reasonable accuracy and minimal cost.
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Affiliation(s)
| | | | - Rong Fu Kuo
- Department of Biomedical Engineering, National Cheng Kung University.,Medical Device Innovation Center, National Cheng Kung University
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Pentti L, Kämppi A, Kukkola K, Mäkynen A, Kaikkonen V, Bulygin G, Molkoselkä E, Anttonen V, Tanner T. Can health kiosks be used to identify oral health care needs? A pilot study. Acta Odontol Scand 2021; 79:370-376. [PMID: 33378624 DOI: 10.1080/00016357.2020.1867765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the reliability of digital imaging for detecting restorative treatment need among individuals in their 20s by comparing the outcome of digital imaging with clinical caries findings at the patient level. MATERIAL AND METHODS Five intraoral clinical daylight and digital fluorescence images were taken extraorally of 21 patients. A clinical examination was then performed by a trained and calibrated dentist. Additionally, the patients answered a multiple-choice questionnaire about their health habits. The images were analysed and caries findings were recorded. For statistical analysis, sensitivity and specificity were calculated. Results were shown as ROC curves and AUC values. All analyses were done using SPSS (version 24.0, Chicago, IL). RESULTS Caries lesions were most often detected in molars and least often in canines. When using the clinical status as gold standard, digital imaging gave an AUC value of 0.617, whereas the outcome by questionnaire gave an AUC value of 0.719. When using the combined outcome of digital imaging and the questionnaire, the AUC value was 0.694 with clinical validation. CONCLUSIONS It can be concluded that health kiosks may help to reduce the number of patients waiting for dental treatment; more specifically, the questionnaire with individual feedback may provide a new instrument for providing instructions for homecare online. However, the camera system must be developed further, and dentists and dental hygienists require training to analyse the images.
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Affiliation(s)
- Laura Pentti
- Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, Oulu, Finland
| | - Antti Kämppi
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Katri Kukkola
- Optoelectronics and Measurement Techniques Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Anssi Mäkynen
- Optoelectronics and Measurement Techniques Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Ville Kaikkonen
- Optoelectronics and Measurement Techniques Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Gleb Bulygin
- Optoelectronics and Measurement Techniques Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Eero Molkoselkä
- Optoelectronics and Measurement Techniques Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tarja Tanner
- Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Paediatric Dentistry, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
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11
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Duong DL, Nguyen QDN, Tong MS, Vu MT, Lim JD, Kuo RF. Proof-of-Concept Study on an Automatic Computational System in Detecting and Classifying Occlusal Caries Lesions from Smartphone Color Images of Unrestored Extracted Teeth. Diagnostics (Basel) 2021; 11:diagnostics11071136. [PMID: 34206549 PMCID: PMC8307588 DOI: 10.3390/diagnostics11071136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Dental caries has been considered the heaviest worldwide oral health burden affecting a significant proportion of the population. To prevent dental caries, an appropriate and accurate early detection method is demanded. This proof-of-concept study aims to develop a two-stage computational system that can detect early occlusal caries from smartphone color images of unrestored extracted teeth according to modified International Caries Detection and Assessment System (ICDAS) criteria (3 classes: Code 0; Code 1-2; Code 3-6): in the first stage, carious lesion areas were identified and extracted from sound tooth regions. Then, five characteristic features of these areas were intendedly selected and calculated to be inputted into the classification stage, where five classifiers (Support Vector Machine, Random Forests, K-Nearest Neighbors, Gradient Boosted Tree, Logistic Regression) were evaluated to determine the best one among them. On a set of 587 smartphone images of extracted teeth, our system achieved accuracy, sensitivity, and specificity that were 87.39%, 89.88%, and 68.86% in the detection stage when compared to modified visual and image-based ICDAS criteria. For the classification stage, the Support Vector Machine model was recorded as the best model with accuracy, sensitivity, and specificity at 88.76%, 92.31%, and 85.21%. As the first step in developing the technology, our present findings confirm the feasibility of using smartphone color images to employ Artificial Intelligence algorithms in caries detection. To improve the performance of the proposed system, there is a need for further development in both in vitro and in vivo modeling. Besides that, an applicable system for accurately taking intra-oral images that can capture entire dental arches including the occlusal surfaces of premolars and molars also needs to be developed.
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Affiliation(s)
- Duc Long Duong
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
- Correspondence: ; Tel.: +886-968-685-225 or +84-935-759-669
| | - Quoc Duy Nam Nguyen
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
| | - Minh Son Tong
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
| | - Manh Tuan Vu
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
| | - Joseph Dy Lim
- Center of Dentistry, COAHS, University of Makati, J.P. Rizal Ext, Makati, Metro Manila 1215, Philippines;
| | - Rong Fu Kuo
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
- Medical Device Innovation Center, National Cheng Kung University, Shengli Rd, Tainan 704, Taiwan
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12
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Zhang X, Liang Y, Li W, Liu C, Gu D, Sun W, Miao L. Development and evaluation of deep learning for screening dental caries from oral photographs. Oral Dis 2020; 28:173-181. [PMID: 33244805 DOI: 10.1111/odi.13735] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Xuan Zhang
- Department of Periodontology Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Yuan Liang
- University of California Los Angeles CA USA
| | - Wen Li
- Department of Endodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Chao Liu
- Department of Orthodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Deao Gu
- Department of Orthodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Weibin Sun
- Department of Periodontology Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Leiying Miao
- Department of Endodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
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13
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Katsouda M, Coolidge T, Simos G, Kotsanos N, Arapostathis KN. Factors associated with gagging during radiographic and intraoral photographic examinations in 4-12-year-old children. Eur Arch Paediatr Dent 2020; 22:129-137. [PMID: 32440854 DOI: 10.1007/s40368-020-00535-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 05/03/2020] [Indexed: 11/25/2022]
Abstract
AIMS No studies are available in paediatric samples evaluating gagging during toothbrushing, radiographic and/or intraoral photographic examinations. The aims were to collectively examine potential factors associated with gagging during radiographs and intraoral photographs in 4-12-year-old children. METHODS Parents/guardians of 395 children (aged 4-12 years old) completed questionnaires asking about their children's toothbrushing habits. Children completed Greek versions of the Gagging Assessment Scale (GAS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), while the dentist used the shorter version of the Gagging Problem Assessment (GPA-de-c/SF) to objectively assess gagging. X-ray and Photo Rating Scales were created to evaluate gagging during X-rays and photographs, respectively. Multivariate logistic regression was used to examine the relationship between the potential factors and gagging. RESULTS 59 of 275 patients (21%) and 56 of 276 patients (20%) who needed X-rays and intraoral photographs, respectively, gagged. Children who gagged during X-rays had significantly higher GAS scores (p = 0.007). Boys, younger children, and those who gagged on GPA-de-c/SF were more likely to gag during X-rays, and children who gagged on GPA-de-c/SF were more likely to gag during photographs. Brushing habits were not related to dental fear or gagging. CONCLUSION Of the variables which we studied, GPA-de-c/SF most strongly affected the odds of gagging during taking radiographs and/or intraoral photographs.
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Affiliation(s)
- M Katsouda
- Department of Paediatric Dentistry, Dental School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - T Coolidge
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - G Simos
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - N Kotsanos
- Department of Paediatric Dentistry, Dental School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - K N Arapostathis
- Department of Paediatric Dentistry, Dental School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
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14
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Zhang W, Mulder J, Frencken JE. Is preventing micro-cavities in dentine from progressing with a sealant successful? Br Dent J 2019; 226:590-594. [PMID: 31028327 DOI: 10.1038/s41415-019-0195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim The hypothesis was tested that dentine carious lesion progression is higher in sealed micro-cavitated pits and fissures than in sealed pits and fissures having no or enamel carious lesions at baseline over a period of four years.Results Epidemiological survey identified no enamel carious lesions (code 0), enamel carious lesions (code 1), and micro-cavitated dentine carious lesions (code 2), in pits/fissures of occlusal surfaces of first permanent molars at baseline. Using block randomisation, 405 children (mean age of eight years) were allocated to high-viscosity glass-ionomer, atraumatic restorative treatment method (HVGIC/ART), thermo-cured HVGIC/ART, glass-carbomer, and resin composite groups, receiving 1,344 sealants. Evaluation was performed after six months and annually. Carious lesion progression for baseline code 0 (n = 784) and code 1 (n = 481) was determined by scoring code 2, and that for baseline code 2 (n = 79) by scoring code 3 or 4 (frank cavitation). Tests were performed using a proportional hazard model with frailty correction.Discussion and conclusion There was neither an effect for sealant group nor between baseline codes 0 and 1. A total of 19 baseline code 0, and 20 code 1 developed a cavitated dentine carious lesion; while 5% of the sealed over micro-cavitated dentine carious lesions developed frank cavitation. The progression of carious lesions in the group baseline code (0 + 1) was not statistically significantly different from the group of baseline code 2 (p = 0.29). Progression of micro-cavities sealed over with HVGIC according to the ART method, a glass-carbomer or a resin composite over a period of four years is low. Dentine lesions with a small orifice (Ø <0.5 mm) in pits/fissures of occlusal surfaces in permanent molars have a high chance of surviving four years if they are sealed over.
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Affiliation(s)
- WeiWei Zhang
- Preventive Department, Key Laboratory for Oral Biomedical Engineering, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, China
| | - Jan Mulder
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jo E Frencken
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Hogan R, Goodwin M, Boothman N, Iafolla T, Pretty IA. Further opportunities for digital imaging in dental epidemiology. J Dent 2019; 74 Suppl 1:S2-S9. [PMID: 29929584 DOI: 10.1016/j.jdent.2018.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022] Open
Abstract
Dental epidemiological research permits accurate tracking of the prevalence and distribution of oral disease across population groups, enabling planning and evaluation of public health interventions and healthcare service provision. This first section of this paper aimed to review traditional assessment methods in dental epidemiology and to consider the methodological and logistical benefits provided by digital imaging, both generally and specifically in relation to an established dual-camera system. The remainder of this paper describes the results of a semi-structured examination of an image archive from previous research utilising a dual-camera system, exploring whether the diagnostic yield of the images might be increased. Common oral conditions are presented alongside suggestions of the diagnostically useful data displayed in example images. Possible scoring mechanisms are discussed with consideration of the limitations that might be encountered for each condition. The retrospective examination suggests further data is obtainable from images acquired using the dual-camera system, however, consideration should be given to how best to validate this clinically. Additionally, other imaging modalities are discussed whilst taking into account the potential limitations of the dual-camera system.
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Affiliation(s)
- Richard Hogan
- Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK.
| | - Michaela Goodwin
- Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
| | - Nicola Boothman
- Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
| | - Timothy Iafolla
- National Institute of Dental and Craniofacial Research, 31 Center Drive, Suite 5B55, Bethesda, MD 20892-2190, USA
| | - Iain A Pretty
- Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
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16
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Carvalho RND, Letieri ADS, Vieira TI, Santos TMPD, Lopes RT, Neves ADA, Pomarico L. Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces. Braz Oral Res 2018; 32:e60. [PMID: 29995065 DOI: 10.1590/1807-3107bor-2018.vol32.0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.
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Affiliation(s)
- Raquel Nogueira de Carvalho
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Aline Dos Santos Letieri
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Thiago Isidro Vieira
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Thais Maria Pires Dos Santos
- Universidade Federal do Rio de Janeiro - UFRJ, Laboratory for Nuclear Instrumentation, Rio de Janeiro, RJ, Brazil
| | - Ricardo Tadeu Lopes
- Universidade Federal do Rio de Janeiro - UFRJ, Laboratory for Nuclear Instrumentation, Rio de Janeiro, RJ, Brazil
| | - Aline de Almeida Neves
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Luciana Pomarico
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
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17
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Signori C, Collares K, Cumerlato CB, Correa MB, Opdam NJ, Cenci MS. Validation of assessment of intraoral digital photography for evaluation of dental restorations in clinical research. J Dent 2018; 71:54-60. [DOI: 10.1016/j.jdent.2018.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 12/01/2022] Open
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18
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Validation of fluorescence devices for evaluation of white spot lesions in orthodontic patients. Eur Arch Paediatr Dent 2018. [DOI: 10.1007/s40368-018-0327-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Bottenberg P, Jacquet W, Behrens C, Stachniss V, Jablonski-Momeni A. Comparison of occlusal caries detection using the ICDAS criteria on extracted teeth or their photographs. BMC Oral Health 2016; 16:93. [PMID: 27604238 PMCID: PMC5015202 DOI: 10.1186/s12903-016-0291-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Using photographs of occlusal surfaces instead of extracted teeth for the detection of caries can be useful in multicenter studies or education. Using a panel of observers, ICDAS scores on teeth or photographs were evaluated against the histological gold standard. The hypothesis was that both outcomes were equivalent. METHODS Four examiners with different experience in ICDAS scored photographs of occlusal surfaces of 100 extracted teeth on a monitor using ICDAS criteria. Two of the examiners had previously scored extracted teeth prior to photography. Digital images of histological sections of the teeth were observed by all examiners and consensus scores were given for each investigation site (gold standard). Kappa statistics and Spearman correlation coefficients as well as repeated measure ANOVA were performed. ROC curves were constructed for each examiner and the areas under the ROC-curves (AUC) of both scoring techniques (extracted teeth, digital images) were compared (α = 0.05). RESULTS Intra- and inter-rater kappa for ICDAS on teeth were 0.81-0.94 and on photographs 0.54-0.88, respectively. Correlation with histology was 0.58- 0.61 for the teeth and 0.50-0.62 for the photographs. AUC of ICDAS scores of extracted teeth (mean 0.89) were slightly higher than those for photographs (mean 0.84). However, both AUC values were not statistically significant (p = 0.38). CONCLUSION Using photographs to assess occlusal surfaces with the ICDAS criteria was not statistically different from scoring the extracted teeth.
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Affiliation(s)
- P. Bottenberg
- Department of Oral Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - W. Jacquet
- Department of Oral Health Sciences, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
- Depatment of Educational Sciences EDWE-LOCI, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Ixelles, Brussels, Belgium
| | - C. Behrens
- Dental School, Department of Pediatric and Community Dentistry, Philipps University of Marburg, Marburg, Germany
| | - V. Stachniss
- Dental School, Department of Restorative Dentistry, Philipps University of Marburg, Georg-Voigt-Straße 3, D-35039 Marburg, Germany
| | - A. Jablonski-Momeni
- Dental School, Department of Pediatric and Community Dentistry, Philipps University of Marburg, Marburg, Germany
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Estai M, Bunt S, Kanagasingam Y, Kruger E, Tennant M. Diagnostic accuracy of teledentistry in the detection of dental caries: a systematic review. J Evid Based Dent Pract 2016; 16:161-172. [DOI: 10.1016/j.jebdp.2016.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/29/2016] [Indexed: 01/17/2023]
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21
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Goodwin M, Emsley R, Kelly M, Rooney E, Sutton M, Tickle M, Wagstaff R, Walsh T, Whittaker W, Pretty IA. The CATFISH study protocol: an evaluation of a water fluoridation scheme. BMC Oral Health 2016; 16:8. [PMID: 26831505 PMCID: PMC4736087 DOI: 10.1186/s12903-016-0169-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
Background Tooth decay is the commonest disease of childhood. We have known for over 90 years that fluoride can prevent tooth decay; it is present in nearly all toothpastes and can be provided in mouthwashes, gels and varnishes. The oldest method of applying fluoride is via the water supply at a concentration of 1 part per million. The two most important reviews of water fluoridation in the United Kingdom (the York Review and MRC Report on water fluoridation and health) concluded that whilst there was evidence to suggest water fluoridation provided a benefit in caries reduction, there was a need to improve the evidence base in several areas. Methods/Design This study will use a natural experiment to assess the incidence of caries in two geographical areas, one in which the water supply is returned to being fluoridated following a discontinuation of fluoridation and one that continues to have a non-fluoridated water supply. The oral health of two discrete study populations will be evaluated - those born 9 months after the water fluoridation was introduced, and those who were in their 1st year of school after the introduction of fluoridated water. Both populations will be followed prospectively for 5 years using a census approach in the exposed group along with matched numbers recruitment in a non-exposed control. Parents of the younger cohort will complete questionnaires every 6 months with child clinical examination at ages 3 and 5, whilst the older cohort will have clinical examinations only, at approximately 5, 7 and 11 years old. Discussion This project provides a unique opportunity to conduct a high quality evaluation of the reintroduction of a water fluoridation scheme, which satisfies the inclusion criteria stipulated by the York systematic review and can address the design issues identified in the MRC report. The research will make a major contribution to the understanding of the costs and effects of water fluoridation in the UK in the 21st Century. Its findings will help inform UK policy on this important public health intervention and may have a significant impact on public health policy in other developed countries. There is currently true equipoise in relation to the effectiveness of water fluoridation in contemporary populations and while the biological plausibility is well established, there is a need to examine impact on the changing epidemiological status of dental decay.
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Affiliation(s)
- Michaela Goodwin
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Michael Kelly
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 OSR, UK.
| | - Eric Rooney
- Dental Observatory, NHS Central Lancashire, Preston Business Centre, Watling Street Road, Fulwood, PR2 8DY, UK.
| | - Matthew Sutton
- Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Martin Tickle
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | - Rebecca Wagstaff
- Public Health England, North West, 1st Floor, York House, Ackhurst Business Park, Foxhole Road, Chorley, PR7 1NY, UK.
| | - Tanya Walsh
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | | | - Iain A Pretty
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
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22
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Detection and monitoring of early caries lesions: a review. Eur Arch Paediatr Dent 2015; 17:13-25. [PMID: 26514842 DOI: 10.1007/s40368-015-0208-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
Abstract
AIM To review the current evidence base of detecting and monitoring early carious lesions in children and adolescents and a rationale proposed to ensure that such lesions are identified and appropriately managed. METHODS The systematic literature search identified initially a review by Gomez and co-workers from 2013 and this still represents the current state of the science in relation to caries detection and monitoring. The review described among others, visible detection systems, image-based detection systems and point-measurement approaches. RESULTS The current evidence base suggests that while there are numerous devices or technology-enabled detection systems, the use of a careful, methodical visual inspection of clean, dry teeth, supplemented where indicated by radiographic views, remains the standard of care in caries detection and diagnostics. Further, it is possible by means of existing visible and radiographical systems to monitor lesions over time. Using low-cost intra-oral cameras facilitates the recording of lesion appearance in the patient record and may be of significant benefit in monitoring early lesions over time following their detection. This benefit extends to the clinician and the patient for whom it may be a useful educational and motivational tool. CONCLUSIONS Recommendations are presented that can be adopted and adapted to local circumstances and that are both substantiated by evidence and promote a clear, simple and consistent approach to caries detection, diagnosis and monitoring in children and adolescents. The diagnoses (initial, active; moderate, active and extensive, active) are linked to appropriate management options within primary care.
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23
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Inês Meurer M, Caffery LJ, Bradford NK, Smith AC. Accuracy of dental images for the diagnosis of dental caries and enamel defects in children and adolescents: A systematic review. J Telemed Telecare 2015; 21:449-58. [DOI: 10.1177/1357633x15605225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/19/2015] [Indexed: 11/15/2022]
Abstract
Aim The aim of this review was to determine if photographic examination and subsequent image analysis provides comparable accuracy to visual inspection for the diagnosis of common dental conditions in children and adolescents. Methods We searched the PubMed database for studies that compared diagnostic accuracy of the two inspection techniques. Studies were screened for inclusion and were assessed for quality and risk of bias using the quality assessment of diagnostic accuracy studies tools. Findings were reported according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Findings Sixteen studies met the inclusion criteria. Nine of the included studies evaluated dental caries and eight evaluated enamel defects (one study evaluated both conditions). Conclusions Three studies found image analysis to be superior. For the remaining six studies the diagnostic accuracy was comparable. For enamel defects, three studies found image analysis to be superior, two found visual inspection to be superior and three studies reported comparable diagnostic accuracy. Most studies have found at least comparable results between photographic and visual inspection techniques. However, the wide variation in equipment and personnel used for the collection and interpretation of photographic images made it impossible to generalise the results. It remains unclear exactly how effective store-and-forward teledentistry is for the diagnosis of common dental conditions in children.
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Affiliation(s)
- Maria Inês Meurer
- Centre for Online Health, The University of Queensland, Australia
- Department of Pathology, Federal University of Santa Catarina, Brazil
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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Pinto GDS, Goettems ML, Brancher LC, da Silva FB, Boeira GF, Correa MB, dos Santos IDS, Torriani DD, Demarco FF. Validation of the digital photographic assessment to diagnose traumatic dental injuries. Dent Traumatol 2015; 32:37-42. [DOI: 10.1111/edt.12204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Marília Leão Goettems
- Post-Graduate Program in Dentistry; Federal University of Pelotas; Pelotas Brazil
- Post-Graduate Program in Health and Behavior; Catholic University of Pelotas; Pelotas Brazil
| | | | | | | | - Marcos Britto Correa
- Post-Graduate Program in Dentistry; Federal University of Pelotas; Pelotas Brazil
- Post-Graduate Program in Epidemiology; Federal University of Pelotas; Pelotas Brazil
| | | | - Dione Dias Torriani
- Post-Graduate Program in Dentistry; Federal University of Pelotas; Pelotas Brazil
| | - Flávio Fernando Demarco
- Post-Graduate Program in Dentistry; Federal University of Pelotas; Pelotas Brazil
- Post-Graduate Program in Epidemiology; Federal University of Pelotas; Pelotas Brazil
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Hu X, Fan M, Rong W, Lo ECM, Bronkhorst E, Frencken JE. Sealant retention is better assessed through colour photographs than through the replica and the visual examination methods. Eur J Oral Sci 2014; 122:279-85. [PMID: 24965565 DOI: 10.1111/eos.12138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to test the hypothesis that the colour photograph method has a higher level of validity for assessing sealant retention than the visual clinical examination and replica methods. Sealed molars were assessed by two evaluators. The scores for the three methods were compared against consensus scores derived through assessing retention from scanning electron microscopy images (reference standard). The presence/absence (survival) of retained sealants on occlusal surfaces was determined according to the traditional and modified categorizations of retention. Sensitivity, specificity, and Youden-index scores were calculated. Sealant retention assessment scores for visual clinical examinations and for colour photographs were compared with those of the reference standard on 95 surfaces, and sealant retention assessment scores for replicas were compared with those of the reference standard on 33 surfaces. The highest mean Youden-index score for the presence/absence of sealant material was observed for the colour photograph method, followed by that for the replica method; the visual clinical examination method scored lowest. The mean Youden-index score for the survival of retained sealants was highest for the colour photograph method for both the traditional (0.882) and the modified (0.768) categories of sealant retention, whilst the visual clinical examination method had the lowest Youden-index score for these categories (0.745 and 0.063, respectively). The colour photograph method had a higher validity than the replica and the visual examination methods for assessing sealant retention.
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Affiliation(s)
- Xuan Hu
- Key Laboratory for Oral Biomedical Engineering of the Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Hu X, Chen X, Ye L, Fan MW, Huysmans MC, Frencken JE. Comparison between visual clinical examination and the replica method for assessments of sealant retention over a 2-year period. Int J Oral Sci 2014; 6:111-5. [PMID: 24625469 PMCID: PMC5130059 DOI: 10.1038/ijos.2014.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 11/09/2022] Open
Abstract
To compare the levels of agreement and the survival rates of sealant retention for different sealing materials over a 2-year period assessed using the visual clinical examination and replica methods, sealant retention data were obtained by visual clinical examination and from replicas of the same sealed tooth at baseline and at 0.5-, 1- and 2-year evaluation points in 407 children and were compared for agreement using kappa coefficients. Survival curves of retained sealants on occlusal surfaces were created using modified categorisation (fully retained sealants and those having all pits and fissures partly covered with the sealant material versus completely lost sealants that included pit and fissure systems that had ≥1 pit re-exposed) according to the Kaplan-Meier method. The kappa coefficient for the agreement between both assessment methods over the three evaluation time points combined was 0.38 (95% confidence interval (CI): 0.35-0.41). More sealant retention was observed from replicas than through visual clinical examination. Cumulative survival curves at the three evaluation times were not statistically significantly higher when assessed from replicas (P=0.47). Using the replica method, more retained sealant material was observed than through visual clinical examination during the 2-year period. This finding did not result in a difference in the survival rates of sealants assessed by the two assessment methods. When replicas cast in die stone are used for assessing sealant retention, the level of reliability of the data is higher than that of data obtained through the commonly used visual clinical examination, particularly if such assessments are conducted over time.
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Affiliation(s)
- Xuan Hu
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xi Chen
- Department of Preventive Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lu Ye
- Private Practitioner, Guangzhou, China
| | - Ming-Wen Fan
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Marie-Charlotte Huysmans
- Department of Preventive and Restorative Dentistry, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jo E Frencken
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Boye U, Willasey A, Walsh T, Tickle M, Pretty IA. Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children. Community Dent Oral Epidemiol 2013; 41:526-33. [DOI: 10.1111/cdoe.12049] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Uriana Boye
- The Oral Health Unit; School of Dentistry; University of Manchester; Manchester Academic Health Sciences Centre; Manchester UK
| | | | - Tanya Walsh
- The Cochrane Oral Health Group; University of Manchester; Manchester Academic Health Sciences Centre; Manchester UK
| | - Martin Tickle
- The Oral Health Unit; School of Dentistry; University of Manchester; Manchester Academic Health Sciences Centre; Manchester UK
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Boye U, Pretty IA, Tickle M, Walsh T. Comparison of caries detection methods using varying numbers of intra-oral digital photographs with visual examination for epidemiology in children. BMC Oral Health 2013; 13:6. [PMID: 23312001 PMCID: PMC3549278 DOI: 10.1186/1472-6831-13-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/27/2012] [Indexed: 11/16/2022] Open
Abstract
Background This was a method comparison study. The aim of study was to compare caries information obtained from a full mouth visual examination using the method developed by the British Association for the Study of Community Dentistry (BASCD) for epidemiological surveys with caries data obtained from eight, six and four intra-oral digital photographs of index teeth in two groups of children aged 5 years and 10/11 years. Methods Five trained and calibrated examiners visually examined the whole mouth of 240 5-year-olds and 250 10-/11-year-olds using the BASCD method. The children also had intra-oral digital photographs taken of index teeth. The same 5 examiners assessed the intra-oral digital photographs (in groups of 8, 6 and 4 intra-oral photographs) for caries using the BASCD criteria; dmft/DMFT were used to compute Weighted Kappa Statistic as a measure of intra-examiner reliability and intra-class correlation coefficients as a measure of inter-examiner reliability for each method. A method comparison analysis was performed to determine the 95% limits of agreement for all five examiners, comparing the visual examination method with the photographic assessment method using 8, 6 and 4 intra-oral photographs. Results The intra-rater reliability for the visual examinations ranged from 0.81 to 0.94 in the 5-year-olds and 0.90 to 0.97 in the 10-/11-year-olds. Those for the photographic assessments in the 5-year-olds were for 8 intra-oral photographs, 0.86 to 0.94, for 6 intra-oral photographs, 0.85 to 0.98 and for 4 intra-oral photographs, 0.80 to 0.96; for the 10-/11-year-olds were for 8 intra-oral photographs 0.84 to 1.00, for 6 intra-oral photographs 0.82 to 1.00 and for 4 intra-oral photographs 0.72 to 0.98. The 95% limits of agreement were −1.997 to 1.967, -2.375 to 2.735 and −2.250 to 2.921 respectively for the 5-year-olds and −2.614 to 2.027, -2.179 to 3.887 and −2.594 to 2.163 respectively for the 10-/11-year-olds. Conclusions The photographic assessment method, particularly assessment of 8 intra-oral digital photographs is comparable to the visual examination method in the primary dentition. With the additional benefits of archiving, remote scoring, allowing multiple scorers to score images and enabling longitudinal analysis, the photographic assessment method may be used as an alternative caries detection method in the primary dentition in situations where the visual examination method may not be applicable such as when examiner blinding is required and in practice based randomised controlled trials (RCTs).
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Affiliation(s)
- Uriana Boye
- The Oral Health Unit, School of Dentistry, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
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