An evaluation of the use of caries risk/susceptibility assessment in an undergraduate dental curriculum

There has been a paradigm shift in patient care with regards to delivering better oral health, towards a team-delivered, person-focused, risk-related model that is known as minimum intervention oral care (MIOC). Student skills should be developed within the undergraduate dental curricula to ensure that graduating dentists and other oral healthcare team members are able to provide phased personalised care plans alongside behavioural management support to patients/caregivers to prevent and manage oral disease in the long term. The purpose of this study is to establish that using an adjunctive caries risk/susceptibility assessment (CRSA) technology (PreViser) had an impact on the behaviour, perception, and knowledge of dental undergraduate students and their clinical teachers, regarding the benefits of such an oral health assessment in the management of patients. Four cohorts of students who did not have exposure to the caries risk susceptibility software were compared with those who did. This study was conducted using a mixed methods approach using a convergent parallel design consisting of collecting quantitative data through questionnaires presented to four cohorts of Year 4 dental students (n = 150 per cohort) and their clinical teachers (n = 10) and qualitative data from structured interviews with students (n = 5) and teachers (n = 7) with suitable statistical analysis and interpretation.

Results

Generally, the items that exhibited statistical significance, when reviewed, showed better behaviour, perception, and knowledge towards CRSA in the Group C (BDS4-22T1) cohort in comparison with the Group A (BDS3-20T2) cohort. The Group D (BDS4-22T2) students felt more confident using the PreViser as a CRSA tool. When comparing the Group C and Group D data, we note that the students from the Group C cohort were more likely to carry out a diet analysis for their patients and were less likely to be negatively impacted by time constraints compared with the Group D students. Both cohorts were equally confident in using the PreViser for CRSA. From a qualitative perspective, although competence and confidence appeared high, the students and teachers acknowledged that they would need more support to use it chairside. The main barrier listed to using PreViser rested in the fact that clinical teachers either preferred their own ways of assessing or did not know how to use the tool and therefore did not encourage using it. Those who did use PreViser highlighted that it was straightforward to use and was a systematic approach, enabling communication with the patients as there is 'evidence' to back up the clinical recommendations.

Conclusion

The cumulative benefit of training and use (even limited) had an impact on the students' knowledge, competence, and confidence regarding CRSA, ultimately facilitating the process of teaching and assisting them in effectively implementing CRSA. The importance of CRSA became more evident immediately following the training. Further research is suggested to understand the factors influencing student behaviour, perception, and knowledge regarding CRSA with the aim to make recommendations on a preferable approach and tool to help streamline CRSA education.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial

PURPOSE

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions.

METHODS

The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12 months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests.

RESULTS

There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month.

CONCLUSION

It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Validation of a Subjective Caries Risk Assessment Tool

OBJECTIVE

The objective was to evaluate the predictive validity of the American Dental Association's caries risk assessment (CRA) tool, adapted with permission, and used by the U.S. Department of Veterans Affairs dental services within their electronic dental record.

METHODS

This analytic epidemiologic study with a retrospective longitudinal design included Veterans who had a minimum of three years of available data. The primary outcome was caries-related treatment during the twelve-month predictive period following the CRA category identification.

RESULTS

The sample included 57,675 Veterans; 50.1% classified as low, 33.2% as moderate and 16.8% as high caries risk. During the twelve-month predictive period, both teeth/person and teeth with caries-related treatment rose sequentially from low to high CRA categories. However, poor sensitivity (0.34-0.58) and better specificity (0.53-0.78) values were observed. Similarly, better negative predictive values (0.72-0.79) compared to positive predictive values (0.28-0.34) were found. Adjusted logistic regression models showed that current treated caries (caries detected at the time of the CRA exam) was more strongly associated with future caries-related treatment than the subjective CRA determination.

CONCLUSIONS

The subjective CRA tool evaluated in this study is better at identifying patients at low risk of requiring future caries-related treatment versus those at higher risk. This makes it difficult to target the most caries susceptible patients with preventive measures. Furthermore, we found that the amount of caries treatment required at the time of the CRA exam had the strongest association with caries-related treatment during the subsequent twelve-month predictive period.

CLINICAL SIGNIFICANCE

The amount of caries-related treatment required at the time of the caries risk classification is the strongest predictor of future caries.

Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis

OBJECTIVES

To assess the predictive performance of caries risk assessment (CRA) models for prediction of caries increment for individuals based on a systematic review and meta-analyses.

DATA/SOURCES

We included external validation studies assessing the predictive performance of CRA models for prediction of caries increment for individuals, using discrimination and calibration as the outcome parameters. PubMed, EMBASE, and CINAHL were searched electronically on 10th September 2020 to identify prediction modeling studies on external validation of CRA models. The risk of bias of the included studies was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST).

STUDY SELECTION

A total of 22 studies with seven different CRA models were included. As for full Cariogram, the pooled area under the receiver operating characteristic curve (AUC) was 0.78 (95 %CI: 0.68; 0.85) based on eight studies regardless of the risk of bias levels, and 0.82 (95 %CI: 0.58; 0.93) based on four studies with low risk of bias only. The pooled observed: expected ratio (O:E ratio) of full Cariogram was 0.91 (95 %CI: 0.72; 1.14) based on 12 studies regardless of the risk of bias levels, and 0.89 (95 %CI: 0.71; 1.12) based on five studies with low risk of bias only. As for reduced Cariogram, the pooled AUC was 0.72 (95 %CI: 0.67; 0.77) based on six studies regardless of the risk of bias levels, and 0.74 (95 %CI: 0.45; 0.91) based on two studies with low risk of bias only. The pooled O:E ratio of reduced Cariogram was 0.84 (95 %CI: 0.59; 1.18) based on six studies regardless of the risk of bias levels, and 1.05 (95 %CI: 0.43; 2.59) based on two studies with low risk of bias only. Based on an insufficient number of studies for the other CRA models, the pooled AUCs ranged from 0.50 to 0.88, while the pooled O:E ratio ranged from 0.38 to 1.00.

CONCLUSION

The average predictive performance of both full and reduced Cariogram seems to be acceptable. However, the evidence from research does not allow a firm conclusion on the performance of the other included CRA models, due to the insufficient number of high-quality studies.

CLINICAL SIGNIFICANCE

Both full and reduced Cariogram were found to be reliable CRA models for prediction of caries increment in clinical practices for dental patients and communities for general populations. The reduced Cariogram showed better predictive performance and less burden in terms of time and resources to individuals than the full Cariogram. Therefore, the reduced Cariogram could be more recommended than the full Cariogram.