RESUMO
OBJECTIVE: To assess the impact of patient risk status on Colombian dentists' caries related treatment decisions for early to intermediate caries lesions (ICDAS code 2 to 4). METHODS: A web-based questionnaire assessed dentists' views on the management of early/intermediate lesions. The questionnaire included questions on demographic characteristics, five clinical scenarios with randomised levels of caries risk, and two questions on different clinical and radiographic sets of images with different thresholds of caries. RESULTS: Questionnaires were completed by 439 dentists. For the two scenarios describing occlusal lesions ICDAS code 2, dentists chose to provide a preventive option in 63% and 60% of the cases. For the approximal lesion ICDAS code 2, 81% of the dentists chose to restore. The main findings of the binary logistic regression analysis for the clinical scenarios suggest that for the ICDAS code 2 occlusal lesions, the odds of a high caries risk patient having restorations is higher than for a low caries risk patient. For the questions describing different clinical thresholds of caries, most dentists would restore at ICDAS code 2 (55%) and for the question showing different radiographic thresholds images, 65% of dentists would intervene operatively at the inner half of enamel. No significant differences with respect to risk were found for these questions with the logistic regression. CONCLUSION: The results of this study indicate that Colombian dentists have not yet fully adopted non-invasive treatment for early caries lesions.
Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Cárie Dentária/terapia , Odontólogos/psicologia , Cariostáticos/uso terapêutico , Colômbia , Resinas Compostas/química , Estudos Transversais , Amálgama Dentário/química , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Esmalte Dentário/patologia , Restauração Dentária Permanente/métodos , Dentina/patologia , Feminino , Fluoretos Tópicos/uso terapêutico , Seguimentos , Odontologia Geral , Humanos , Masculino , Higiene Bucal/educação , Fotografia Dentária , Selantes de Fossas e Fissuras/uso terapêutico , Radiografia , Medição de Risco , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To compare the efficacy of a new dentifrice containing 1.5% arginine and 1450 ppm fluoride to a positive control dentifrice containing 1450 ppm fluoride alone in arresting and reversing primary root caries lesions in adults. STUDY DESIGN: A total of 3779 subjects from Piracicaba, Säo Paulo, Brazil were screened; 284 had at least one leathery primary root caries lesion and were eligible for the study. The new dentifrice contained 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate; the matched positive control dentifrice contained 1450 ppm fluoride. One lesion for each subject was selected for inclusion in the study and was examined at baseline, 3 and 6 months. RESULTS: A total of 253 subjects completed the study with 129 of 144 subjects included in the final statistical analysis for the test dentifrice and 124 of 140 for the positive control. The mean age of subjects was 45.7 (±9.19) years and 56.5% were female. After 6 months product use, 70.5% of root caries lesions improved for subjects using the arginine-containing dentifrice compared to 58.1% for subjects using the positive control. The difference in the number of root caries lesions becoming hard in the two groups was statistically significant (p=0.038). CONCLUSION: A new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, provided statistically significantly superior efficacy in arresting and reversing active root caries lesions in adults compared to a matched positive control dentifrice containing fluoride alone.
Assuntos
Arginina/uso terapêutico , Carbonato de Cálcio/uso terapêutico , Cariostáticos/uso terapêutico , Dentifrícios/uso terapêutico , Fluoretos/uso terapêutico , Fosfatos/uso terapêutico , Cárie Radicular/prevenção & controle , Adulto , Idoso , Esmalte Dentário/efeitos dos fármacos , Esmalte Dentário/patologia , Índice de Placa Dentária , Feminino , Seguimentos , Gengiva/patologia , Dureza , Humanos , Masculino , Pessoa de Meia-Idade , Cárie Radicular/patologia , Remineralização Dentária/métodos , Resultado do TratamentoRESUMO
The aims of this in vitro study were to compare the combination of FOTI and visual inspection to other diagnostic methods for the detection and evaluation of the depth of occlusal caries and assess the effect of stain on diagnostic performance. Five diagnostic methods (combined FOTI/Visual (CFV), Visual, FOTI, DIAGNOdent and Electrical Caries Monitor) were considered. Histological validation was performed in the 152 occlusal molar sites (111 teeth) using 350-microm sections and a stereomicroscope. The rank correlation coefficients with histology ranged from 0.42 (DIAGNOdent) to 0.66 (CFV). The area under the ROC curves (AUC) for enamel lesions ranged from 0.82 (ECM) to 0.88 (CFV) and from 0.81 (DIAGNOdent) to 0.91 (CFV) for dentine lesions. The AUC at the dentine level for CFV and FOTI were similar (p > 0.05), but the AUC for CFV was significantly greater than for visual (p < 0.001), DIAGNOdent (p = 0.005) and the ECM (p = 0.04). FOTI was found to be particularly useful for the detection of dentine lesions. The exclusion of stain and brown spot lesions improved performance for all methods. It is concluded that CFV is useful for the determination of occlusal lesion depth and that in the presence of stain and brown spot lesions different cut-off points may be required for the ECM and DIAGNOdent to identify dentine lesions.
Assuntos
Cárie Dentária/diagnóstico , Área Sob a Curva , Testes de Atividade de Cárie Dentária , Esmalte Dentário/patologia , Dentina/patologia , Impedância Elétrica , Eletrodiagnóstico , Tecnologia de Fibra Óptica , Fluorescência , Humanos , Variações Dependentes do Observador , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Descoloração de Dente/diagnósticoRESUMO
The aim of this study was to compare the performance of fibre-optic transillumination (FOTI), visual inspection and bite-wing radiographs to detect occlusal caries and estimate the lesion depth. Fifty-nine extracted molars were assessed using FOTI and visual examination by 4 trained examiners and 1 examiner evaluated the bite-wing radiographs. Histological validation was performed using 250-microm sections examined with a stereomicroscope. For the three methods, the correlation between the lesion depth and the histological scores varied from 0.65 to 0.73. For dentinal caries detection, the areas under ROC curves ranged from 0.83 to 0.87. The radiographic method was poor at detecting lesions confined to enamel. FOTI, visual inspection and radiographs showed a good correlation with the histology but had difficulty in distinguishing lesions located deep in enamel or in the outer third of dentine. FOTI was shown to be as accurate as a detailed visual inspection in detecting occlusal caries.
Assuntos
Cárie Dentária/diagnóstico , Radiografia Interproximal , Transiluminação , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Dentina/diagnóstico por imagem , Dentina/patologia , Tecnologia de Fibra Óptica , Humanos , Microtomia , Dente Molar/diagnóstico por imagem , Dente Molar/patologia , Variações Dependentes do Observador , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
The aims of this study were, to record developmental enamel in three areas of Brazil with a range of fluoride concentrations in their drinking water and to consider the association between clinical and photographic methods of recording enamel defects. A total of 457 subjects were examined from areas with less than 0.01, 0.7 and 2-3 ppm F in their drinking water. From the photographs, the prevalences of subjects with TF scores of one or more for the upper permanent central incisors were 7 per cent, 52 per cent and 92 per cent respectively for the three areas. The prevalence of demarcated opacities decreased with increasing fluoride levels in the drinking water (p < 0.008). There was substantial agreement between the Thylstrup Fejerskov (TF) scores using clinical and photographic methods (kappa = 0.63). However, prevalences of TF scores of one or more were higher using the photographic (44.9 percent) than clinical (41.4 percent) method (p < 0.01). The results of this study were compared with one undertaken in the United Kingdom and Ireland which also used the same photographic method. Although the prevalences of TF scores of one or more were similar in the areas with near 'optimal' levels of fluoride in the drinking water, in the groups with levels of fluoride less than 0.1 ppm the prevalence of subjects with TF scores of one or more was higher in the United Kingdom population than in Brazil. This study demonstrates the utility of photographic methods of collecting information on enamel opacities over a wide range of fluoride exposure. Results suggest that for the groups from areas with low levels of fluoride in the drinking water the overall fluoride exposure of the UK children was greater than the Brazilian.
Assuntos
Esmalte Dentário/anormalidades , Fatores Etários , Brasil , Criança , Esmalte Dentário/patologia , Fluoretos/análise , Humanos , Incisivo/anormalidades , Irlanda , Fotografação , Prevalência , Reprodutibilidade dos Testes , Calcificação de Dente , Reino Unido , Abastecimento de Água/análiseRESUMO
Los objetivos de este estudio fueron los de registrar los defectos de desarrollo del esmalte en tres áreas de Brasil con diferentes concentraciones de fluoruros en el agua de bebida y considerar la asociación entre los métodos clínicos y fotográficos en el registro de defectos del esmalte. Se examinó un total de 457 individuos de zonas con menos de 0,01, 0,7 y de 2-3 ppm de F en el agua de bebida. En el estudio fotográfico, la prevalencia de sujetos con un índice de Thylstrup Fejerskov (TF) de uno o más en los incisivos centrales superiores fue de 7 por ciento, 52 por ciento y 92 por ciento respectivamente, en cada una de las tres zonas. La prevalencia de opacidades demarcadas disminuyó con el aumento del nivel de fluoruros en el agua de bebida (p<0,008). Hubo un acuerdo sustancial entre los valores del índice TF al usar métodos clínicos y fotográficos (kappa=0,63). Sin embargo, la prevalencia de los valores TF mayores de uno fue más alta al usar el método fotográfico (44,9 por ciento) que el clínico (41,4 por ciento) (p<0.01). Los resultados de este estudio se compararon con los de uno realizado en el Reino Unido y otro en Irlanda en los que se usó el miesmo método fotográfico. Aunque la prevalencia de los valores del indice TF de uno o más fue similar en las zonas con niveles casi óptimos de fluoruro en el agua de bebida, en los grupos con niveles de fluoruro menores de 0,1 ppm, la prevalencia de sujetos con valores TF de uno o más fue mayor en la población del Reino Unido que en la de Brasil. Este estudio demuestra la utilidad de los métodos fotográficos para el registro de datos sobre opacidades del esmalte en casos de exposición a un amplio rango de concentraciones de fluoruro. Los resultados sugierem que en los grupos provenientes de zonas con bajos niveles de fluoruro en el agua de bebida, la exposición total a fluoruros fue mayor entre los ni±os del Reino Unido que en los de Brasil
Assuntos
Humanos , Masculino , Feminino , Criança , Água Potável/efeitos adversos , Esmalte Dentário/química , Halogenação/efeitos adversos , Brasil/epidemiologia , Fotografação , Purificação da Água/métodos , Microbiologia da ÁguaRESUMO
OBJECTIVES: The main aim of this study was to consider the association between water fluoride levels and caries prevalence in three Brazilian populations. METHODS: A total of 457 6-12-year-old lifetime residents from three economically deprived groups with 2-3, 0.7, and less than 0.01 ppm F in their water supplies were examined. Dental caries was recorded on permanent upper central incisors and first molars and all primary teeth (dmft). RESULTS: There was a significant trend (P < 01) for the mean dmft to decrease with increasing levels of fluoride in the drinking water. Caries experience in the six permanent teeth was significantly lower (P < 01) in the area with 0.7 ppm F than in the other two groups For the 2-3 ppm F group significantly more caries was found in subjects with higher TF scores (P < 05). CONCLUSION: Optimization of fluoride levels in the drinking water remains a valuable dental public health measure in Brazil.