Background This cross-sectional study aimed to compare two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth. Methods The two clinical visual criteria tested for the assessments of restored teeth were: FDI criteria—based on the caries presence, marginal adaptation and staining criteria, adapted from the FDI (International Dental Federation) criteria and CARS criteria—"Caries Associated with Restorations or Sealants" (CARS) criteria described by the International Caries Classification and Management System. Adults were randomized according to the criteria. One calibrated examiner assessed the restorations and assigned the treatment according to the criteria. The primary outcome was replacement indication. Results A total of 185 patients were included, totalling 718 restorations. The strongest correlation founded between the methods was for the presence of caries lesions (Rho = 0.829). A moderate correlation (Rho = 0.420) was founded between the treatment decisions proposed by the CARS and by the FDI criteria. The multilevel regression analysis showed that the FDI criteria indicated five times more replacements when compared to the CARS (< 0.001). Also, using the FDI criteria restorations were 2.7 times more related to caries around restorations (p < 0.001) compared to the other criterion. Conclusions The visual criteria used on the restoration's assessment directly influences the treatment decision to intervene or not on the restoration. The use of a minimally invasive based approach for assessing secondary caries may prevent overtreatment.

Background The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults. Methods The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. Discussion This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).

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Objetivo: identificar a satisfação profissional de cirur­giões-dentistas atuantes na atenção básica do Sistema Único de Saúde em um município do sul do Brasil, que foi pioneiro na implantação de diretrizes municipais de saúde bucal. Sujeitos e método: para a coleta dos da­dos, foram utilizados componentes descritivos a partir de dados secundários obtidos por meio de um questio­nário aplicado para todos os cirurgiões-dentistas atuan­tes no referido serviço. Resultados: no total, 46 profis­sionais foram incluídos na amostra, sendo que 82,5% estavam satisfeitos em seu trabalho e, desses, o reco­nhecimento dos usuários do serviço foi o fator que os cirurgiões-dentistas mais associaram à felicidade. Já os fatores mais relacionados à infelicidade no trabalho são as críticas ao salário e os usuários não colaboradores; 97,8% acreditavam que seu trabalho fazia diferença na comunidade em que estavam inseridos. Conclusão: este estudo sugere que estabelecer diretrizes no proces­so de trabalho pode ter um impacto positivo na prática e na satisfação dos profissionais, e essas estratégias po­dem ser utilizadas como amparo para planejamento em gestão de saúde bucal de forma sistematizada.

The aim of this study was to compare the performance of two visual criteria used for the detection of caries around restorations in permanent teeth. In this delayed-type cross-sectional study, the study sample was randomly allocated to one of two visual criteria for the assessment of restorations, as follows: a) FDI criteria (International Dental Federation; considers marginal staining, marginal adaptation, and caries recurrence), and b) CARS (Caries Associated with Restorations or Sealants) criteria, defined by the International Caries Classification and Management System. A calibrated examiner assessed the restorations using two reference standards, as follows: i) for restorations requiring operative interventions (repair/replacement), the restoration was partially or totally removed and the presence or absence of carious tissue was assessed; and ii) for restorations requiring non-operative intervention, follow-up for a period of one year was recommended to allow identification of the presence of new lesions not detected at baseline. The sensitivity, specificity, area under Receiver Operating Characteristic (ROC) curve (Az), and accuracy of the criteria were assessed. The study included 305 restorations. The FDI marginal staining parameter had the lowest Az value (Az = 0.501), while similar sensitivity was observed between the CARS (62.0%), FDI presence of caries (65.0%), and FDI marginal adaptation (74.0%) parameters. CARS exhibited the highest specificity (88.3%) and accuracy (85.6%). The CARS criteria exhibited better specificity and accuracy in detecting caries around restorations, followed by the FDI criteria for caries recurrence and marginal adaptation. Considering marginal staining or combining multiple marginal features to assess secondary caries resulted in an increased risk of false-positive outcomes and over-treatment.