Caries treatment decisions among undergraduate and postgraduate students supported by visual detection systems

Abstract

International Journal of Paediatric Dentistry 2018; 28: 92-101Background. The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention. Aim. This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria. Design. Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers' consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables. Results. Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non-operative treatments for the same lesions. Conclusions. IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.

Impact of a diagnostic workshop on undergraduate teaching‐learning process for the diagnosis and management of tooth restorations—A randomised controlled study

“…However, the binary assessment (yes/no) of only presence or absence of caries could result in inappropriate interventions. 33 The ability of the student to perform a diagnosis considering/assessing the lesion activity and severity is one of the core competencies required for undergraduate students, 11 because correct assessment of lesions results in improvements in the treatment decision. 34 The results from the multilevel regression model reinforce the positive impact of the workshop strategy on the assessment of lesion activity and show a trend (P = 0.05) to better performance in the assignment of lesion severity.…”

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta‐analysis

“…In the majority of the studies, to assess the undergraduate students’ performance in detecting and staging caries lesions, extracted teeth were employed using histology as validation. Three studies performed clinical evaluation of children with primary or mixed dentition . For these studies, validation was the clinical consensus among experts.…”

“…Regarding caries activity status, clinical consensus was used as reference standard. Only two studies investigated the treatment decision based on caries detection …”

“…None of the studies performed the sample size calculation, and the majority of studies were performed in Brazil. 15,[21][22][23][24][25][26] The ICDAS criteria were often chosen for staging caries severity and Nyvad system for assessing caries activity status. Students' performance for caries activity status, however, was tested in only 42.9% of the studies.…”

“…Three studies performed clinical evaluation of children with primary or mixed dentition. 22,24,25 For these studies, validation was the clinical consensus among experts. Some papers considered different thresholds such as all lesions or only cavitated lesions for evaluating the students' performance in staging caries.…”