Clinical Performance of Two Visual Scoring Systems in Detecting and Assessing Activity Status of Occlusal Caries in Primary Teeth

Abstract

This study aimed to compare the clinical performance of two sets of visual scoring criteria for detecting caries severity and assessing caries activity status in occlusal surfaces. Two visual scoring systems – the Nyvad criteria (NY) and the ICDAS-II including an adjunct system for lesion activity assessment (ICDAS-LAA) – were compared using 763 primary molars of 139 children aged 3–12 years. The examinations were performed by 2 calibrated examiners. A subsample (n = 50) was collected after extraction and histology with 0.1% red methyl dye was performed to validate lesion depth and activity. The reproducibility of the indices was calculated (kappa test) and ROC analysis was performed to assess their validity and related parameters were compared using McNemar’s test. The association between the indices and with the histological examination was evaluated using Spearman’s correlation coefficient (r_s). Visual criteria showed excellent reproducibility both regarding severity (NY: 0.94; ICDAS-II: 0.91) and activity (NY: 0.90; LAA: 0.91). The NY and LAA showed good association in caries activity assessment (r_s = 0.88; 95% CI = 0.86–0.89; p < 0.001). Nevertheless, considering only cavitated lesions, this association was not significant (p > 0.05). Concerning the severity, both indices presented similar validity parameters. At D2 threshold, the sensitivity was higher for NY (NY = 0.87; ICDAS = 0.61, p < 0.05). Regarding activity status, NY showed higher specificities and accuracies. In conclusion, NY and ICDAS-II criteria are comparable and present good reproducibility and validity to detect caries lesions and estimate their severities, but the LAA seems to overestimate the caries activity assessment of cavitated lesions compared to NY.

Validation of Visual Caries Activity Assessment

“…Additional criteria systems for activity assessment have been investigated to be used in association with the ICDAS (ICDAS Coordinating Committee, 2005;Ekstrand et al, 2007;Braga et al, 2009;Braga et al, 2010;Ferreira-Zandona et al, 2012;Gimenez et al, 2013;Piovesan et al, 2013).…”

New methodology to assess activity status of occlusal caries in primary teeth using laser fluorescence device

“…However, we used ranked scoring visual indices, previously validated clinically for activity assessment in primary teeth. 24 Although it is not a perfect standard method, this methodology permits us to detect early caries lesions, assessing initial demineralization stages accurately. 25 The option for using two visual systems is related to different activity assessment processes inherent in the two scoring criteria.…”

Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth

“…Our study evaluated criterion validity using a pH dye indicator, as in other studies published previously. 22,23,28 Conversely, the other study retrospectively evaluated the progression of the lesions with higher red fluorescence using QLF; hence, the predictive validity of the method was assessed. 16 This latter study 16 actually has a superior design to evaluate the validity of methods for caries activity assessment.…”

“…The examiners then classified the lesions into inactive, when the sections were stained yellow, or active, when the lesions appeared red or reddish. 22,23 After some training using images from other studies, the examiners performed the evaluations independently, and in case of disagreements, a consensus was reached after a discussion between them.…”