Diagnosis, Risk Assessment, and Treatment Decisions for Occlusal Caries: A Survey from the Danish Public Dental Health Service

Abstract

This study validates a case-based survey method and analyzes the extent to which Danish dental professionals apply current concepts and strategies for occlusal caries management in children, adolescents, and young adults. A case-based, precoded questionnaire consisting of 10 clinical cases/patients with 26 teeth/occlusal surfaces was developed. The cases were set up in a PowerPoint presentation and color printed as a booklet illustrating patients with different patterns of caries activity, severity, and risk. A total of 69 dental professionals participated. Content and face validity of the survey method was established using a panel of experts. The panel also assessed the reliability of the method using a test-retest procedure (κ ≥ 0.80) and acting as benchmark. Measurements of agreement between dental professional and benchmark assessments showed substantial agreement for overall caries activity and risk assessment of patients and for clinical and radiographic severity of occlusal lesions (κ = 0.61-0.67). For assessment of caries lesion activity on occlusal surfaces, the agreement was moderate (κ = 0.50). Regarding treatment decisions, dental professionals showed substantial agreement when indicating restorative treatments (κ = 0.68). Multivariate logistic regression analysis showed a significant influence of various patient-, lesion-, and participant-related variables in the assessment of caries risk, caries activity and severity, and treatment decision. In conclusion, Danish dental professionals participating in the study apply reasonably well current concepts on overall caries activity and risk assessment, clinical and radiographic severity of occlusal lesions, and, to a certain extent, assessment of caries lesion activity on occlusal surfaces. Nonoperative treatment decisions had a high priority among Danish professionals.

Impact of the undergraduate clinical teaching-learning process on caries detection and treatment decision-making

“…Such influence may be related to the students' experience measured by caries diagnosis and treatment decision using ICDAS and Nyvad's system. Photographs were used to depict clinical situations 20,21 that allowed reproducing the same lesions in the two-year period that involved this study, which would not have been possible in a clinical study. The use of extracted teeth is more common in studies that evaluate visual diagnostic criteria performance, enabling the study of reproducibility and avoiding patient exposure to multiple examinations 14,20,21 .…”

“…Photographs were used to depict clinical situations 20,21 that allowed reproducing the same lesions in the two-year period that involved this study, which would not have been possible in a clinical study. The use of extracted teeth is more common in studies that evaluate visual diagnostic criteria performance, enabling the study of reproducibility and avoiding patient exposure to multiple examinations 14,20,21 . However, this study protocol is not ideal for the evaluation of diagnostic criteria involving lesion activity signs, since extracted teeth do not allow visualization of indicators such as plaque stagnation area, roughness, quality of the marginal gingiva and lesions, translucency, or opacity.…”

Diagnosis, risk assessment, and treatment decisions for tooth wear in daily practice: a case presentation survey among Belgian dentists

“…High risk patients had background variables that promote the development of pathological tooth wear and/or presented several tooth wear lesions in the dentition [19]. The variables considered were: age of the patient (several teeth with wear disproportionate to age), reason for visiting the dentist (control visit, esthetic demand, sensitivity, regular breaking of fillings/teeth, masticatory discomfort), oral hygiene habits (aggressive toothbrushing, hard toothbrush, high abrasiveness of toothpaste), diet and lifestyle habits (frequent consumption of acidic food and beverages, low stimulated saliva flow rate), other habits related to tooth wear (teeth clenching or bruxism, unstable occlusion), and general health status (good general health or being medically compromised: gastro‐esophageal reflux disease [GERD], regurgitation, Sjögren's syndrome, head and neck radiation therapy).…”

Clinical Diagnosis of Dental Caries in the 21st Century: Introductory Paper – ORCA Saturday Afternoon Symposium, 2016

“…Accordingly, the rate of caries progression expressed by caries lesion activity assessment should be the cornerstone of currently used clinical caries diagnostic methods [Holmen et al, 1987;Artun and Thylstrup, 1989;Thylstrup et al, 1994;Nyvad and Fejerskov, 1997]. Moreover, assessments of individuals' overall caries activity and caries risk are equally relevant in the framework of clinical caries diagnostic methods [Bader et al, 2001; Swedish Council on Technology Assessment in Health Care, 2007;Twetman et al, 2013;Mejàre et al, 2014;Carvalho, 2014;Leal and Nyvad, 2016;Carvalho et al, 2017Carvalho et al, , 2018.…”

“…Diagnostic decisions as well as decisions about when to intervene vary significantly among the dental practitioners, with the tendency to treat dental caries overinvasively [Innes and Schwendicke, 2017], although this trend seems to be less pronounced in the Scandinavian countries [Mejàre et al, 1999;Espelid et al, 2001;Kopperud et al, 2016;Carvalho et al, 2018].…”