Influence of Examiner Experience on Clinical Performance of Visual Inspection in Detecting and Assessing the Activity Status of Caries Lesions

Gimenez, Thaís; Bittar, Daniela Gonçalves; Piovesan, Chaiana; Guglielmi, Camila de Almeida Brandão; Fujimoto, Karina Y.; Matos, Renato Camargo; Novaes, Tatiane Fernandes; Braga, Mariana Minatel; Mendes, Fausto Medeiros

doi:10.2341/12-067-c

Cited by 21 publications

(43 citation statements)

References 19 publications

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“…Though many authors have concluded stating that experience or training of the examiner need not influence the detection power of the visual examination tool, experience gained during training seems to be influencing the diagnostic decisions with ICDAS II. 27,28 Visual and enhanced visual, under magnification achieved comparable values of sensitivity and specificity for both the examiners, in our study. In our study, the ICDAS II behaved as a sensitive diagnostic method for occlusal caries diagnosis in the 0-2 codes, irrespective of the use of magnification.…”

Section: Discussionsupporting

confidence: 52%

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Sathyanarayanan¹,

Usha²,

Sudhagar³

2017

Int J Sci Rep

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INTRODUCTIONDental caries is a disease that is characterized by the localized destruction of susceptible dental hard tissue by acidic by-products from bacterial fermentation of dietary carbohydrates. The process is a dynamic interaction at the biofilm-tooth interface characterised by alternating cycles of demineralisation and remineralization. A caries/carious lesion are a detectable change in the tooth structure that results from this interaction. The changes may range from initial outer surface demineralization, at the molecular level, through subsurface demineralization producing enamel white-spot lesion formation, through macroscopic lesion cavitation, to dentine and pulpal infection, to ABSTRACT Background: Pit and fissure caries presents diagnostic challenges due to its anatomical complexity and fluoride exposure. ICDAS II is a coding system for caries detection using clinical visual inspection. It identifies carious lesions by the change in colour, texture and surface integrity. Magnification might facilitate better detection of the lesions by enhancing the visual acuity. Thus, the objective of this study is to compare the reliability and validity of ICDAS II in detection of occlusal caries, with and without magnification, by using histological standard. Methods: This single blinded, randomized study included 334 unrestored extracted human premolars and molars. Two examiners independently scored pit and fissure caries status using ICDAS II criteria without magnification and later under 6 x magnification using surgical microscope. The samples were sectioned and lesions were scored using the ERK histological criteria, under Stereo microscope. The scores of the examiners were correlated with the histological scoring. Kappa statistics and Spearman correlation coefficients were performed. Optimal sensitivity, specificity of visual and enhanced visual examination was calculated by Receiver Operating Characteristic Curve (ROC). Likelihood ratios (LR) were also calculated. Results:The kappa values for Inter examiner reproducibility of visual and enhanced visual examination under microscope were 0.638-0.694 and for histological examination it was 0.979. Intra examiner reproducibility for visual and enhanced visual examination was 0.665 -0.594. There was a strong relationship between visual, enhanced visual and histological examinations. Spearman's correlation coefficient of ICDAS-II visual and enhanced visual examination for each examiner, to ERK histological scores was 0.869-0.848. The sensitivity and LR+ for visual and enhanced visual examination was decreased as the ICDAS score was increased and specificity and LR-increased with increased ICDAS score. Conclusions: Reliability and validity of ICDAS scoring in detecting occlusal caries under magnification did not differ from clinical visual inspection.

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Section: Discussionsupporting

confidence: 52%

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Sathyanarayanan¹,

Usha²,

Sudhagar³

2017

Int J Sci Rep

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“…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).…”

Section: Introductionmentioning

confidence: 99%

Validation of Visual Caries Activity Assessment

et al. 2014

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“…Moreover, an objective method could be less influenced by examiner's experience than would visual inspection. 4 Considering that LFpen and QLF (red fluorescence measurement) are methods based on the fluorescence emitted by microorganisms present in the caries lesions, 9,11,15 and since active caries lesions are more infected than inactive ones, 16 this possibility would be plausible. The old version of the LF method used with different drying times had been tested for this purpose previously, 28 but this methodology was not compared with visual inspection.…”

Section: Discussionmentioning

confidence: 99%

“…percentage of green fluorescence loss on the suspicious site compared with green fluorescence from sound tooth tissue; Localized enamel breakdown in opaque or discoloured enamel (without visual signs of dentinal involvement) 4 Underlying dark shadow from dentine Probably active -…”

Section: Fluorescence-based Methodsmentioning

confidence: 99%

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

et al. 2017

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We aimed to investigate the performance of fluorescencebased methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

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Influence of Examiner Experience on Clinical Performance of Visual Inspection in Detecting and Assessing the Activity Status of Caries Lesions

Cited by 21 publications

References 19 publications

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

Validation of Visual Caries Activity Assessment

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

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