Reliability of a New Caries Diagnostic System Differentiating between Active and Inactive Caries Lesions

Abstract

Current scoring systems for dental caries do not consider the dynamic nature of the disease. The aims of the present study were to describe a new set of clinical caries diagnostic criteria which differentiate between active and inactive caries lesions at both the cavitated and non–cavitated levels and to evaluate the reliability of this criteria system in a population with high caries experience. Ten diagnostic codes were defined: 0 = sound; 1 = active (intact); 2 = active (surface discontinuity); 3 = active (cavity); 4 = inactive (intact); 5 = inactive (surface discontinuity); 6 = inactive (cavity); 7 = filling; 8 = filling with active caries; 9 = filling with inactive caries. Distinction between active and inactive caries lesions was made on the basis of a combination of visual and tactile criteria. The inter– and intra–examiner reliability was assessed through repeated examinations of 50 children by 2 recorders over a period of 3 years. The percentage agreement of caries diagnoses varied between 94.2 and 96.2%. The kappa values ranged between 0.74 and 0.85 for intra–examiner examinations and between 0.78 and 0.80 for inter–examiner examinations; 81.6% of all misclassifications involved non–cavitated caries lesions. Disagreement between sound surfaces and non–cavitated active or non–cavitated inactive lesions (31.3 and 31.2%, respectively) was more common than disagreement between non–cavitated active and non–cavitated inactive lesions (10.6%). The probability of reconfirming a sound, non–cavitated active or non–cavitated inactive caries lesion – given that the surface was diagnosed as either sound, non–cavitated active or non–cavitated inactive at the first examination – was 98.0, 68.7 and 72.5%, respectively. The results show that the use of a new set of clinical caries diagnostic criteria based on activity assessment can be performed with a high reliability, even when non–cavitated diagnoses are included in the criteria system.

Association between clinical parameters and the presence of active caries lesions in first permanent molars

“…Therefore, many authors have proposed diagnostic criteria based on a single visual inspection for distinguishing active and arrested caries lesions. 9,10,20 A set of clinical diagnosis criteria to assess caries lesions activity has been proposed with good reliability, 20 and it presented construct and predictive values in previous studies. 19 However, there are some difficulties involved in using this visual score system in clinical practice.…”

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

“…20,21 This process is usually performed by visual inspection, 3 which is the only validated method to assess caries activity 6, 21,24 with high specificity for the detection of caries lesions. 2 However, due to its subjective nature, quantitative methods have been suggested as possible alternatives.…”

“…16 This latter study 16 actually has a superior design to evaluate the validity of methods for caries activity assessment. 21 Nevertheless, as it is retrospective, 16 and considering the fact that the caries activity assessment made by visual inspection also presented predictive validity using the same participants, 24 visual inspection remains as a validated method for assessing the activity status of caries lesions that is easier to use and less expensive. Therefore, it should be indicated as the method for carious lesions activity assessment in daily clinical practice.…”

Research in primary dental care Part 4: Measures

“…This is a particular problem with questionnaire studies where researchers often 'cherry-pick' questions from existing questionnaires or alter the wording of questions to suit their study. If you CLINICAL OUTCOME MEASURES Measuring caries DMFT/dmft 8 British Association for the Study of Community Dentistry (BASCD) criteria for caries 9 Clinical caries diagnostic criteria 10 Measuring gingivitis and periodontal disease Community Periodontal Index of Treatment Needs (CPITN) or Basic Periodontal Examination (BPE) 11 Gingival Index 12 Periodontal pocket probing depth 13 Clinical attachment level 13 The Extent and Severity Index 14…”