Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions

Mai E Khalaf 1, Asma Alyahya 2, Muawia A Qudeimat 3

Affiliations

01 April 2023

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doi: 10.1016/j.identj.2022.06.024

Abstract

Aim: There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children.

Materials and methods: Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations.

Results: For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001).

Conclusions: For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.

Keywords: Caries management; Caries risk; Clinical decision-making; Dental caries.

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References

  1.  
    1. Carvalho JC, Dige I, Machiulskiene V, et al. Occlusal caries: biological approach for its diagnosis and management. Caries Res. 2016;50(6):527–542. - PubMed
  2.  
    1. Zhu F, Chen Y, Yu Y, Xie Y, Zhu H, Wang H. Caries prevalence of the first permanent molars in 6-8 years old children. PLoS One. 2021;16(1) - PMC - PubMed
  3.  
    1. Machiulskiene V, Campus G, Carvalho JC, et al. Terminology of dental caries and dental caries management: consensus report of a workshop organized by ORCA and Cariology Research Group of IADR. Caries Res. 2020;54(1):7–14. - PubMed
  4.  
    1. Schwendicke F, Walsh T, Lamont T, et al. Interventions for treating cavitated or dentin carious lesions. Cochrane Database Syst Rev. 2021;7(7) - PMC - PubMed
  5.  
    1. Elderton RJ. Diagnosis and treatment of dental caries: the clinicians’ dilemma. Scope for change in clinical practice. J R Soc Med. 1985;78(Suppl 7):27–32. - PMC - PubMed
  6.  
    1. Bader JD, Shugars DA. The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries. J Evid Based Dent Pract. 2006;6(1):91–100. - PubMed
  7.  
    1. Carvalho JC, Qvist V, Aimée NR, Mestrinho HD, Bakhshandeh A. Diagnosis, risk assessment, and treatment decisions for occlusal caries: a survey from the Danish Public Dental Health Service. Caries Res. 2018;52(1-2):58–70. - PubMed
  8.  
    1. Qudeimat MA, Altarakemah Y, Alomari Q, Alshawaf N, Honkala E. The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study. BMC Oral Health. 2019;19(1):41. - PMC - PubMed
  9.  
    1. Qudeimat MA, Al-Saiegh FA, Al-Omari Q, Omar R. Restorative treatment decisions for deep proximal carious lesions in primary molars. Eur Arch Paediatr Dent. 2007;8(1):37–42. - PubMed
  10.  
    1. Bussaneli DG, Boldieri T, Diniz MB, Rivera LM, Santos-Pinto L, Cordeiro Rde C. Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth. Int J Paediatr Dent. 2015;25(6):418–427. - PubMed
  11.  
    1. Ismail AI, Pitts NB, Tellez M, et al. The International Caries Classification and Management System (ICCMS™) an example of caries management pathway. BMC Oral Health. 2015;15(Suppl 1):59. - PMC - PubMed
  12.  
    1. Schwendicke F, Splieth C, Breschi L, et al. When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig. 2019;23(10):3691–3703. - PubMed
  13.  
    1. Soderstrom U, Johansson I, Sunnegardh-Gronberg K, et al. A retrospective analysis of caries treatment and development in relation to assessed caries risk in an adult population in Sweden. BMC Oral Health. 2014;14:126. - PMC - PubMed
  14.  
    1. Downer MC. Concurrent validity of an epidemiological diagnostic system for caries with the histological appearance of extracted teeth as validating criterion. Caries Res. 1975;9(3):231–246. - PubMed
  15.  
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. - PubMed
  16.  
    1. Wilson NHF, Lynch CD, Brunton PA, et al. Criteria for the replacement of restorations: Academy of Operative Dentistry European Section. Oper Dent. 2016;41(S7):48–57. - PubMed
  17.  
    1. Diniz MB, Rodrigues JA, Hug I, Cordeiro Rde C, Lussi A. Reproducibility and accuracy of the ICDAS-II for occlusal caries detection. Community Dent Oral Epidemiol. 2009;37(5):399–404. - PubMed
  18.  
    1. Macey R, Walsh T, Riley P, et al. Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries. Cochrane Database Syst Rev. 2021;6(6) - PMC - PubMed
  19.  
    1. Altarakemah Y, Al-Sane M, Lim S, Kingman A, Ismail AI. A new approach to reliability assessment of dental caries examinations. Community Dent Oral Epidemiol. 2013;41(4):309–316. - PubMed
  20.  
    1. Khalaf ME, Qudeimat M, Alomari QD, Al-Tarakmeh Y, Honkala E. Impact of magnifying loupes on interexaminer agreement in the detection of noncavitated occlusal carious lesions. Oral Health Prev Dent. 2018;16(4):375–380. - PubMed
  21.  
    1. Jobim Jardim J, Henz S, Barbachan E,, Silva B. Restorative treatment decisions in posterior teeth: a systematic review. Oral Health Prev Dent. 2017;15(2):107–115. - PubMed
  22.  
    1. Kateeb ET, Warren JJ, Gaeth GJ, Momany ET, Damiano PC. Understanding pediatric dentists' dental caries management treatment decisions: a conjoint experiment. JDR Clin Trans Res. 2016;1(1):86–94. - PMC - PubMed
  23.  
    1. Rohlin M, Mileman PA. Decision analysis in dentistry-the last 30 years. J Dent. 2000;28(7):453–468. - PubMed
  24.  
    1. Yorty JS, Walls AT, Wearden S. Caries risk assessment/treatment programs in U.S. dental schools: an eleven-year follow-up. J Dent Educ. 2011;75(1):62–67. - PubMed
  25.  
    1. Heaven TJ, Gordan VV, Litaker MS, et al. National Dental PBRN Collaborative Group Agreement among dentists’ restorative treatment planning thresholds for primary occlusal caries, primary proximal caries, and existing restorations: findings from the National Dental Practice-Based Research Network. J Dent. 2013;41(8):718–725. - PMC - PubMed
  26.  
    1. Gordan VV, Bader JD, Garvan CW, et al. Dental Practice-Based Research Network Collaborative Group Restorative treatment thresholds for occlusal primary caries among dentists in the dental practice-based research network. J Am Dent Assoc. 2010;141(2):171–184. - PMC - PubMed
  27.  
    1. Brostek AM, Walsh LJ. Minimal intervention dentistry in general practice. Oral Health Dent Manag. 2014;13(2):285–294. - PubMed
  28.  
    1. Sisodia N, Manjunath MK. Impact of low level magnification on incipient occlusal caries diagnosis and treatment decision making. J Clin Diagn Res. 2014;8(8):ZC32–ZC35. - PMC - PubMed
  29.  
    1. National Institutes of Health (U.S.). NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. Available from: https://consensus.nih.gov/2001/2001DentalCaries115Program.pdf. Accessed 1 April 2022.
  30.  
    1. Aryanpur S, van Niewenhuysen J-P, D'Hoore W. Endodontic retreatment decisions: no consensus. Int Endod J. 2000;33(3):208–218. - PubMed
  31.  
    1. Makhija SK, Gilbert GH, Funkhouser E, et al. Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: findings from the National Dental Practice-Based Research Network. J Am Dent Assoc. 2014;145(11):1112–1118. - PMC - PubMed

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