Abstract
BackgroundAn advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries. One limitation to date is that assessments of lesion status have been based on a tactile test where a sharp probe or explorer is drawn across the surface of a lesion to assess its hardness. This is a technique-sensitive step and has the potential for iatrogenic damage, especially when a lesion is deep. This study was undertaken to determine whether an alternative, non-invasive, visual assessment could be a reliable indicator of lesion status. The approach was based on the retention, or otherwise, of a black surface deliberately created at the time of initial treatment.MethodsA total of 88 lesions in the primary molars of 45 children, aged 5 to 10 years, were treated with a one-minute application of 40% silver fluoride. The surface of the lesions was then deliberately turned black by the application of 10% stannous fluoride as a reducing agent. All lesions were on an approximal or occlusal surface of a first or second primary molar. The presence or absence of a continuous black surface at 6 months and any changes in radiographic depth that had occurred in that period were determined from digitized photographs and bitewing radiographs.ResultsThe retention of an uninterrupted black surface was associated with minimal or no caries progression whereas lesions with an incomplete or lost black surface were 4.6 times more likely to have progressed. Use of the Datta and Satten Rank-Sum Test to account for any clustering effect showed that the difference was statistically significant (p < 0.0001). The sensitivity and specificity of the approach were 80% and 81% respectively.ConclusionThe retention of a continuous black surface after the application of silver fluoride followed by a reducing agent on carious lesions in primary molars can provide a useful visual indicator of lesion progression and so be relevant for use in dental outreach programs.
Highlights
An advantage of using silver fluoride treatments for carious primary teeth in outreach programs especially where dental resources are limited is that the treatments can be carried out by dental auxiliaries
A black surface is a characteristic of arrested silver fluoride-treated lesions, color change in itself has not been used to assess lesion status [4,5,6,7]
If the black surface remained it was suggestive of lesion stasis and, if it was lost, it provided a possible indication of lesion progression
Summary
The study was carried out on children living in Bourke, an isolated town in western New South Wales, Australia. All walls and the floor of each lesion had to be clearly visible at baseline These parameters were necessary for lesion progression to be assessed from bitewing radiographs and for the presence or absence of an uninterrupted surface film to be assessed from photographs. To compensate for any minor variations in projection angles during taking of the radiographs at baseline and 6 months, geometric alignment of the images was carried out as described previously [10]. As a preliminary step, the first and second radiographic readings of lesion depth at baseline and the two readings at 6 months were examined to determine the validity of using the mean values for subsequent statistical analyses. The Kappa Index of Agreement was used to measure intra-examiner agreements between duplicate readings of photographs These statistical tests were performed using the appropriate statistical package (SAS Version 9.2, SAS Institute Inc, Cary, USA). The adequacy of the sample size was checked once the readings were taken to ensure a 5% statistical significance level and an 80% power
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