Abstract
BackgroundThe diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The influence of using ICDAS on caries treatment recommendations has received increasing attention in recent years. Therefore, the aim of this study was to assess the impact of ICDAS on dentists’ occlusal caries lesions’ treatment decisions for patients at high risk for caries.MethodsFive dentists examined the occlusal surfaces of 270 extracted premolars and permanent molars. For a predetermined clinical scenario, the examiners were asked to indicate their treatment recommendations for each tooth. Four weeks later, all the examiners were trained and calibrated for the use of ICDAS. Then the investigators examined the same 270 teeth independently and indicated their treatment recommendations using the same clinical scenario. Histological validation was used to determine the caries lesions detection performance of the examiners using ICDAS and to assess the relationship between the presence of dentin caries and treatment recommendations for each examiner before and after ICDAS training. Specificity, sensitivity, area under the receiver operating characteristic curve (AUC), and Spearman’s correlation coefficients were calculated. The Wilcoxon two-related sample rank test was used to test for differences between treatment recommendations.ResultsThe strongest correlation for inter-examiner reproducibility was found between the ICDAS D2 cut-off point (ICDAS codes 3–6 as dentin caries) and histologic dentin caries. Treatment recommendations among different examiners before and after ICDAS training demonstrated a statistically significant increase in operative intervention and an increase in the percentage of overtreatment recommendations for two examiners.ConclusionsThe impact of ICDAS on the examiners’ caries lesion treatment recommendations varied among the dentists in this study. Treatment decision-making can be influenced by the caries lesion’s detection and classification system used.
Highlights
The diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment
International Caries Detection and Assessment System (ICDAS) has been shown to provide a more accurate detection and an improved sensitivity for the detection of occlusal caries lesions compared to other methods and tools [2, 3, 5, 6]
The main objectives for the International Caries Classification and Management System (ICCMSTM) are to stage and assess the activity of the caries process which is followed by risk-adjusted preventive care, control of initial non-cavitated lesions, and conservative treatment for cavitated and deep dentinal caries lesions [4]
Summary
The diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The aim of this study was to assess the impact of ICDAS on dentists’ occlusal caries lesions’ treatment decisions for patients at high risk for caries. Even with the increasing use of methods and tools that are more accurate for caries lesions’ detection among dental practitioners and researchers [13], the mechanisms or criteria dentists use for making caries treatment decisions are still not fully understood [14,15,16]. The influence of ICDAS as a caries detection and classification system on the clinician’s caries treatment decision-making has received increasing attention in recent years [15, 16, 19]. The null hypothesis was that there is no difference in occlusal caries lesion treatment decisions among dentists before and after ICDAS training
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