D3 Threshold Research Articles

SUBJECTIVE ACCEPTANCE OF PEDIATRIC PATIENTS DURING CAVITY PREPARATION WITH Er:YAG LASER AND CONVENTIONAL ROTARY INSTRUMENTS

SUMMARY Aim: The aim of the present study is to evaluate and compare the subjective acceptance in children during hard dental tissue therapy using Er:YAG laser 2940nm and conventional rotary instruments. Methods and materials: The study included ninety 6-12-years-old children with matched carious lesions (D3 threshold, WHO system), divided into two equal treatment groups. In the intervention group the cavities were prepared with Erbium:YAG laser 2940nm and in the control group with conventional rotary instruments, without anaesthesia. After cavity preparation patient’s subjective acceptance was assessed by a questionnaire concerning primary stress triggers. Results: The annoyance factor (vibration) was found as a stress trigger in the majority of control children (86.7%), while in the intervention group it was found in 2.2% of cases. The most anxiety provoking items in the intervention group were smell (67.7%) and taste (42.2%). The sound was found to be a stress trigger in more than half of control children (62.2%) and less than one-fifth of the children in the intervention group (15.6%). The study results showed significant difference in these items between two groups (p< 0.001). Conclusions: The Erbium:YAG lasers reduce three of four stress triggers in ‘4S‘ principle - vibration, sight and sound. They are a good treatment option for fearful children since they have acceptable efficiency in treatment of pediatric anxiety disorders compared to the mechanical preparation.

A Comparative Study of Different Radiographic Methods for Detecting Occlusal Caries Lesions

Objectives: The aim of this in vitro study was to compare the diagnostic accuracy of different radiographic imaging modalities in detecting occlusal caries lesions. Materials and Methods: Under standardized conditions, 125 extracted human permanent molar teeth with sound or occlusal caries lesions were radiographed using a conventional film system (F-speed), a direct digital imaging system (complementary metal oxide semiconductor sensor), an indirect digital imaging system (photostimulable phosphor plate) and a cone beam computed tomography system (CBCT). Two observers scored the resultant images for the presence or absence of caries. Then, the teeth were histologically prepared and a definite diagnosis was determined by stereomicroscopic assessment. The area under the receiver operating characteristic curve (A_z), sensitivity, specificity and accuracy of each imaging modality were calculated, as well as the intra- and interexaminer reproducibility. Results: For both thresholds, interexaminer agreement were higher for CBCT. For intraexaminer agreement, observers had different scores for both thresholds, but the scores were generally higher for CBCT. Similar A_z values were achieved with all imaging methods at a diagnostic D1 threshold. The A_z values of the CBCT system were found to be statistically higher than those of the other imaging modalities at a diagnostic D3 threshold (p > 0.05); no significant differences were found among the other imaging modalities. All radiographic methods showed similar sensitivities, specificities and accuracy in detecting D1 threshold. The CBCT system showed higher sensitivity and accuracy in detecting dentine lesions. Conclusions: Within the limitations of this study, CBCT exhibited better performance in detecting deep occlusal caries lesions than the other radiographic systems.

26. High intensity transcranial electrical stimulation: Brainstem fugal motor tracts may augment epidural D-waves of the cortico-spinal system

Introduction At increasing intensities of transcranial electrical stimulation (TES) the cortico-spinal tract will depolarize deeper in the brain down to the foramen magnum, possibly causing other spine bounded tracts originating from the brainstem to depolarize too. It is hypothesized that the threshold to activate these parapyramidal (PP) axons is higher than the subcortical motor threshold of axons of the corticospinal tract (CT). In addition, one may expect that action potentials of PP axons join d-waves of the CT and augment their amplitudes. Methods A cohort of 19 patients (11 female; age mean: 51.3 ± 14y) with surgical procedures in the spinal canal under intraoperative neuromonitoring were included. TES was performed using C3 and C4 stimulation with constant voltage at 100 or 200 mcs pulse width. D-waves were measured caudal or rostral from the cord lesions. Muscular motor evoked potentials (mMEPs) were taken from the abductors pollicis brevis (APB) at cervical epidural recording levels or otherwise the anterior tibialis (AT). Voltage motor threshold parameters were derived for d-waves at subcortical level (Vthd1), at brainstem level at a latency jump of around −0.8 ms (Vthd2) and for mMEPs (VthAPB, and VthAT). The threshold ratio TRd1d2 equals Vthd2/ Vthd1. ARd1d2 is the supramaximal amplitude ratio of d1 and d2 waves. Results TRd1d2, ARd1d2, d1 and mMEP threshold values are listed below. TRd1d2 ARd1d2 Cervical level Other spinal levels Vthd1 VthAPB Vthd1 VthAT N 19 13 8 8 11 11 mean ± SD 3.09 ± 0.74 2.26 ± 0.53 31.9 ± 7.8 V 33.4 ± 7.4 V 61.8 ± 40.1 V 70.0 ± 48.6 V Paired differences Mean ± SD −1.5 ± 2.7 V −8.2 ± 16.8 V No significant differences (P = 0.05) between d1 and mMEP thresholds were found. d2 amplitudes may double or triple d1 amplitudes, whereas the mean TRd1d2 is 3.1. Conclusions At TES intensities over 3× threshold, parapyramidal axons apparently increase d-wave amplitudes and do not exclusively represent the corticospinal tract function.

In vitro performance of a pen-type laser fluorescence device and bitewing radiographs for approximal caries detection in permanent and primary teeth.

To evaluate the performance of a pen‑type laser fluorescence device (DIAGNOdent 2190; LFpen, KaVo, Germany) and bitewing radiographs (BW) for approximal caries detection in permanent and primary teeth. A total of 246 anterior approximal surfaces (102 permanent and 144 primary) were selected. Contact points were simulated using sound teeth. Two examiners assessed all approximal surfaces using LFpen and BW. The teeth were histologically assessed for the reference standard. Optimal cut‑off limits were calculated for LFpen for primary and permanent teeth. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (Az) were calculated for D1 (enamel and dentin lesions) and D3 (dentin lesions) thresholds. The reproducibility was assessed by intraclass correlation coefficient (ICC) and Cohen's weighted kappa values. For permanent teeth, the LFpen cut‑off were 0-27 (sound), 28-33 (enamel caries) and >33 (dentin caries). For primary teeth, the LFpen cut‑off were 0-7 (sound), 8- 32 (enamelcaries) and >32 (dentin caries). The LFpen presented higher sensitivity values than BW for primary teeth (0.58 vs. 0.32 at D1 and 0.80 vs. 0.47 at D3) and permanent teeth (0.80 vs. 0.57 at D1 and 0.94 vs. 0.51 at D3). Specificity did not show a significant difference between the methods. Rank correlations with histology were 0.59 and 0.83 (LFpen) and 0.36 and 0.70 (BW) for primary and permanent teeth, respectively, considering all lesions. ICC values for LFpen were 0.71 (inter) and 0.86 (intra) for permanent teeth and 0.94 (inter) and 0.90/0.99 for primary teeth. Kappa values for BW were 0.69 (inter) and 0.68/0.90 (intra) for permanent teeth and 0.64 (inter) and 0.89/0.89 for primary teeth. LFpen presented better reproducibility for primary and permanent teeth and higher accuracy in detecting caries lesions at D1 threshold than BW for permanent teeth. LFpen should be used as an adjunct method for approximal caries detection.

Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study

ABSTRACT%Background and objective: Proximal caries detection is of great importance because of the rapid rate of caries progression and the difficulty in determining the absence or presence of a lesion in primary dentition. Although, various methods for caries diagnosis offer good diagnostic performances, they provide varying sensitivities for detecting proximal carious lesions. The objective of this study was to compare, in vivo, the accuracy of DIAGNOdent and bitewing radiography at detecting proximal caries in primary teeth.Materials and methods: One Hundred and one primary maxillary and mandibular molars without obvious cavities of children between the age group of 3 and 10 years were included. The teeth were first subjected to DIAGNOdent examination followed by bitewing radiography. The specificity and sensitivity of the systems were calculated.Results: At the dentin caries (D3) level, the sensitivity of DIAGNOdent and bitewing radiography was 78.5%; at the enamel caries (D1 and D2) level it was 39.12% and for the sound teeth (D0) it was found to be 76.52%. A strong association was observed between the DIAGNOdent and the bitewing radiograph (p < 0.001).Conclusion: The DIAGNOdent can be used as an alternative diagnostic method in detection of proximal caries in primary teeth. But when seen at the each caries level, the DIAGNOdent is more accurate at the D0 and D3 threshold.How to cite this article: Mepparambath R, Bhat SS, Hegde SK, Anjana G, Sunil M, Mathew S. Comparison of Proximal Caries Detection in Primary Teeth between Laser Fluorescence and Bitewing Radiography: An in vivo Study. Int J Clin Pediatr Dent 2014;7(3):163-167.

The Performance of ICDAS-II Using Low-Powered Magnification with Light-Emitting Diode Headlight and Alternating Current Impedance Spectroscopy Device for Detection of Occlusal Caries on Primary Molars

Early detection of occlusal caries in children is challenging for the dentists, because of the morphology of pit and fissures. The aim of this study was to compare in vitro the diagnostic performance of low-powered magnification with light-emitting diode headlight (LPMLED) using ICDAS-II criteria and AC Impedance Spectroscopy (ACIS) device, on occlusal surfaces of primary molars. The occlusal surfaces of 18 extracted primary molars were examined blindly by two examiners. The teeth were sectioned and examined under light microscopy using Downer's histological criteria as gold standard. Good to excellent inter- and intraexaminer reproducibility, higher sensitivity, specificity, and AUC values were achieved by LPMLED at D1 threshold. Also the relationship between histology and LPMLED was statistically significant. In conclusion visual aids have the potential to improve the performance of early caries detection and clinical diagnostics in children. Despite its potential, ACIS device should be considered as an adjunct method in detecting caries on primary teeth.

Comparison of laser fluorescence devices for detection of caries in primary teeth

The aim of this in vivo study was to evaluate the performance of fluorescence-based devices in detecting occlusal caries lesions in primary molars compared with conventional methods. Two examiners assessed 44 occlusal surfaces of first and second primary molars in 20 patients using two fluorescence devices: DIAGNOdent (LF) and DIAGNOdent pen (LFpen). Teeth were also assessed by visual examination and bitewing radiograph. Histological examination served as the gold standard after extraction. By using the McNemar test, the sensitivity, specificity, accuracy, and area under the receiver operating curve were calculated as outer enamel (D1), inner enamel (D2) and dentine caries (D3) lesion thresholds. The intra- and inter-examiner reproducibility were calculated using the Cohen's unweighted kappa statistics. At the D1 threshold, the LFpen sensitivity was statistically higher than LF and radiographic examination (P < 0.001), whereas there was no statistically significant difference among the groups at the D2 and D3 thresholds (P > 0.05). All methods demonstrated the highest sensitivity values at D3. At the D1 and D2 thresholds, there were no significant differences between the LFpen specificity and the other methods. All methods presented similar performance in detecting all lesions considering the area under the receiver operating curve. The LFpen showed better performance than LF. Furthermore, visual examination and the LFpen device seem to be sufficient for detection of occlusal caries in primary molars.

Evaluation of a new fluorescence-based device in the detection of incipient occlusal caries lesions

The aim of this in vitro study was to evaluate the performance of various contemporary detection tools at incipient occlusal caries. Thirty eight freshly extracted posterior teeth with non-cavitated occlusal caries were subjected to clinical examination and coding according to ICDAS criteria (n = 38). Standardized fluorescence images were taken with VistaProof (Dürr Dental, Bietigheim-Bissingen, Germany). Furthermore, the teeth were calculated with a laser fluorescence pen device (DIAGNOdent pen, Kavo, Biberach, Germany). In all detection methods, assessment of caries was performed twice (with 1-week interval) by two calibrated examiners. Finally, the caries lesions were validated in tooth sections by histological examination. The intra-examiner and inter-examiner kappa coefficient, sensitivity, and specificity were determined for all detection methods at enamel lesions (D1 threshold). Degrees of agreement of each method with the histological status were calculated using receiver operating characteristic statistics and the area under curve (Az values). The kappa intra-examiner/inter-examiner coefficient values (mean ± SD) were 0.74 ± 0.04/0.73 ± 0.07, 0.87 ± 0.04/0.82 ± 0.07, and 0.91 ± 0.06/0.83 ± 0.08 for clinical examination, DIAGNOdent pen, and VistaProof, respectively. The sensitivity for ICDAS was 0.80-0.86, for DIAGNOdent pen was 0.66-0.75, and for the VistaProof device was 0.97. The specificity for all the detection methods were 0.5 (0.02-0.99). The accuracy value for ICDAS was 0.76-0.81, for DIAGNOdent pen 0.66-0.71, and for the VistaProof device 0.92-0.95. The Az values (mean ± SD) were 0.431 ± 0.187, 0.583 ± 0.215, and 0.486 ± 0.207 for ICDAS, DIAGNOdent pen, and VistaProof examination, respectively. No significant differences in Az values were noted among the methods. All detection methods were presented with high inter-examiner and intra-examiner agreement. The new VistaProof device showed the best sensitivity, while DIAGNOdent pen demonstrated the worst one. Specificities were the same for all detection methods. Moreover, they presented the same performance in detection of incipient occlusal caries.

Clinical Performance of Two Fluorescence-Based Methods in Detecting Occlusal Caries Lesions in Primary Teeth

This in vivo study aimed to evaluate the performance of 2 fluorescence-based methods in detecting occlusal caries lesions in primary teeth, compared with the performance of visual inspection and radiographic methods, and to propose a mathematic correction of the diagnostic parameters due to the imperfect reference standard method used in the study. Two examiners assessed the occlusal surfaces of 407 primary teeth (62 children) using visual inspection (ICDAS), radiographic, DIAGNOdent pen (pen type laser fluorescence; LFpen), and fluorescence camera (FC) methods. At the noncavitated threshold (NC) the reference standard method was the results of ICDAS, and at the dentine caries threshold (D3) teeth diagnosed with dentine caries by ICDAS or radiographic methods were subjected to operative treatment to confirm the presence of lesion. Reproducibility, sensitivity, specificity, accuracy, and the area under the ROC curve were calculated for the methods at both thresholds. At the NC threshold, LFpen had a slightly better performance compared to the FC and radiographic methods. However, at the D3 threshold, both fluorescence-based methods performed similarly. Visual inspection and radiographic methods presented higher specificities but lower sensitivities than fluorescence methods. After corrections, there was a significant decrease in some parameters. In conclusion, both fluorescence-based methods presented similar performance in detecting occlusal dentine caries lesions in primary teeth, but they usually gave more false-positive results than did the visual and radiographic methods. The correction proposed shows that the performance of the methods can be overestimated, and the correction should be validated and considered in further studies that use an imprecise reference standard method.

Performance of a fluorescence camera for detection of occlusal caries in vitro

The aim of this study was to assess inter- and intra-examiner reproducibility and accuracy in the detection and assessment of occlusal caries in extracted human teeth using the newly developed fluorescence based camera VistaProof. Serial sectioning and microscopy are considered the gold standard. The occlusal surfaces of 53 teeth (99 investigation sites) were examined by two examiners with different levels of experience in cariology (one experienced dentist, one final-year dental student) and the VistaProof. Thereafter, the teeth were serially sectioned and assessed for lesion depth. The intraclass correlation coefficients for inter- and intra-examiner reproducibility for the fluorescence-based examinations were 0.76-0.95. There was a significant correlation between the fluorescence and histological examinations for both examiners (r (s) = 0.47 and 0.55, P < 0.01). At the D₁ diagnostic threshold (enamel and dentin lesions), sensitivity was 0.71-0.86 and specificity was between 0.32 and 0.76 at different cutoff values. At the D₃ diagnostic threshold (dentin lesions), sensitivity was 0.04-0.91 and specificity was 0.56-0.99 for both examiners. When the areas under the receiver-operating characteristic curves were compared, there was no significant difference in the performance between the examiners (P = 0.52 at the D₁ threshold, P = 0.81 at the D₃ threshold). The VistaProof demonstrated high reproducibility and good diagnostic performance for the detection of occlusal caries at various stages of the disease process. Novice and experienced examiners were able to apply this system as a supportive device for caries diagnostic and monitoring purposes. Sensitivity and specificity values varied depending on the cutoff values.

Validity and reliability of methods for the detection of secondary caries around amalgam restorations in primary teeth

Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods--visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination--for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.

In vitro Comparison of Nyvad’s System and ICDAS-II with Lesion Activity Assessment for Evaluation of Severity and Activity of Occlusal Caries Lesions in Primary Teeth

This in vitro study of occlusal surfaces on primary molars aimed to: (1) evaluate the reproducibility of the Nyvad and ICDAS-II visual systems in detecting caries; (2) to test the accuracy of the systems in estimating lesion depth, and (3) to examine the association between the Nyvad system and the Lesion Activity Assessment system, an adjunct to ICDAS-II. Two samples of extracted primary molars (sample 1, n = 38; sample 2, n = 69) were evaluated independently by 2 examiners. In this in vitro study, evaluation of plaque in the Nyvad system was not possible. Histology (sample 2) was used to validate lesion depth. Area under ROC curves (A_z), sensitivity, specificity and percent agreement of both systems were calculated at D1, D2 and D3 thresholds. Both systems showed kappa for intra- and inter-examiner agreement >0.86 and good correlation with histology: Spearman ρ = 0.73 (Nyvad) and 0.78 (ICDAS-II). They presented similar performances except that ICDAS-II showed significantly higher sensitivity (Nyvad 0.89; ICDAS 0.92) and A_z (Nyvad 0.85; ICDAS 0.90) for the D1 threshold. The correlation between the systems for lesion activity (Cramer’s V) was 0.71. Therefore, both visual systems are reliable and can estimate caries lesion depth on primary teeth. Under in vitro conditions, there is no major difference between the Nyvad system and Lesion Activity Assessment in assessing caries activity.

An in vivo investigation of associations between saliva properties, caries prevalence and potential lesion activity in an adult UK population

Objective To investigate associations between prevalence and activity of intra-oral incipient, carious lesions and salivary properties tested using the Saliva Check kit (GC Corp., Belgium). Methods With ethical approval, 58 subjects with >16 teeth underwent clinical/radiographic examination. Conventional decayed, missing, filled teeth/decayed, missing, filled surfaces (DMFT/DMFS) indices and a more recently developed visual index described by International Caries Detection and Assessment System (ICDAS) were used to ascertain caries prevalence. Potential lesion activity was scored using an Ekstrand visual index. Saliva properties tested included hydration, resting pH, stimulated flow and buffering capacity. Spearman's rank correlation was used to analyse data. Results No saliva parameters correlated significantly with DMFT/DMFS caries prevalence scores (D3 threshold). The resting pH correlated negatively and significantly with the total number of lesions ( r = −0.267, p = 0.043), with ICDAS scores >1 ( r = −0.333, p = 0.011) and with mild lesions ( r = −0.263, p = 0.046). A negative correlation was found between saliva buffering capacity and the potential activity of moderate lesions (ICDAS 3 and 4; r = −0.227, p = 0.035). Conclusions There appeared to be a correlation between the resting pH of saliva and the prevalence of early lesions as well as the saliva buffering capacity and the potential lesion activity of moderate lesions. A difference was shown between lesion prevalence calculated using traditional DMFT(S) D3 versus the ICDAS D1 thresholding.

In vivo evaluation of laser fluorescence performance using different cut-off limits for occlusal caries detection

The aim of this in vivo study was to evaluate the performance of laser fluorescence (LF) comparing different cut-off limits for occlusal caries detection. One hundred and thirty first permanent molars were selected. Visual examination and LF assessments were performed independently. The extent of caries was assessed after operative intervention. New cut-off limits were established and compared with those proposed by the manufacturer and by Lussi et al. (Eur J Oral Sci 109:14-19, 2001). Similar sensitivity and higher specificity was found at D(2) (considering as disease only dentin caries) when the LF cut-off limits proposed by Lussi et al. and the new one were compared. At the D(3) threshold (considering as disease only deep dentin caries), no statistically significant difference among the cut-off limits for sensitivity was found. However, the new cut-off limits showed higher specificity. The LF device provided good ability to detect dentin caries lesions. Furthermore, the new cut-off limits and the values proposed by Lussi et al. could be suggested for the in vivo detection of occlusal caries.

QCD sum rules study of the meson [formula omitted

We use QCD sum rules to study the recently observed meson Z+(4430), considered as a D∗D1 molecule with JP=0−. We consider the contributions of condensates up to dimension eight and work at leading order in αs. We get mZ=(4.40±0.10) GeV in a very good agreement with the experimental value. We also make predictions for the analogous mesons Zs and Zbb considered as Ds∗D1 and B∗B1 molecules, respectively. For Zs we predict mZs=(4.70±0.06) GeV, which is above the Ds∗D1 threshold, indicating that it is probably a very broad state and, therefore, difficult to observe experimentally. For Zbb we predict mZbb=(10.74±0.12) GeV, in agreement with quark model predictions.

Use of a ranked scoring system to detect occlusal caries in primary molars

The available literature concerning systems for occlusal caries detection in primary teeth is limited. The aim of this study was to compare in vitro a ranked scoring system for occlusal caries detection in primary molar teeth with bitewing radiography and to investigate the most accurate cut-off point for dentine caries detection when using this ranked scoring system. Sixty primary molar teeth were examined in vitro visually and by bitewing radiography (two examiners) using Ekstrand' criteria. Histological examination revealed that 13% were sound, 38% had enamel caries and the remainder had dentine caries. Similar accuracy was seen when comparing bitewing radiographs and visual examination for caries detection at the d3 threshold, while visual examination was more accurate at the d1 threshold. The most suitable cut-off for diagnosing caries at the d1 threshold was V1 (no/slight change in enamel translucency after air drying). Either V2 (opacity/discoloration visible without air drying) or V3 (enamel breakdown in opaque/discoloured enamel and/or greyish discoloration) were suitable cut-off points at the d3 threshold. Visual examination was more accurate than bitewing radiographs for detection at the d1 threshold (the cut-off point of V1). Either V2 or V3 can be used for caries detection at the d3 threshold.

Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions

To compare performance of visual inspection and Laser fluorescence methods to detect occlusal caries lesions under clinical and laboratory conditions in permanent teeth. One hundred and ten sites in 57 third molars scheduled for extraction were examined with visual inspection and laser fluorescence (DIAGNOdent) device by two trained examiners. After the extraction, teeth were re-examined. Then, teeth were sectioned to perform histological validation. Best cut-off points were calculated with ROC analysis, and sensitivity, specificity and accuracy were calculated at D2 and D3 thresholds. Comparisons between the methods and conditions of examination were performed using McNemar test. Inter-examiner agreement in the same conditions and agreement between the methods performed in vivo and in vitro conditions were assessed by Kappa test. Laser fluorescence values obtained in two conditions were compared with Wilcoxon test. No difference was observed with visual inspection in both conditions. Laser fluorescence performed in vitro presented higher specificity and accuracy at D3 threshold. Visual inspection showed higher reproducibility. After adjustment of cut-off points for laser fluorescence method, there was no difference between the evaluated parameters. Only slightly differences were observed between the examinations performed under clinical and laboratory conditions in the detection of occlusal caries lesions in permanent teeth.

Performance of DIAGNOdent for detection and quantification of smooth-surface caries in primary teeth

To evaluate the performance of the laser fluorescence device (DIAGNOdent) for detection and quantification of smooth-surface caries lesions in primary teeth. Seventy-seven approximal surfaces with no caries or with white spot caries lesions without cavitation was selected from 51 primary molars. Laser fluorescence readings were performed and the site of higher value in each surface was indicated. After the readings, the surfaces were cut and the samples were destined for histopathological and cross-sectional microhardness evaluation. ROC analysis was conducted and the area under the ROC curve and the best cut-off points were obtained at D1, D2 and D3 thresholds. With these cut-off values, the sensitivity, specificity and accuracy were calculated at these thresholds. The regression lines of laser fluorescence readings as function of lesion extension, lesion depth and cross-sectional microhardness values were plotted and the Pearson correlation coefficients were obtained. The best DIAGNOdent performance was obtained at D3 threshold (A(z)=0.90) and the worst performance was achieved at D1 threshold (A(z)=0.82). The correlation was better between the laser fluorescence readings and lesion depth obtained in polarized light microscope examination (r=0.78), than that obtained with the microhardness values (r=-0.57). The laser fluorescence shows a good performance to predict caries lesions extension. Device presents a better correlation with the lesion depth than with mineral loss in smooth-surface caries lesions.

Predicting the experience of dentinal caries or restorative dental treatment in adolescents using D1 and D3 visual caries assessments.

Standardised epidemiological caries assessments used in oral health surveys have been shown to be poor at predicting whether a tooth surface will be treated restoratively when a patient visits a dentist. However, it has been argued that oral health surveys may be more relevant in determining needs at the level of an individual or groups of individuals. The objective of this study was to determine the discriminatory power of visual caries assessments at two thresholds (D1 & D3) in adolescents of average age 12.1 years to predict experience of dentinal caries 3 years later or the experience of restorative treatment (not re-treatment) during the 3-year period. The data was derived from a prospective 3-year longitudinal study in which the dental care provided by 41 dentists for 403 adolescents was monitored. Dental caries experience was monitored by annual standardised assessments of caries undertaken by a single trained examiner. ROC analysis showed that caries assessed visually at the D1 threshold in 12-year-olds was a better predictor (P < 0.001) of experiencing some dentinal caries after 3 years (Az = 0.781) than was caries assessed visually at D3 threshold in 12-year-olds (Az = 0.670). Assessing caries visually at either the D1 or the D3 threshold had no discriminatory power for predicting whether an individual would experience some restorative treatment during the ensuing 3-year period (Az for D1 = 0.507; Az for D3 = 0.518).

Clinical Diagnosis of Dental Caries: A European Perspective

The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.