Experienced Dentists Research Articles

Near-infrared light reflection for the early detection of proximal caries in posterior teeth: an in vivo study

BackgroundThe purpose of this study was to evaluate the validity of near-infrared light reflection for detecting different depths of proximal caries in posterior teeth and to compare it with commonly used clinical oral examinations and bitewing radiography images.MethodsTwenty-six patients with a total of 516 proximal surfaces were included in this study. The ground truth of the proximal caries was determined through a consensus reached by two experienced dentists after an intraoral examination assisted by bitewing radiographs. Two general dentists assessed the condition of proximal caries on posterior teeth on near-infrared light reflection images. Accuracy, sensitivity, and specificity were evaluated to determine the diagnostic efficacy of near-infrared light reflection for detecting proximal caries in posterior teeth.ResultsFor posterior teeth, the accuracy of near-infrared light reflection was 0.78, with a sensitivity of 0.44 and a specificity of 0.83. Cohen’s kappa showed poor consistency between the two diagnostic methods, near-infrared light reflection and bitewing radiography.ConclusionNear-infrared light reflection is an effective clinical tool for detecting proximal caries in posterior teeth, yet this method does not demonstrate superiority over traditional methods such as bitewing radiography.Trial registrationThe clinical trial was registered with the China Clinical Trial Registry (https://www.chictr.org.cn/) on 18 August 2023 under the trial number ChiCTR2300074877.

Performance comparison in workflow efficiency between a remotely installed 3D workstation and an on-premises image processing workstation for dental cone-beam CT image reconstruction.

This study aims to compare the image processing times of dental cone beam CT (CBCT) images using a remote medical image processing workstation (RW) versus on-premises image processing (OP) and assess its impact on workflow efficiency. Data from 100 CBCT cases were randomly selected and processed using the OP3D VISION 17-19DX (EH Japan Co., Ltd.). In the OP environment, OnDemand 3D Dental (Cybermed Inc.) was used on a local terminal, while the RW setup involved a remote workstation-ZIO STATION (Ziosoft Inc.) connected via a 2 Gbps network. Seven experienced dentists processed the same data in both environments, and various processing times, including data transfer, re-slicing, 3D reconstruction, and PACS transfer, were compared. The RW environment showed significantly shorter data transfer and re-slicing times than the OP environment. However, 3D image reconstruction times were similar between the two setups. Overall, processing time was significantly reduced in the RW environment. Variability in processing times among operators was observed, with most achieving reductions in the RW environment. Remote processing of dental CBCT images using a dedicated image processing device offers equivalent or improved performance compared to on-premises processing. This approach can enhance workflow efficiency by reducing processing times and freeing up local resources, although further research is needed to optimize remote display protocols and multi-client access.

Novel pain assessment tool specific for pulp symptoms to aid diagnosis.

Although many pain assessment tools exist, none are specific to the relatively unique presentation of pulpal pain. The aim of this study was to develop and validate a novel pain assessment tool based on pulp symptoms. A preliminary list of items best-describing pulpitis was developed based on deductive and inductive approaches and the preliminary tool was piloted (n = 80). A final 11-item pain assessment tool was developed comprising 5 closed-ended items evaluating pain intensity to diverse stimuli (thermal and sweet) and 6 closed-ended items assessing various aspects of pulp pain (such as spontaneity, duration, referral, postural pain, pain upon biting and requirement for analgesics). The tool was tested on 300 adult patients (age range = 18-54 years) who presented with symptoms indicating some form of pulpitis. The 11 items were each scored from 1 to 4, yielding a total score between 11 and 44. These scores were subsequently compared to a set of diagnoses made utilizing established clinical reference standards, these include patient history, clinical examination, periapical radiographs, and pulp testing. All items in the tool reached an excellent content validity index score (≥0.83) for relevance. Following the pilot, six items were rephrased and five were removed. After final testing the constructed tool had a reliability coefficient of .8641, indicating a high level of internal consistency. Factor analysis extracted two factors that accounted for 59.61% of variance. The sensitivity and specificity was 95.36% and 86.58%, respectively. Likelihood ratio was 7.104 (LR+) and 0.05 (LR-) at cut-off point. The area under the ROC curve was 0.9714 with a SE of 0.0076. The cut off score by Youden index was 25 between reversible and irreversible pulpitis. The developed tool proved to be both valid and reliable. It is the first comprehensive multidimensional tool designed to standardize the pulp pain assessment protocol, covering various attributes of pulp pain and effectively distinguishing between reversible and irreversible pulpitis with a defined cut-off score. Furthermore, its use is anticipated to provide support in diagnosing ambiguous cases of inflamed pulp, which is especially helpful for less experienced dentists.

Radiation dose and image quality in pediatric bitewing imaging.

Bitewing examinations are used to examine the pediatric dental status. The aim of this study was to compare the image quality and radiation dose between two different X-ray systems used for pediatric bitewing imaging. Data were obtained from both pediatric in vivo bitewing studies and phantom studies. Two X-ray systems were used: Trophy CCX digital (TCCX) (Trophy Irix 70, Marne-la-Vallee, France) and Planmeca Pro X (PPX) (Planmeca, Helsinki, Finland). An Unfors dosimeter (Unfors EDD-30, Billdal, Sweden) was used to measure the skin dose. Image quality was evaluated blindly by three experienced dentists using a Likert scale of 1-5 based on the visual representation of the anatomical structures with emphasis on caries. The highest scoring in vivo bitewing images were obtained with TCCX, but the skin dose was 36% higher (mean 3029±613 μGy) and 113% higher (mean 1364±276 μGy) with standard settings than with compared to PPX. The evaluation of image quality revealed a higher median value for all ratings of TCCX compared to PPX for both the patient and phantom studies, meaning that the images of TCCX were rated as higher quality than the images from PPX. No correlation was found between the median score and the skin dose or between the median score and the exposure times. A significant difference in radiation dose and image quality was found between TCCX and PPX in bitewing imaging. TCCX generally produced higher doses and better graded images, although all images were suitable for diagnosis.

Development of Periapical Index Score Classification System in Periapical Radiographs Using Deep Learning.

Periapical index (PAI) scoring system is the most popular index for evaluating apical periodontitis (AP) on radiographs. It provides an ordinal scale of 1 to 5, ranging from healthy to severe AP. Scoring PAI is a time-consuming process and requires experienced dentists; thus, deep learning has been applied to hasten the process. However, most models failed to score the early stage of AP or the score 2 accurately since it shares very similar characteristics with its adjacent scores. In this study, we developed and compared binary classification methods for PAI scores which were normality classification method and health-disease classification method. The normality classification method classified PAI score 1 as Normal and Abnormal for the rest of the scores while the health-disease method classified PAI scores 1 and 2 as Healthy and Diseased for the rest of the scores. A total of 2266 periapical root areas (PRAs) from 520 periapical radiographs (Pas) were selected and scored by experts. GoogLeNet, AlexNet, and ResNet convolutional neural networks (CNNs) were used in this study. Trained models' performances were evaluated and then compared. The models in the normality classification method achieved the highest accuracy of 75.00%, while the health-disease method models performed better with the highest accuracy of 83.33%. In conclusion, CNN models performed better in classification when grouping PAI scores 1 and 2 together in the same class, supporting the health-disease PAI scoring usage in clinical practice.

Overdiagnosis of dental caries in South Korea: a pseudo-patient study

BackgroundTo evaluates the tendency of South Korean dentists to over-diagnose clinically healthy teeth in pseudo-patients.MethodsWe conducted a pseudo-patient, cross-sectional study in 196 private dental clinics with 58 pseudo-patients in South Korea between August and December 2018. Trained pseudo-patients with no previous oral diseases, including dental caries, diagnosed by two experienced dentists, were sent to each dental clinic. Before visiting each private dental clinic, participants were instructed to state, “I have no symptoms, but I would like to have a dental caries examination”. The oral examination was performed using visual and tactile inspection methods only. The interactions between the dental clinic staff and the pseudo-patient were documented on a data collection form shortly after each visit.ResultsIn 33.2% (65/196) of these interactions, the pseudo-patients were diagnosed as having no dental caries. 11.7% (23/196), 12.8% (25/196), 10.7% (21/196), and 10.7% (21/196) of the sample were diagnosed with dental caries in one, two, three, and four teeth, respectively. Dentists diagnosed five or more dental caries in 20.9% (41/196) of the sample. 196 dental clinics diagnosed a total of 503 dental caries. Of these, 392 were in molars. Small solo practice dentists diagnosed 3.54 dental caries and large group practice dentists 1.57, but the difference was not significant (p = 0.07). The recommendation rate for dental caries treatment was highest among 43 (55.1%) large solo practices, and lowest in 7 (33.3%) large group practices. However, small solo practices had the lowest rate of preventive care recommendations at 12 (30.8%) and 10 (47.6%) in large group practices. The data shows that preventive care recommendations increased as the practice size increased.ConclusionThe study findings indicate that Korean dentists tend to over-diagnose dental caries, which could pose a threat to public health both in Korea and worldwide. Therefore, it is important to carefully consider strategies to improve the correct diagnosis and standard of care for dental caries by private dentists.

Developing an AI-based application for caries index detection on intraoral photographs.

This study evaluates the effectiveness of an Artificial Intelligence (AI)-based smartphone application designed for decay detection on intraoral photographs, comparing its performance to that of junior dentists. Conducted at The Aga Khan University Hospital, Karachi, Pakistan, this study utilized a dataset comprising 7,465 intraoral images, including both primary and secondary dentitions. These images were meticulously annotated by two experienced dentists and further verified by senior dentists. A YOLOv5s model was trained on this dataset and integrated into a smartphone application, while a Detection Transformer was also fine-tuned for comparative purposes. Explainable AI techniques were employed to assess the AI's decision-making processes. A sample of 70 photographs was used to directly compare the application's performance with that of junior dentists. Results showed that the YOLOv5s-based smartphone application achieved a precision of 90.7%, sensitivity of 85.6%, and an F1 score of 88.0% in detecting dental decay. In contrast, junior dentists achieved 83.3% precision, 64.1% sensitivity, and an F1 score of 72.4%. The study concludes that the YOLOv5s algorithm effectively detects dental decay on intraoral photographs and performs comparably to junior dentists. This application holds potential for aiding in the evaluation of the caries index within populations, thus contributing to efforts aimed at reducing the disease burden at the community level.

'Feeling more like a mechanic' - A qualitative study on experiences of caries prevention to patients with recurrent cavities among experienced dentists.

To explore experiences of caries prevention in adult patients with recurrent cavities among experienced dentists. Method: Five focus group discussions consisting of seven men and nine women, 38-61 years of age, and with working experience as dentists between 5 and 35 years, were conducted. The participants represented Public Dental Health Service clinics and private practitioners. Qualitative content analysis was used to analyze data. Results: The participants emphasized the importance of effective communication and patient engagement in caries prevention. They described their experiences as an endless trail, making fillings. They expressed their inability to take necessary responsibility and being stuck in the dental care system due to various circumstances. The understanding of caries was contradictory, and an inadequate mandate to control time to fulfill their preventive work was evident. They felt responsible to do the best for their patients, but how to share responsibility with colleagues and patients and having enough time for this seemed difficult and unclear. These problems did not motivate to further education in cariology. The findings underscore the urgent need for improvement in preventive caries treatment and the necessity of allocating sufficient time for dentists to engage in this crucial aspect of their work.

A Data-Driven Approach Identifies Subtypes of Caries From Dental Charting.

The objectives were to: (i) assess the accuracy of dental data for adults obtained from the Swedish Quality Register on Caries and Periodontitis (SKaPa); (ii) explore whether Latent Class Analysis (LCA) can identify groups of people based on caries data; and (iii) characterise the dental, medical and behavioural characteristics of people in the LCA-derived classes. Caries data from the SKaPa register were compared with clinical data collected by five experienced dentists in a nested subgroup of the Malmö Offspring Study (MOS), namely the Malmö Offspring Dental Study (MODS) (n = 724) for validation. Dental data from SKaPa were then used to classify 61 984 adult participants of the Västerbotten Intervention Programme (VIP) into five classes using LCA and DMFS-based quintile ranking, respectively. Dental status (including caries progression over 5 years), medical, anthropometric and behavioural characteristics were compared between the groups. Analyses were replicated in 2767 adults in the MOS. DMFS-scores and number of teeth recorded within -2 to +2 years showed excellent agreement between the SKaPa and reference data with intra-class correlations > 0.90. The five LCA classes differed in mean DMFS from 10.0 to 94.4. There were strong associations between LCA class and health, and health and behavioural measures respectively, including some associations that were not detected using DMFS-ranked quintile groups. LCA class was associated with incremental change in DMFS, DFS, and number of teeth. The results in the MOS cohort were consistent with the results in the VIP cohort. Dental data for adults from the SKaPa registry were considered accurate within 2 years of recording. The LCA approach can classify participants into caries subtypes based on dental charting. These groups differ in health and behavioural characteristics and future caries increment. The LCA approach may capture some information that is missing from DMFS-ranked quintile groups, but is also heavily influenced by total DMFS, meaning that applying LCA in cumulative, highly age-determined diseases, such as caries, is a challenge.

Evaluation of DIAGNOdent pen for initial occlusal caries diagnosis in permanent teeth

BackgroundTo verify the validity of diagnosing initial caries on occlusal surface of permanent posterior teeth by laser fluorescence instrument DIAGNOdent pen.MethodsPatients from School of Stomatology in Wuhan University were selected and their posterior teeth were examined using DIAGNOdent pen and the International Caries Detection and Assessment System (ICDAS II) by an experienced dentist. After teeth extraction, histological criteria were used to determine the severity of the lesions. The sensitivity, specificity, accuracy, the area under the curve (AUC), and correlation of DIAGNOdent pen and ICDAS II were analyzed compared with histological criteria. Examiners’ agreement was measured.ResultsThe sensitivity range was 0.440-1 while that of specificity was 0.750–0.994. The accuracy and AUC were above 80% and 0.7 respectively. Consistency of examiners’ kappa values of ICDAS II, DIAGNOdent pen, and histological criteria were ranged from 0.629 to 0.840.ConclusionsICDAS II and DIAGNOdent pen can be effectively used in tandem or independently for the assessment of initial caries.

Periodontitis diagnosis: A review of current and future trends in artificial intelligence.

Artificial intelligence (AI) acts as the state-of-the-art in periodontitis diagnosis in dentistry. Current diagnostic challenges include errors due to a lack of experienced dentists, limited time for radiograph analysis, and mandatory reporting, impacting care quality, cost, and efficiency. This review aims to evaluate the current and future trends in AI for diagnosing periodontitis. A thorough literature review was conducted following PRISMA guidelines. We searched databases including PubMed, Scopus, Wiley Online Library, and ScienceDirect for studies published between January 2018 and December 2023. Keywords used in the search included "artificial intelligence," "panoramic radiograph," "periodontitis," "periodontal disease," and "diagnosis." The review included 12 studies from an initial 211 records. These studies used advanced models, particularly convolutional neural networks (CNNs), demonstrating accuracy rates for periodontal bone loss detection ranging from 0.76 to 0.98. Methodologies included deep learning hybrid methods, automated identification systems, and machine learning classifiers, enhancing diagnostic precision and efficiency. Integrating AI innovations in periodontitis diagnosis enhances diagnostic accuracy and efficiency, providing a robust alternative to conventional methods. These technologies offer quicker, less labor-intensive, and more precise alternatives to classical approaches. Future research should focus on improving AI model reliability and generalizability to ensure widespread clinical adoption.

Trigeminal n eu ra l gia diagnosis - a c ha l lenge - a cros s-se ct ional sur ve y to a ssess the k nowledge and a ttit ud e among t he dentists of S au di A ra bia.

To analyse the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia. The cross-sectional study was conducted from 17/12/ 2020 - 9/2/2021 at Prince Sat t am Bin Abdulaziz University, Al-Kharj, Riyadh Elm University, Riyadh, and Dar Al-Uloom University, Riyadh, Kingdom of Saud i Arabia. The sample comprised dentists and postgraduate dental students from every speciality. Data was collected online using a predesigned self-structured questionnaire consisting of three par ts, assessing knowledge, practice and attitude of the subjects. Data was analysed using SPSS 22. A total of 202 questionnaire about the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia were completed. The knowledge level was significantly higher in those senior age group compared to the young dentists with respect to the type of pain observed in TN, the unilateral pain of TN, and the abrupt, unexpected and transient nature of TN pain, local anaesthetic, the first-line treatment for TN, and the effect of TN on oral hygiene. Older and experienced dentists had more knowledge than younger and less experienced ones.

AI-initiated second opinions: a framework for advanced caries treatment planning

Integrating artificial intelligence (AI) into medical and dental applications can be challenging due to clinicians’ distrust of computer predictions and the potential risks associated with erroneous outputs. We introduce the idea of using AI to trigger second opinions in cases where there is a disagreement between the clinician and the algorithm. By keeping the AI prediction hidden throughout the diagnostic process, we minimize the risks associated with distrust and erroneous predictions, relying solely on human predictions. The experiment involved 3 experienced dentists, 25 dental students, and 290 patients treated for advanced caries across 6 centers. We developed an AI model to predict pulp status following advanced caries treatment. Clinicians were asked to perform the same prediction without the assistance of the AI model. The second opinion framework was tested in a 1000-trial simulation. The average F1-score of the clinicians increased significantly from 0.586 to 0.645.

The 24 months clinical evaluation of class II bulk fill composite restorations

Background: Resin Composite materials are widely used in daily clinical dentistry because of their moderate cost compared with ceramics, easy placement, adequate esthetics, ability to bond with enamel and dentine, and physico-chemical properties. Bulkfill composite materials were introduced to reduce chairside time. These materials have properties such as optimal bond strength, decreased polymerization shrinkage, and reduced cuspal deflection. This in-vivo study compared the clinical performance of three different class II resin composite restorations. Methods: Seventy-one patients (41 females and 30 males) aged 20–43 years with at least three approximal caries were included in the present study. Two hundred twenty-three teeth with approximal caries were restored with two bulk-fill composites (Tetric-N Ceram Bulk fill [TEC], Filtek Bulk Fill [FB]) and a posterior resin composite (Gradia Direct Posterior [GDP]). Two experienced dentists clinically evaluated the restorations with a 5x magnification loupe using the modified United States Public Health Service (USPHS) criteria at baseline and at 24 months. Results: The chi-square test was performed for statistical analysis. The cumulative retention rate for all restorations at 24 months was 90.5%. Retention loss was observed for three TEC (6.1%), four FB (8.2), and seven GDP (14%) restorations. There was no statistically significant difference among the three resin composite restoration groups in color match, marginal adaptation, surface roughness, marginal discoloration, anatomical form, and secondary caries criteria (P>0.05). Conclusion: Bulk-fill composite restorations in class II slot cavities have the same clinical results as traditional posterior composite restorations.

Studying eruption patterns of mandibular third molars for forensic age assessment: Introducing current reference data from a population of black South Africans

IntroductionEvaluation of the eruption of mandibular third molars in orthopantomograms (OPGs) is a method of forensic age assessment. The objective of our study was to provide valid reference data for this trait within a population of black South Africans. The study was guided by the criteria for reference studies in age assessment.Materials and methodsA study population from Pretoria, South Africa comprising 670 OPGs obtained from 338 black females and 332 black males aged between 15.00 and 25.97 years was analysed. All OPGs were performed for medical indication during the period from 2011 to 2022 and were retrospectively evaluated. From the 670 OPGs, a total of 1021 mandibular third molars were evaluated. The assessment of mandibular third molars was conducted using the staging scale presented by Olze et al. in 2012. Two experienced dentists evaluated the OPGs independently of each other. If the two examiners diverged in their assessments, a consensus stage was assigned.ResultsAs expected, the mean, median and minimal age increased with higher stages for both teeth and both sexes. The minimum age recorded for stage D, indicating complete tooth eruption, was 15.79 years in females and 16.62 years in males.ConclusionAs it is the case for previous reference studies in other countries, placing exclusive reliance on the evaluation of mandibular third molar eruption is inadequate for ascertaining the age of majority among Black South Africans. Future studies need to examine if our results are transferable to other countries in Sub-Saharan Africa.

3D intraoral scanning techniques support the effects of crown morphology on dental caries

BackgroundWith the development and utilization of three-dimensional (3D) intraoral scanning (IOS) technology, the morphological characteristics of teeth were quantitatively assessed. In this research, we aimed to explore the prevalence of dental caries in relation to each measurable morphological indicator of the tooth body via 3D intraoral scanning techniques.MethodsA hospital-based single-centre study was conducted at our hospital from Dec. 2021 to Apr. 2023. A total of 53 patients were involved in the study, providing complete morphological data for 79 teeth. Each patient completed an oral hygiene routine questionnaire and underwent examination by an experienced dentist to evaluate caries conditions before undergoing 3D intraoral scanning to obtain a digital dental model. Geomagic Studio 2014 was used to extract oral morphological data from the models. The acquired data were entered, cleaned and edited using Excel 2016 and subsequently exported to SPSS version 25.0 for analysis. Chi-square analysis and logistic regression analyses were employed to test the associations.ResultsAmong the participants, 33 (61.1%) were female, with a mean age of 26.52 ± 10.83 years. Significant associations were found between dental caries and the vertical distance between the distal tip and the gum (OR 14.02; 95% CI 1.80-109.07; P = 0.012), the distal lateral horizontal distance of occlusion (OR 0.40; 95% CI 0.18–0.90; P = 0.026), and the mesial horizontal distance of occlusion (OR 2.20; 95% CI 1.12–4.31; P = 0.021). The Hosmer–Lemeshow test indicated a P value of 0.33.ConclusionsThe vertical distance between the distal tip and the gum, the distal lateral horizontal distance of the occlusion and the mesial horizontal distance of the occlusion were the influencing factors for dental caries (identified as independent risk factors). We hypothesize that these factors may be associated with the physiological curvature of teeth and the role of chewing grooves in plaque formation over time. However, further studies involving larger population samples and more detailed age stratification are still needed.

Evaluation of body composition and bone mineral density in patients with and without idiopathic condylar resorption of temporomandibular disorders by dual energy X-ray absorptiometry

Background/purposeThe impact of temporomandibular joint (TMJ) osseous destruction on bone mineral density (BMD) remains unclear due to controversial findings. Besides, no previous study has explored the relationship between idiopathic condylar resorption (ICR) and body composition. This study aimed to investigate the relationship between ICR and BMD or body composition. Materials and methodsBetween July 2018 and August 2022, patients evaluated by an experienced dentist and diagnosed with temporomandibular disorders (TMDs) were referred to our center. They were recruited while they received the magnetic resonance image (MRI) examination, BMD and body composition completely. Patients were further categorized into TMDs with or without ICR groups according to MRI findings. One-way analysis of variance was used to compare the variables of BMD and body composition in the two groups. ResultsIn total, 67 patients were included in the analysis, with 42 categorized as TMDs with ICR and 25 as TMDs without ICR. Patients with ICR had a significantly higher lean mass percentage and lower fat mass percentage; lower android/gynoid fat ratio, and visceral adipose tissue area than those without ICR (P < 0.05). Besides, patients above age 30 with ICR had lower Z scores (P = 0.017) compared with subjects without ICR. ConclusionTMDs patients with ICR show a relationship with body composition and affect the lean and fat mass distribution, especially android/gynoid fat ratio. The pathophysiological mechanism remains unclear. Further researches to investigate teeth binding, malocclusion and dietary habits are important to understand the association of ICR, BMD and body composition.

Management of midline diastema using the direct composite resin technique - A case report

Diastema or space between the anterior teeth is a common aesthetic complaint of patients. Direct composite resins in midline diastema cases allow dentists to have complete control in formation of natural smiles. This case report describes midline diastema closure with esthetic composite layering technique. A 25-year-old male patient reported to the clinic, with a complaint of spacing in the upper front tooth region of the jaw. The direct aesthetic composite laminate veneer was considered as the treatment of choice for the build-up of both maxillary central incisors as a more conservative, inexpensive, aesthetic, and quicker option. A2 &amp; A3 shades were selected; prepared tooth surface was etched for 15 seconds using 37% phosphoric acid, rinsed with water for 20 seconds, and air dried with slight air pressure. Bonding agent was applied (Adper single Bond, 3M ESPE, USA) and cured for 20 seconds using (Vivadent Blue phase) curing light. The labial surface of the restoration was flattened using red banded knife-edge tip diamond bur. The natural look of the restored teeth was achieved after finishing and polishing. At six-month and one-year recalls the general outlook of the maxillary anterior teeth was considered natural and aesthetical. Clinically, both restorations have no fractures and also the restoration margins on both maxillary central incisors demonstrated no discolorations. By taking this into consideration and according to the positive results, an experienced dentist with proper case selection, using an appropriate technique and modern materials, can perform highly aesthetic and durable direct composite resin restorations that can satisfy patients as under the conditions of the case presented.

Is poor oral health a risk factor for idiopathic granulomatous mastitis?

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease that can be clinically and radiologically mistaken for carcinoma. Although its etiology remains uncertain, potential associations with pregnancy, lactation, hormonal imbalances, autoimmunity, smoking, and various microorganisms have been suggested. This study aimed to evaluate the relationship between IGM and oral health. We included 42 female patients diagnosed with IGM based on histopathological evaluations conducted between September 2018 and October 2023. The reference group consisted of 47 female patients with clinically, radiologically, and laboratory-proven non-specific mastitis and 36 healthy female individuals. The oral health of all participants was evaluated by an experienced dentist using the "Decayed, Missing and Filled Teeth" (DMFT) index and the "Simplified Oral Hygiene Index" (OHI-S). The ages of IGM patients included in this study ranged from 29 to 51 years, with a mean age of 34.88 ± 4.87 years. The most common clinical findings were pain (n = 38), palpable breast mass, erythema, induration, and dermal sinus. Comparison of the OHI-S and DMFT index values among participants revealed that those diagnosed with IGM had significantly higher values than those in the reference group (P < 0.05). Our findings suggest a potential involvement of poor oral health in the etiology of IGM. Future studies should consider oral health as a factor in IGM etiology and explore the oral microbiota in samples obtained from the affected tissue.

Automatic caries detection in bitewing radiographs—Part II: experimental comparison

ObjectiveThe objective of this study was to compare the detection of caries in bitewing radiographs by multiple dentists with an automatic method and to evaluate the detection performance in the absence of a reliable ground truth.Materials and methodsFour experts and three novices marked caries using bounding boxes in 100 bitewing radiographs. The same dataset was processed by an automatic object detection deep learning method. All annotators were compared in terms of the number of errors and intersection over union (IoU) using pairwise comparisons, with respect to the consensus standard, and with respect to the annotator of the training dataset of the automatic method.ResultsThe number of lesions marked by experts in 100 images varied between 241 and 425. Pairwise comparisons showed that the automatic method outperformed all dentists except the original annotator in the mean number of errors, while being among the best in terms of IoU. With respect to a consensus standard, the performance of the automatic method was best in terms of the number of errors and slightly below average in terms of IoU. Compared with the original annotator, the automatic method had the highest IoU and only one expert made fewer errors.ConclusionsThe automatic method consistently outperformed novices and performed as well as highly experienced dentists.Clinical significanceThe consensus in caries detection between experts is low. An automatic method based on deep learning can improve both the accuracy and repeatability of caries detection, providing a useful second opinion even for very experienced dentists.