The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service.
The Finnish Defence Forces' unique oral health-screening protocol (FDFsp) has been in use for decades. In FDFsp, restorative treatment need is determined based on the World Health Organization (WHO) criteria. The aim of this study was to compare the outcome of screening restorative treatment need with the outcome of using the International Caries Detection and Assessment System (ICDAS) classification at both individual and tooth levels. Our hypothesis was that the outcome of screening with FDFsp agrees with the outcome of using the ICDAS classification.
In this study, a trained, calibrated examiner estimated, in a visual-tactile manner the restorative treatment need of 337 young healthy adults using the FDFsp. During the screening, 74 conscripts were selected for a thorough inspection. The inclusion criteria for those selected were: having no, having one to five, or having six or more caries lesions needing restorative treatment. In the thorough inspection, the participants were inspected in a visual-tactile manner using the ICDAS classification. The association of the outcomes achieved using the two different methods was analysed at individual and tooth levels. Sensitivity, specificity, and kappa values were calculated. Wisdom teeth were excluded.
At the individual level, the agreement between the outcomes of using FDFsp and ICDAS =4 was excellent: sensitivity, 94.1%; specificity, 97.5%; and kappa = 0.92. When ICDAS =3 was used, the values were 72.7%, 96.7%, and 0.66%, respectively.
Screening performed by a trained examiner using specific criteria is a reliable method for detecting individuals with restorative treatment need. The outcome of screening agrees strongly with results using the ICDAS classification.
The objective of this review is to describe and discuss the content validity of a sample of caries detection criteria reported in the literature between January 1, 1966, and May 1, 2000. Using filters to locate randomized or controlled clinical trials on dental caries, fluorides, sealants, and "restorative" care, I identified a total of 171 documents from MEDLINE and the Cochrane Collaboration's Oral Health Group (CC-OHG) special register. These articles met the following inclusion criteria: (1) Data had been collected from samples of patients or populations; and (2) dental caries was assessed clinically, and criteria were either published or described in the paper. From the selected articles, evidence tables were prepared describing each caries detection criterion. Analysis of the content validity of the criteria systems was based on evaluation of the disease process, exclusion of non-caries lesions, subjectivity, use of explorers, and drying of teeth prior to examination. This review included 29 unique criteria systems. Of those, 13 originated from the UK, 3 from the USA, 4 from Denmark, and others from the World Health Organization (WHO), Sweden, Switzerland, Norway, Netherlands, and Canada. Thirteen of the criteria systems either measured active and inactive early and cavitated lesions or defined separate criteria for smooth and occlusal tooth surfaces. Nine systems measured early as well as cavitated stages of the caries process, and 7 measured cavitation only. Eleven of the criteria systems provided explicit descriptions of the disease process measured or information on how to exclude non-caries from caries lesions. The use of explorers and drying and cleaning of teeth varied widely among the criteria. The majority of the newly developed criteria systems originated from Europe. In conclusion, this review of the content validity of the 29 criteria systems found substantial variability in disease processes measured, inclusion and exclusion criteria, and examination conditions.