Dental Caries And Treatment Needs In Adolescents From The State Of Sao Paulo, Brazil

Objective: To estimate the prevalence of dental caries and treatment needs in 12-year-olds and adolescents. Methods: Cross-sectional study based on results from the epidemiological surveys: Oral Health Conditions in the State of Sao Paulo, 2002 and the Brazilian Oral Health Survey (SBBrasil) 2010. Secondary data for 5,782 (2002) and 369 (2010) 12-year-olds and 880 (2002) and 300 (2010) 15-to 19-year-olds were analyzed. Dental caries attack was evaluated using the DMFT (decayed, missing or fi lled teeth) index and the need for treatment verifi ed using the criteria proposed by the World Health Organization. The Signifi cant Caries Index was used to measure the severity of the decay in the tercile of the group with the highest prevalence of the disease. In order to analyze the results, the Chi-squared and Mann-Whitney tests were used, with a 5% signifi cance. Results: There was a decrease of 39.3 percentage points in the DMFT index for 12-year-olds (p < 0.001) and of 41.1 percentage points for the adolescents (p < 0.001) between 2002 and 2010, and an increase of around 161.0 and 303.0 percentage in the group which was free from dental caries respectively. The percentage of restored teeth decreased in both age groups, although the prevalence of dental caries did not change in the group more affected by dental caries. In the group with few dental caries, there was a decrease in the component 'tooth loss' for adolescents and increase in the component 'decayed teeth' for the 12-yearsold and the adolescents. There was an increase in the need for dental treatment in the group as a whole and in the group of 12-year-olds more affected by dental caries; and among the adolescents, the need for restoration on two or more surface decreased in the group as a whole and also in the group which suffered least from dental caries. Conclusions: The decreasing need for non-complex treatment in adolescents suggests that promotion and prevention activities are having a positive effect on this group. Moreover, the two epidemiological surveys in the state of Sao Paulo show improvements in oral health conditions in both age groups studied and calls for monitoring aimed also at the group least affected by dental caries.47SUPPL.35058Al-Haddad, K.A., Al-Hebshi, N.N., Ak'hali, M.S., Oral health status and treatment needs among school children in Sana'a City, Yemen (2010) Int J Dent Hyg., 8 (2), pp. 80-85. , DOI: 10.1111/j.1601-5037.2009.00398.xArmfield, J.M., Spencer, A.J., Slade, G.D., Changing inequalities in the distribution of caries associated with improving child oral health in Australia (2009) J Public Health Dent., 69 (2), pp. 125-134. , Pesquisa Nacional de Saúde Bucal (SBBrasil) DOI: 10.1111/j.1752-7325.2008.00110.xBagramian, R.A., Franklin, G.G., Anthony, R.V., The global increase in dental caries (2009) A pending public health crisis. Am J Dent., 22 (1), pp. 3-8Bratthall, D., Introducing the Signifi cant Caries Index together with a proposal for a new global oral health goal for 12-year-olds (2000) Int Dent J., 50 (6), pp. 378-384. , DOI: 10.1111/j.1875-595X.2000.tb00572.xCampus, G., Sacco, G., Cagetti, M., Abati, S., Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children (2007) BMC Public Health., 7, p. 28Constante, H.M., Bastos, J.L., Peres, M.A., Trends in dental caries in 12-and 13-year-old schoolchildren from Florianópolis between 1971 and 2009 (2010) Braz J Oral Sci., 9 (3), pp. 410-414Davies, G.M., Jones, C.M., Monaghan, N., Morgan, M.Z., Neville, J.S., Pitts, N.B., The caries experience of 11 to 12 year-old children in Scotland and Wales and 12 year-olds in England in 2008-2009: reports of co-ordinated surveys using BASCD methodology (2012) Community Dent Health., 29 (1), pp. 8-13. , DOI: 10.1111/j.1471-4159.2012.07745.xDash, J.K., Sahoo, P.K., Bhuyan, S.K., Sahoo, S.K., Prevalence of dental caries and treatment needs among children of Cuttack (Orissa) (2002) J Indian Soc Pedo Prev Dent., 20 (4), pp. 139-143Ditmyer, M., Dounis, G., Mobley, C., Schwarz, E., Inequalities of caries experience in Nevada youth expressed by DMFT index vs (2011) Signifi cant Caries Index (SiC) over time. BMC Oral Health., 11, p. 12. , DOI: 10.1186/1472-6831-11-12Do, L.G., Distribution of caries in children: Variations between and within Populations (2012) J Dent Res., 91 (6), pp. 536-543. , DOI: 10.1177/0022034511434355Duraiswamy, P., Kumar, T.S., Dagli, R.J., Chandrakant, K.S., Dental caries experience and treatment needs of green marble mine laborers in Udaipur district, Rajasthan, India (2008) Indian J Dent Res., 19 (4), pp. 331-334. , DOI: 10.4103/0970-9290.44537Dye, B.A., Arevalo, O., Vargas, C.M., Trends in paediatric dental caries by poverty status in the United States, 1988-1994 and 1999-2004 (2010) Int J Paediatr Dent., 20 (2), pp. 132-143. , DOI: 10.1111/j.1365-263X.2009.01029.xFrias, A.C., Antunes, J.L.F., Narvai, P.C., Precisão e validade de levantamentos epidemiológicos em saúde bucal: cárie dentária na Cidade de São Paulo, 2002 (2004) Rev Bras Epidemiol., 7 (2), pp. 144-154. , DOI: 10.1590/S1415-790X2004000200004Gushi, L.L., Soares, M.C., Forni, T.I.B., Vieira, V., Wada, R.S., Sousa, M.L.R., Cárie dentária em adolescents de 15 a 19 anos de idade no Estado de São Paulo, Brasil, 2002 (2005) Cad Saude Publica., 21 (5), pp. 1383-1391. , DOI: 10.1590/S0102-311X2005000500010Gushi, L.L., Rihs, L.B., Soares, M.C., Forni, T.I.B., Vieira, V., Wada, R.S., Cárie dentária e necessidades de tratamento em adolescentes do estado de São Paulo, 1998 e 2002 (2008) Rev Saude Publica., 42 (3), pp. 480-486. , DOI: 10.1590/S0034-89102008005000015Kulkami, S.S., Deshpande, S.D., Caries prevalence and treatment needs in 11-15 year old children of Belgaum city (2002) J Indian Soc Prev Dent., 20 (1), pp. 12-15Martins, R.J., Garbin, C.A.S., Garbin, A.J.I., Moimaz, S.A.S., Saliba, O., Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004 (2006) Cad Saude Publica., 22 (5), pp. 1035-1041. , DOI: 10.1590/S0102-311X2006000500016Mashoto, K.O., Astrom, A.N., Skeie, M.S., Masalu, J.R., Socio-demographic disparity in oral health among the poor: a cross sectional study of early adolescentes in Kilwa district, Tanzania (2010) BMC Oral Health., 10, p. 7. , DOI: 10.1186/1472-6831-10-7Narvai, P.C., Frazão, P., Roncalli, A.G., Antunes, J.L.F., Cárie dentária no Brasil: declínio, iniqüidade e exclusão social (2006) Rev Panam Salud Publica., 19 (6), pp. 385-393. , DOI: 10.1590/S1020-49892006000600004Piovesan, C., Mendes, F.M., Antunes, J.P.F., Ardenghi, T.M., Inequalities in the distribution of dental caries among 12-year-old Brazilian schoolchildren (2011) Braz Oral Res., 25 (1), pp. 69-75. , DOI: 10.1590/S1806-83242011000100012Rihs, L.B., Sousa, M.L.R., Cypriano, S., Abdalla, N.M., Desigualdades na distribuição da cárie dentária em adolescents de Indaiatuba (SP), 2004 (2010) Cienc Saude Coletiva., 15 (4), pp. 2173-2180. , DOI: 10.1590/S1413-81232010000400031Schulte, A.G., Momeni, A., Pieper, K., Caries prevalence in 12-year-old children from Germany (2006) Results of the 2004 national survey. Community Dent Health., 23 (4), pp. 197-202. , DOI: 10.1590/S1413-81232010000400031Steiner, M., Menghini, G., Marthaler, T.M., Imfeld, T., Changes in dental caries in Zurich school-children over a period of 45 years (2010) Schweiz Monatsschr Zahnmed., 120 (12), pp. 1084-1104Tang, J., Yu, Y., Ma, Y., The Epidemic Tendency of Dental Caries Prevalence of School Students from 1991 to 2005 in China (2010) J Huazhong Univ Sci Technol., 30 (1), pp. 132-137. , DOI: 10.1007/s11596-010-0124-2Umesi-Koleoso, D.C., Ayanbadejo, P.O., Oremosu, O.A., Dental caries trend among adolescents in Lagos, Southwest Nigeria (2007) WAJM., 26 (3), pp. 201-205Oral health surveys: basic methods (1997), World Health Organization. 4. ed. Genev

Dental caries and treatment needs in adolescents from the state of Sao Paulo, Brazil

OBJECTIVE: To estimate the prevalence of dental caries and treatment needs in 12-year-olds and adolescents. METHODS: Cross-sectional study based on results from the epidemiological surveys: Oral Health Conditions in the State of Sao Paulo, 2002 and the Brazilian Oral Health Survey (SBBrasil) 2010. Secondary data for 5,782 (2002) and 369 (2010) 12-year-olds and 880 (2002) and 300 (2010) 15- to 19-year-olds were analyzed. Dental caries attack was evaluated using the DMFT (decayed, missing or filled teeth) index and the need for treatment verified using the criteria proposed by the World Health Organization. The Significant Caries Index was used to measure the severity of the decay in the tercile of the group with the highest prevalence of the disease. In order to analyze the results, the Chi-squared and Mann-Whitney tests were used, with a 5% significance. RESULTS: There was a decrease of 39.3 percentage points in the DMFT index for 12-year-olds (p &lt; 0.001) and of 41.1 percentage points for the adolescents (p &lt; 0.001) between 2002 and 2010, and an increase of around 161.0 and 303.0 percentage in the group which was free from dental caries respectively. The percentage of restored teeth decreased in both age groups, although the prevalence of dental caries did not change in the group more affected by dental caries. In the group with few dental caries, there was a decrease in the component &#8216;tooth loss&#8217; for adolescents and increase in the component &#8216;decayed teeth&#8217; for the 12-years-old and the adolescents. There was an increase in the need for dental treatment in the group as a whole and in the group of 12-year-olds more affected by dental caries; and among the adolescents, the need for restoration on two or more surface decreased in the group as a whole and also in the group which suffered least from dental caries. CONCLUSIONS: The decreasing need for non-complex treatment in adolescents suggests that promotion and prevention activities are having a positive effect on this group. Moreover, the two epidemiological surveys in the state of Sao Paulo show improvements in oral health conditions in both age groups studied and calls for monitoring aimed also at the group least affected by dental caries.OBJETIVO: Estimar a prevalência de cárie dentária e necessidades de tratamento em crianças de 12 anos e adolescentes. MÉTODOS: Estudo transversal com base nos resultados dos levantamentos epidemiológicos Condições de Saúde Bucal no Estado de São Paulo em 2002 e Pesquisa Nacional de Saúde Bucal (SBBrasil) 2010. Foram analisados os dados secundários de 5.782 crianças (2002) de 12 anos e outras 369 (2010); e para a faixa de 15 a 19 anos foram analisados 880 jovens (2002) e 300 jovens em 2010. A experiência de cárie foi avaliada pelo índice CPOD (dentes cariados, perdidos e obturados) e foram verificadas as necessidades de tratamento odontológico segundo os critérios propostos pela Organização Mundial da Saúde. O índice Significant Caries Index foi empregado para medir a severidade da cárie no terço do grupo que apresentou maior prevalência da doença. Para a análise dos resultados utilizaram-se os testes de Qui-quadrado e Mann-Whitney, com nível de 5% de significância. RESULTADOS: Houve diminuição de 39,3 pontos percentuais no índice CPOD aos 12 anos (p < 0,001) e de 41,1 pontos percentuais nos adolescentes (p < 0,001) entre 2002 e 2010, e aumento de aproximadamente 161,0 pontos percentuais e 303,0 pontos percentuais no grupo livres de cárie, respectivamente. A porcentagem de dentes restaurados diminuiu nos dois grupos etários, mas a prevalência de dentes cariados não se alterou para o grupo de alta experiência de cárie. No grupo de baixa experiência de cárie ocorreu diminuição do componente perdido para os adolescentes e aumento do componente cariado aos 12 anos e adolescentes. Houve aumento da necessidade de tratamento endodôntico no grupo total e no de alta experiência de cárie aos 12 anos; e entre os adolescentes a necessidade de restauração de duas ou mais faces diminuiu no grupo todo e também no de baixa experiência. CONCLUSÕES: A diminuição da necessidade de tratamento de baixa complexidade entre adolescentes sugere que as ações de promoção e prevenção estão afetando positivamente esse grupo. Além disso, os dois levantamentos epidemiológicos no estado de São Paulo mostram melhorias na condição de saúde bucal dos grupos etários estudados e que se faz necessário o monitoramento direcionado também para o grupo de baixa experiência de cárie.OBJETIVO: Estimar la prevalencia de caries dentaria y necesidades de tratamiento en ni&#241;os de 12 a&#241;os y adolescentes. M&#201;TODOS: Estudio transversal con base en los resultados de las pesquisas epidemiol&#243;gicas de las Condiciones de Salud Bucal en el Estado de Sao Paulo en 2002 y Proyecto SBBrasil2010. Se analizaron los datos secundarios de 5.782 ni&#241;os (2002) de 12 a&#241;os y 369 (2010); y para el grupo etario de 15 a 19 a&#241;os se analizaron 880 j&#243;venes (2002) y 300 j&#243;venes en 2010. La experiencia de caries fue evaluada por el &#237;ndice CPOD (dientes cariados, perdidos y obturados) y se verificaron las necesidades de tratamiento odontol&#243;gico seg&#250;n los criterios propuestos por la Organizaci&#243;n Mundial de la Salud. El &#237;ndice Significant Caries Index fue empleado para medir la severidad de la caries en el tercio del grupo que present&#243; mayor prevalencia de la enfermedad. Para el an&#225;lisis de los resultados se utilizaron las pruebas de Chi-cuadrado y Mann-Whitney, con nivel de 5% de significancia. RESULTADOS: Hubo disminuci&#243;n de 39,3 puntos porcentuales en el &#237;ndice CPOD a los 12 a&#241;os (p&lt;0,001) y de 41,1 puntos porcentuales en los adolescentes (p&lt;0,001) entre 2002 y 2010 y aumento de aproximadamente 161,0 puntos porcentuales y 303,0 puntos porcentuales en el grupo libres de caries, respectivamente. El porcentaje de dientes restaurados disminuy&#243; en los dos grupos etarios, pero la prevalencia de dientes cariados no se alter&#243; para el grupo con alta experiencia de caries. En el grupo con baja experiencia de caries ocurri&#243; disminuci&#243;n del componente perdido para los adolescentes y aumento del componente cariado para los de 12 a&#241;os y adolescentes. Hubo aumento de la necesidad de tratamiento endod&#243;ntico en el grupo total y en el de alta experiencia de caries a los 12 a&#241;os; y entre los adolescentes la necesidad de restauraci&#243;n de dos o m&#225;s faces disminuy&#243; en el grupo todo y tambi&#233;n en el de baja experiencia. CONCLUSIONES: La disminuci&#243;n de la necesidad de tratamiento de baja complejidad entre adolescentes sugiere que las acciones de promoci&#243;n y prevenci&#243;n est&#225;n afectando positivamente este grupo. As&#237; mismo, las dos pesquisas epidemiol&#243;gicas en el estado de Sao Paulo muestran mejor&#237;as en la condici&#243;n de salud bucal de los grupos etarios estudiados y que se hace necesario el monitoreo direccionado para el grupo de baja experiencia de caries.505

Dental caries trends among preschool children in Indaiatuba, SP, Brazil

AIM:To evaluate caries experience and associated factors in 5-year-old preschool children in the city of Indaiatuba, SP, Brazil.METHODS:This was a cross-sectional, representative study, conducted from an epidemiological oral health survey (2010) with 303 children. The sample was established by the systematic probabilistic method, in public and private schools, in accordance with WHO criteria. The sample was checked for caries experience (dmft) by four trained and calibrated dentists, reaching acceptable levels of agreement for data collection. Parents or guardians answered questions related to their education and monthly income, and the children answered questions related to dental care and pain. Descriptive and bivariate analyses of independent variables were performed. Variables with p&lt;0.20 were included in the model (Poisson regression analysis).RESULTS:The sample consisted of 151 boys and 152 girls, with a mean dmft of 1.46. The reasons for visiting a dentist due to pain or need for treatment were associated with dmft &gt; 0 (PR=3.76, 95%CI=2.06-6.84) after adjustment of the regression model.CONCLUSIONS:Among the preschool children of this study, pain or need for treatment due to caries disease in the primary dentition and the reason to visit the dentist due pain emphasizing the importance of the professional not only in curative actions, but as a health promoter at the first contact with the child.1

RELATO DE CASO SOBRE O USO DA ACUPUNTURA NO TRATAMENTO DA DOR OROFACIAL

A DTM (Disfuno temporomandibular) considerada uma doena de etiologia multifatorial. Seus sintomas mais comuns so dor funcional da mandbula, cefaleia, tenso muscular na regio cervical, limitao na abertura da boca, desvio mandibular. Os tratamentos mais indicados so as terapias no invasivas e reversveis. Acupuntura tem se mostrado to eficiente no controle de dores facial quanto as terapias convencionais, principalmente, tratando-se de dores de origem muscular. Acupuntura uma terapia chinesa milenar que consiste na insero de agulhas descartveis para promover o equilbrio das energias que circulam pelo corpo humano. Este trabalho descreve o caso clnico da paciente C. G., 29 anos, que apresentava dor generalizada na face ao acordar, desgastes nas superfcies dentrias oclusais, tenso muscular na regio cervical. O tratamento foi realizado de acordo com o desequilbrio energtico apresentado pela paciente, que desde a primeira sesso relatou diminuio da sintomatologia

Effects of the intervention of the Multicenter Study IDEFICS on the prevalence of caries in Spanish children

Aim: To evaluate the effects of an intervention for the prevention of obesity on the prevalence of dental caries disease in Spanish children. Methods: Two cities participated intervention study nested in a cohort IDEFICS (Identification and prevention of dietary and lifestyle induced health effects in children and infants): Huesca, where there was a 2-year intervention, which encouraged less sugar consumption; and Zaragoza (control). The prevalence of caries was evaluated by examining the 1st permanent molars in the 7-11 age range, using the ICDAS (International Caries Detection and Assessment System). These teeth erupt at 6 years of age and at the baseline (2007-2008) were free of caries because they were not present in the oral cavity. As outcomes, white spots were selected, combining the ICDAS criteria 1 and 2, and untreated caries, combining criteria 4, 5 and 6. Their association with socioeconomic variables, BMI (Body Mass Index), frequency of sugar intake, sex and parents’ perceptions of their children, was investigated. To do so, the chi-square test was applied (p&lt;0.05). Results: The sample consisted of 281 children. The prevalence of white spots and untreated caries was higher in Huesca, despite the intervention. There was no association between the outcomes and the variables studied (p&gt;0.05). Conclusion: The intervention for the prevention of obesity did not exert any association with the prevalence of caries in Spanish children

Cárie dentária, alterações de esmalte e necessidades de tratamento em pré-escolares e escolares de Araras, SP

The aim of this cross-sectional study was to describe the prevalence of dental caries and enamel defects, such as hypoplasia, demarcated opacity and fl uorosis, as well as to report the treatment needs in 5-year-old pre-schoolchildren and 12-year-old schoolchildren, from Araras, São Paulo State, Brazil, in 2004. The probabilistic sample consisted of 382 5-year-old pre-schoolchildren (n=186) and 12-year-old schoolchildren (n=196). The epidemiologicalexaminations were performed by four calibrated examiners, under natural light, using mirrors and “ball point” probes, following the WHO recommendations. Dental caries was recorded using dmft and DMFT indexes. Fluorosis was recorded following the Dean index in 12-yearolds. The results showed that the dmft index in 5 year-olds was 1.74 (dp=3.04) and that the DMFT in 12-year-olds was 1.58 (dp=2.39). Among the 5- and 12-year-old children, 52.2% and 42.3% were caries free, respectively. Approximately one third of examined children presented signs of caries activity. The one surface fi lling was the most required treatment in both pre-schoolchildren (42.1%) and schoolchildren (39.0%). The demarcated enamel opacity was detected in 65.4% of pre-schoolchildren and 14.4% of schoolchildren and the hypoplasia in 5.9% and 1.5%, respectively. Regarding fl uorosis, 18% of 12-year-olds presented enamel disturb. The results indicate that the pre-schoolchildren and schoolchildren examined presented treatment needs of low complexity, since the proportion of caries free was high and the disease activity was low.O objetivo deste estudo transversal foi descrever a prevalência de cárie dentária, hipoplasia, fluorose e opacidade demarcada de esmalte, assim como relatar as necessidades de tratamento em pré-escolares de 5 anos e de escolares de 12 anos, do município de Araras, em 2004. A amostra probabilística consistiu de 381 indivíduos, sendo 186 pré-escolares de 5 anos e 195 escolares de 12 anos. Os exames epidemiológicos foram realizados por quatro examinadores previamente calibrados, sob luz natural, utilizando-se espelho bucal sonda “ball point”, seguindo as recomendações da OMS. Cárie dentária foi registrada utilizando-se os índices ceod e CPOD. As lesões sem cavidades ativas, necessidades de tratamento, hipoplasia e opacidade demarcada também foram avaliadas. A fluorose foi registrada seguindo o Índice de Dean nos escolares de 12 anos. Os resultados mostraram que o índice ceod aos 5 anos foi 2,07 (dp=3,21) e o CPOD aos 12 anos foi de 2,14 (dp=2,56). Dentre as crianças de 5 e 12 anos examinadas, 52,2% e 42,3% estavam livres de cárie, respectivamente. Aproximadamente um terço dos examinados apresentaram sinais de atividade de cárie. As restaurações de uma face foram as necessidades de tratamento predominantes tanto nos pré-escolares (42,1%) quanto nos escolares (39,0%). A opacidade demarcada esteve presente em 65,1% dos pré-escolares e 14,4% dos escolares; a hipoplasia em 5,9% e 1,5%, respectivamente e 18% dos escolares de 12 anos apresentaram fluorose. Pode-se concluir que os pré-escolares e os escolares examinados apresentaram necessidades de baixa complexidade, uma vez que a proporção de livres de cárie foi alta e a atividade da doença foi baixa

Fluorescence devices for the detection of dental caries

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non‐invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence‐based devices. There are three categories of fluorescence‐based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence‐based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a fluorescence‐based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity‐specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta‐analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta‐analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non‐generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta‐regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi(2) = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS: There is considerable variation in the performance of these fluorescence‐based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence‐based devices appeared to outperform red fluorescence‐based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta‐analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies

Using laser fluorescence (DIAGNOdent) in surveys for the detection of noncavitated occlusal dentine caries

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Objective The aim of this study was to evaluate the use of the DIAGNOdent system in epidemiological studies to detect noncavitated occlusal caries lesions, and compare the results with those found in radiographic examinations. Methods The sample consisted of 1,290 occlusal surfaces of permanent molars, examined in 179 schoolchildren aged 12-15 years. The methods used were: visual inspection, radiographic examination and DIAGNOdent exam, with radiographic examination being considered the gold standard, and noncavitated caries lesions identified in dentin under sound enamel. The inclusion criterion of this study was to have sound occlusal surfaces on visual inspection. The sensitivity and specificity, positive and negative predictive values were used for statistical analysis. Results: Of the 1,290 surfaces examined during visual inspection, 918 were scored as clinically sound. Of these, 789 were examined by radiographic examination and DIAGNOdent, considering that in more than half of them (410) there were coincident results in the absence of noncavitated lesion in both methods (radiographic examination by DIAGNOdent), with specificity of 74% and negative predictive values of 82% and 155 coincident surfaces with presence of caries, with sensitivity of 64% and positive predictor values of 53% for DIAGNOdent. Conclusion These results suggest that although DIAGNOdent is not a substitute method for the radiographic examination in surveys, it may be an alternative as an auxiliary to visual inspection.2811721Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP