C Deery

The Effect of Placing a Clear Pit and Fissure Sealant on the Validity and Reproducibility of Occlusal Caries Diagnosis

The purpose of this in vitro study was to assess the validity and reproducibility of the diagnosis of fissure caries prior to and following the placement of a clear sealant. One hundred and twelve extracted molar teeth were examined by 7 experienced clinicians. Each examiner conducted four visual examinations, 2 prior to and 2 after sealing, allowing an assessment of reproducibility. The teeth were subsequently serially sectioned to provide the histological validation. After placement of a sealant, a significant (p < 0.05) loss of sensitivity was found for the diagnosis of enamel lesions and dentine lesions, but specificity was not altered. The overall reproducibility expressed by the kappa statistic was 0.60 and 0.47, before and after sealing, respectively. The examiners significantly (p < 0.001) underestimated the severity of lesions detected after sealing compared to their assessment prior to sealing. The investigation suggests that sealed surfaces require careful assessment and monitoring.

Prevalence of Dental Caries in Latvian 11– to 15–Year–Old Children and the Enhanced Diagnostic Yield of Temporary Tooth Separation, FOTI and Electronic Caries Measurement

The aim of this study was to test the feasibility of employing clinical visual examination at the D1 (enamel and dentine caries) diagnostic threshold, fibre–optic transillumination (FOTI), elective temporary tooth separation (ETTS) and electronic caries measurement (ECM) in the environment of an epidemiological study or clinical trial. It also aimed to compare the diagnostic yield of these diagnostic aides and methods. The sample consisted of 182 Latvian children, mean age 13.3 years (range = 10.6–15.7). For 12–year–old subjects the mean D3MFS was 10.58 (SD 6.05) and the mean D1MFS was 19.97 (SD 10.47). The additional diagnostic yield from FOTI examination of approximal sites was 40.0% at the D1 threshold. The additional apparent yield for ETTS was 52.8% at the D1 threshold. ETTS detected 38.3% more carious surfaces than FOTI at the D1 threshold. Conversely 57 surfaces thought to be carious on FOTI examination were judged sound following ETTS. Although the ECM appeared practical to use, it broke early in the trial and the results obtained prior to breakdown appeared inaccurate. In conclusion, all diagnostic methods were feasible under the conditions of an epidemiological study or clinical trial.

A proposed method for assessing the quality of sealants – the CCC Sealant Evaluation System

OBJECTIVES The aim of this paper is to introduce the C (colour) C (coverage) C (caries) Sealant Evaluation System and to present results of its use on a sample of adolescent patients in Scotland. METHODS Baseline data are presented from a 3-year prospective study in general dental practices across Scotland. Subjects were examined under standardised conditions by one trained and calibrated examiner. RESULTS 78.6% of the subjects had one or more sealed teeth, over half of these sealants being judged inadequate. There was a low prevalence of dentine caries associated with the sealed teeth (2.8%). The CCC sealant Evaluation System proved practical as demonstrated by its use during the project and had substantial intra-examiner reproducibility. CONCLUSIONS There was a high level of sealant provision; however, this provision may not be optimal in terms of both targeting of provision and sealant maintenance. The CCC sealant Evaluation System appeared to be a useful assessment tool for assessing sealed surfaces.

General dental practitioners diagnostic and treatment decisions related to fissure sealed surfaces

OBJECTIVES The purpose of this in-vitro study was to assess the validity and reproducibility of the diagnosis and treatment planned for occlusal surfaces prior to and following the placement of a clear sealant by a sample of general dental practitioners (GDPs). METHODS 160 permanent posterior teeth were examined by 25 GDPs. The GDPs were not given any criteria and were therefore free to diagnose and plan care, as they felt appropriate. Each GDP conducted four examinations, two prior to and two after sealing. The teeth were serially sectioned to provide the validating criterion. RESULTS After sealant placement, there was a statistically significant increase in specificity and decrease in sensitivity of both diagnostic and treatment decisions. The reproducibility expressed by the kappa-statistic was of the order of 0.5 prior to and after sealing with regard to diagnostic decisions. There was a general tendency to diagnose less disease after placement of a sealant (P<0. 001). There was also significantly less care (preventive or restorative) planned after sealant placement (P<0.001). CONCLUSIONS The placement of a sealant resulted in the diagnosis of less disease and less restorative treatment. This may be appropriate as evidence exists to support the use of sealants as caries therapeutic agents.