Cristiana Tengan

A new approach for interexaminer reliability data analysis on dental caries calibration

Objectives a) to evaluate the interexaminer reliability in caries detection considering different diagnostic thresholds and b) to indicate, by using Kappa statistics, the best way of measuring interexaminer agreement during the calibration process in dental caries surveys. Methods Eleven dentists participated in the initial training, which was divided into theoretical discussions and practical activities, and calibration exercises, performed at baseline, 3 and 6 months after the initial training. For the examinations of 6-7-year-old schoolchildren, the World Health Organization (WHO) recommendations were followed and different diagnostic thresholds were used: WHO (decayed/missing/filled teeth – DMFT index) and WHO + IL (initial lesion) diagnostic thresholds. The interexaminer reliability was calculated by Kappa statistics, according to WHO and WHO+IL thresholds considering: a) the entire dentition; b) upper/lower jaws; c) sextants; d) each tooth individually. Results Interexaminer reliability was high for both diagnostic thresholds; nevertheless, it decreased in all calibration sections when considering teeth individually. Conclusion The interexaminer reliability was possible during the period of 6 months, under both caries diagnosis thresholds. However, great disagreement was observed for posterior teeth, especially using the WHO+IL criteria. Analysis considering dental elements individually was the best way of detecting interexaminer disagreement during the calibration sections.

Diagnóstico e decisão de tratamento das lesões de cárie proximais

As lesoes de carie incipientes localizadas nas superficies proximais sao, na maioria das vezes, de dificil diagnostico durante o exame clinico convencional, que determina a utilizacao de recursos diagnosticos adicionais. O objetivo deste trabalho foi descrever os metodos de diagnostico mais comumente utilizados em superficies proximais, como a inspecao visual, o exame radiografico, a separacao interdental e a transiluminacao por fibra optica, bem como tecer consideracoes a respeito da decisao de tratamento para as lesoes de carie localizadas nesses sitios. A presenca de perdas minerais nessa regiao pode ser detectada por meio do exame radiografico ou da transiluminacao por fibra optica (FOTI). A separacao dental temporaria pode fornecer informacoes sobre a presenca ou nao de cavitacao clinica e das caracteristicas da lesao presente na area de contato (atividade da doenca). Somando-se a essas informacoes, dados como a presenca de placa bacteriana e sangramento da papila adjacente sao sugestivos de atividade da doenca na regiao. Recomenda-se que a terapeutica restauradora somente seja instituida quando as lesoes de carie proximais estiverem cavitadas e localizadas na metade interna da dentina, ou na metade externa da dentina se houver retencao de placa, dificultando o controle por parte do paciente.