Understanding dentists' caries management: The COM-B ICCMS™ questionnaire

The professional perception of the International Caries Classification and Management System (ICCMS): a pragmatic randomised clinical trial

Introduction The International Caries Classification and Management System (ICCMS) was developed to standardise caries diagnosis, risk assessment and treatment decisions based on overall evidence. To evaluate its criteria in practice, a clinical trial assessed professionals' perceptions of two caries management systems.Methods A perception questionnaire was administered to two groups: one using ICCMS criteria and the other based on professional experience criteria (non-ICCMS group). The online questionnaire included quantitative scale questions to measure effort and satisfaction and two open-ended questions to collect the positive and negative perceptions of dentists by using either criteria system. The questionnaires were administered six months after the study's implementation.Results Both groups showed high levels of effort and satisfaction. Professionals using ICCMS reported more positive perceptions by citing improved diagnosis (71.4%) and standardised patient care (43%). However, they also noted negative aspects, such as increased number of questionnaires and records (58%), longer clinical sessions (43%) and higher rates of patient absenteeism (29%).Conclusion Professionals who used the ICCMS had a positive outlook on the system, with benefits seen in diagnosis and patient monitoring. However, there is room for improvement in terms of automation and simplification to enhance the professional use of the system in the clinical setting.

Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study

PURPOSE

 There are unfavorable opinions connected with rubber dam isolation amongst dental students during adhesive restorative treatments. The aim of this study was to investigate the various barriers to practicing rubber dam isolation during dental procedures and provide necessary insight towards implementation of rubber dam among undergraduate dental students in Jazan.

MATERIALS AND METHODS

 A pre-validated questionnaire in English entitled Rubber Dam Isolation Survey (E-RDIS) based on the Capability Opportunity Motivation-Behaviour (COM-B) model of behavioral change wheel was responded by 226 university dental students.

RESULTS

 The satisfaction of training was highest among sixth year students (Mean=3.57, p<0.001). Fourth year dental students scored higher in the capability (Mean=3.18) and were more highly motivated to use rubber dams (Mean=4.21). Third year students were more likely to use rubber dams in anterior teeth (Mean=3.52) whereas fourth year students use rubber dam in posterior teeth (Mean=3.74). Lack of motivation was found to be the significant barrier influencing rubber dam usage (odds ratio (OR)=12.1; 3.74, p<0.05).

CONCLUSION

 The satisfaction with training differed among the students of different years. The rubber dam technique might be used more frequently if it were made clear to students that mastering it would be necessary for them to receive good grades.

How do dental practitioners, educators and students diagnose and manage caries risk and caries lesions? A COM-B analysis

OBJECTIVE

The International Caries Classification and Management System (ICCMS™), a comprehensive, evidence-informed, best clinical practice system, comprises a 4D cycle: 1D-Determine risk; 2D-Detect and assess lesions; 3D-Decide on a personalized care plan; and 4D-Do preventive and tooth-preserving care. The aim of this study was to establish how Colombian dental practitioners, educators and students diagnose and manage caries risk and caries lesions using the COM-B model and the ICCMS™ system.

METHODS

A total of 1094 participants (practitioners: n = 277; educators: n = 212; students: n = 605) completed a previously validated 79-item questionnaire which explores, based on the COM-B model, the practitioners' self-reported caries diagnosis and management behaviours. Descriptive statistics, Welch's ANOVAs and multiple linear regressions were computed.

RESULTS

All groups generally performed the behaviours within the 4-D categories 'Most of the time' to 'Always' (students: 4.06 ± 0.95; educators: 3.94 ± 0.98; practitioners: 3.86 ± 1.01). The most frequently performed diagnosis behaviours (1D/2D) were for practitioners assessing initial/moderate lesions (4.09 ± 1.01) and for educators and students cleaning teeth before lesion assessment (4.41 ± 0.80 and 4.38 ± 0.77 respectively). The least frequently performed decision/management (3D/4D) behaviour was non-operative care for moderate-caries lesions (when applicable) (practitioners: 2.64 ± 1.23; educators: 2.68 ± 1.17; students: 3.22 ± 1.41). Opportunity (Resources and Relevance) was the best COM-B predictor for diagnostic behaviours, whereas capability and opportunity (Relevance) were the strongest predictors for management behaviours.

CONCLUSION

Colombian practitioners, educators and students diagnose and manage caries risk and caries lesions implementing best practice with a high to very high frequency.

Special Care Patients and Caries Prevalence in Permanent Dentition: A Systematic Review

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.

Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial

OBJECTIVE

This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments.

MATERIAL AND METHODS

With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed.

RESULTS

Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15).

CONCLUSION

Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.

From 'ICDAS' to 'CariesCare International': the 20-year journey building international consensus to take caries evidence into clinical practice

This paper charts the 20-year collaborative journey made by international teams of dental researchers, educators and practitioners. Following the initial development of the International Caries Detection and Assessment System (ICDAS) in 2002, the International Caries Classification and Management System (ICCMS) was collaboratively developed between 2010-2017 with several dental research and practice organisations, and influenced by best evidence judged via SIGN methodology, the UNEP Minamata Treaty (and linked phasing down of dental amalgam), three Dental Policy Labs and an international movement in operative dentistry to move towards minimally invasive dentistry. The FDI World Dental Federation publicised and advocated the ICCMS in 2019, when the 'CariesCare International' Consensus Guide and 4D caries management system was published to aid the delivery of ICCMS into practice. This system, which is designed to help practitioners deliver optimal caries care for patients, is now being adapted internationally for post-pandemic use in the 'Caries OUT' study. It is also being used as a vehicle for implementing the updated Delivering better oral health guidance on caries, as part of the minimum intervention oral healthcare delivery framework in the UK.

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

Background

Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time.

Methods

In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate.

Discussion

The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.

Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01674-1.

Rubber Dam Isolation Survey (RDIS) for adhesive restorative treatments

INTRODUCTION

Rubber dam isolation is considered as an essential component of modern adhesive dentistry. However, dental students do not always use it due to several barriers they face on their clinical practice. The aim of this study was to design and validate a questionnaire based on the COM-B model to measure students' implementation of rubber dam isolation in restorative treatments with adhesive materials.

MATERIALS AND METHODS

A 7-item questionnaire was developed based on the COM-B model, with questions measuring the Capability, Opportunity (Relevance and Resources), and Motivation to perform rubber dam isolation (Behaviour). Content validation of the questionnaire was conducted by experts in aesthetic/restorative dentistry that assessed the clarity, coherence and relevance of the questions. The final survey was administered to a dental student population from three large private universities in the Dominican Republic. Descriptive analysis, t tests, polychoric correlations and a path analysis were carried out to establish the validity of the instrument.

RESULTS

A total of 382 students from three universities completed the questionnaire. According to the COM-B path model, the significant predictors of the implementation of rubber dam isolation were Capability and Motivation for University A, Motivation and Opportunity-Resources for University B, and Opportunity-Relevance and Capability for University C.

CONCLUSIONS

The RDIS is a very short, easy to administer and valid questionnaire that can be applied by the universities to determine where they need to focus their interventions to achieve better rubber dam isolation implementation by their students.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study

INTRODUCTION

COVID-19 has impacted dentistry in unprecedented ways.

OBJECTIVE

The following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire.

BASIC RESEARCH DESIGN

An online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed.

RESULTS

The great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term.

CONCLUSIONS

Respondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes.

CLINICAL SIGNIFICANCE

COVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the 'new normal'. Assessing the results could be useful in informing support strategies moving forward.

The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study

Background

The diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The influence of using ICDAS on caries treatment recommendations has received increasing attention in recent years. Therefore, the aim of this study was to assess the impact of ICDAS on dentists’ occlusal caries lesions’ treatment decisions for patients at high risk for caries.

Methods

Five dentists examined the occlusal surfaces of 270 extracted premolars and permanent molars. For a predetermined clinical scenario, the examiners were asked to indicate their treatment recommendations for each tooth. Four weeks later, all the examiners were trained and calibrated for the use of ICDAS. Then the investigators examined the same 270 teeth independently and indicated their treatment recommendations using the same clinical scenario. Histological validation was used to determine the caries lesions detection performance of the examiners using ICDAS and to assess the relationship between the presence of dentin caries and treatment recommendations for each examiner before and after ICDAS training. Specificity, sensitivity, area under the receiver operating characteristic curve (AUC), and Spearman’s correlation coefficients were calculated. The Wilcoxon two-related sample rank test was used to test for differences between treatment recommendations.

Results

The strongest correlation for inter-examiner reproducibility was found between the ICDAS D2 cut-off point (ICDAS codes 3–6 as dentin caries) and histologic dentin caries. Treatment recommendations among different examiners before and after ICDAS training demonstrated a statistically significant increase in operative intervention and an increase in the percentage of overtreatment recommendations for two examiners.

Conclusions

The impact of ICDAS on the examiners’ caries lesion treatment recommendations varied among the dentists in this study. Treatment decision-making can be influenced by the caries lesion’s detection and classification system used.