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Abdelaziz M. Detection, Diagnosis, and Monitoring of Early Caries: The Future of Individualized Dental Care. Diagnostics (Basel) 2023; 13:3649. [PMID: 38132233 PMCID: PMC10742918 DOI: 10.3390/diagnostics13243649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Dental caries remains a significant global health issue. It was highlighted by the World Health Organization's 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists' approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.
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Affiliation(s)
- Marwa Abdelaziz
- Division of Cariology and Endodontology, Department of Preventive Dental Medicine and Primary Care, University Clinics of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
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Schwendicke F, Bombeck L. Cost-effectiveness of school-based caries screening using transillumination. J Dent 2023; 137:104635. [PMID: 37541420 DOI: 10.1016/j.jdent.2023.104635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES School-based screening for caries lesions usually only employs visual-tactile detection means (standard of care). Near-infrared-light-transillumination (NILT) could be used to support school-based screening and to identify early proximal caries, facilitating referral and appropriate non- or micro-invasive management in dental practice. METHOD We assessed the cost-effectiveness of NILT for school-based caries screening. A German mixed-payers' perspective was adopted. A Markov model was used to simulate the consequences of true and false positive and negative detections and the subsequent decisions over the lifetime of initially 12 years old patients. Our health outcome was tooth retention in years. Costs were measured in Euro 2020. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness-acceptability at different willingness-to-pay-thresholds were quantified. RESULTS NILT was minimally more effective (tooth retention for a mean (2.5-97.5%) 56 (53-59) years) and minimally less costly (515 (416-616) Euro) than standard of care (56 (50-59) years; 526 (427-628 Euro)). The ICER was -503 Euro/year, i.e. school-based caries screening using NILT saved money at higher effectiveness in the modelled population. The cost-effectiveness of NILT increased for payers with a willingness-to-pay for additional tooth retention time. The biggest driver of costs were (avoided) tooth replacements later in life. CONCLUSIONS NILT-based screening is likely to yield limited effectiveness gains and cost savings in the modelled populations. In countries where regular practice-based screening of children is less common than in Germany, the cost-effectiveness of NILT for school-based caries screening is likely higher. CLINICAL SIGNIFICANCE NILT-based caries screening in German schools is unlikely to be cost-effective. In countries with different utilization patterns or generally higher caries prevalence and risk, this may differ.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Lisa Bombeck
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
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Bruhnke M, Naumann M, Beuer F, Böse MWH, von Stein-Lausnitz M, Schwendicke F. Implant or tooth? - A cost-time analysis of managing "unrestorable" teeth ✰. J Dent 2023; 136:104646. [PMID: 37527727 DOI: 10.1016/j.jdent.2023.104646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Retaining and restoring severely compromised teeth with subcrestal defect extensions or removing and replacing them using implant-supported crowns (ISC) remains controversial, and economic analyses comparing both strategies remain scarce. We performed a cost-time analysis, comparing the expenditures for retaining "unrestorable" teeth using forced orthodontic extrusion and restoration (FOE) versus extraction and ISC, in a clinical prospective cohort study. METHODS Forty-two patients (n = 21 per group) were enrolled from clinical routine at a university into this study. Direct medical and indirect costs (opportunity costs) were assessed for all relevant steps (initial care, active care, restorative care, supportive care) using the private payer's perspective in German healthcare based on a micro-costing approach and/or national fee items. Statistical comparison was performed with Mann-Whitney-U test. RESULTS Patients were followed up for at least one year after initial treatment (n = 40). The drop-out rate was 5% (n = 2). Total direct medical costs were higher for ISC (median: 3439.05€) than FOE (median: 1601.46€) with p<0.001. We observed a higher number of appointments (p = 0.002) for ISC (median: 14.5) in comparison to FOE (median: 12), while cumulatively, FOE patients spent more time in treatment (median: 402.5 min) in comparison to ISC (median: 250 min) with p<0.001, resulting in comparable opportunity costs for both treatment groups (FOE: 304.50€; ISC: 328.98€). CONCLUSIONS ISC generated higher costs than FOE. More in-depth and long-term exploration of cost-effectiveness is warranted. CLINICAL SIGNIFICANCE ISCs were associated with higher initial medical costs and required more appointments than the restoration of severely compromised teeth after FOE. Treatment time was higher for patients with FOE, resulting in similar opportunity costs for both treatment approaches. Future research needs to investigate long-term cost-effectiveness.
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Affiliation(s)
- Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Manja von Stein-Lausnitz
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Bruhnke M, Naumann M, Böse MWH, Beuer F, Schwendicke F. Health economic evaluation of forced orthodontic extrusion of extensively damaged teeth: up to 6-year results from a clinical study. Clin Oral Investig 2023; 27:5587-5594. [PMID: 37498335 PMCID: PMC10492751 DOI: 10.1007/s00784-023-05178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Clinical data on retaining extensively damaged teeth using forced orthodontic extrusion followed by restorative rehabilitation are scarce, and economic evaluations are basically absent. A health economic evaluation of this method was performed based on a clinical study. MATERIALS AND METHODS In a convenience sample of individuals recruited from routine care, extensively damaged teeth were orthodontically extruded prior to restoration. Patients were followed up for up to 6 years. The health outcome was tooth retention time. Direct medical, non-medical, and indirect initial and follow-up costs were estimated using the private payer's perspective in German healthcare. Association of initial direct medical treatment costs and cofounding variables was analyzed using generalized linear models. Success and survival were secondary outcomes. RESULTS A total of 35 teeth in 30 patients were followed over a mean ± SD of 49 ± 19 months. Five patients (14%) dropped out during that period. Median initial costs were 1941€ (range: 1284-4392€), median costs for follow-up appointments were 215€ (range: 0-5812€), and median total costs were 2284€ (range: 1453 to 7109€). Endodontic re-treatment and placement of a post had a significant impact on total costs. Three teeth had to be extracted and in three patients orthodontic relapse was observed. The survival and success rates were 91% and 83%, respectively. CONCLUSIONS Within the limitations of this clinical study, total treatment costs for orthodontic extrusion and subsequent restoration of extensively damaged teeth were considerable. Costs were by large generated initially; endodontic and post-endodontic therapies were main drivers. Costs for retreatments due to complications were limited, as only few complications arose. CLINICAL RELEVANCE The restoration of extensively damaged teeth after forced orthodontic extrusion comes with considerable initial treatment costs, but low follow-up costs. Overall and over the observational period and within German healthcare, costs are below those for tooth replacement using implant-supported crowns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: DRK S00026697).
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Affiliation(s)
- Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Tabatabaian F, Vora SR, Mirabbasi S. Applications, functions, and accuracy of artificial intelligence in restorative dentistry: A literature review. J ESTHET RESTOR DENT 2023; 35:842-859. [PMID: 37522291 DOI: 10.1111/jerd.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The applications of artificial intelligence (AI) are increasing in restorative dentistry; however, the AI performance is unclear for dental professionals. The purpose of this narrative review was to evaluate the applications, functions, and accuracy of AI in diverse aspects of restorative dentistry including caries detection, tooth preparation margin detection, tooth restoration design, metal structure casting, dental restoration/implant detection, removable partial denture design, and tooth shade determination. OVERVIEW An electronic search was performed on Medline/PubMed, Embase, Web of Science, Cochrane, Scopus, and Google Scholar databases. English-language articles, published from January 1, 2000, to March 1, 2022, relevant to the aforementioned aspects were selected using the key terms of artificial intelligence, machine learning, deep learning, artificial neural networks, convolutional neural networks, clustering, soft computing, automated planning, computational learning, computer vision, and automated reasoning as inclusion criteria. A manual search was also performed. Therefore, 157 articles were included, reviewed, and discussed. CONCLUSIONS Based on the current literature, the AI models have shown promising performance in the mentioned aspects when being compared with traditional approaches in terms of accuracy; however, as these models are still in development, more studies are required to validate their accuracy and apply them to routine clinical practice. CLINICAL SIGNIFICANCE AI with its specific functions has shown successful applications with acceptable accuracy in diverse aspects of restorative dentistry. The understanding of these functions may lead to novel applications with optimal accuracy for AI in restorative dentistry.
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Affiliation(s)
- Farhad Tabatabaian
- Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Siddharth R Vora
- Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahriar Mirabbasi
- Department of Electrical and Computer Engineering, Faculty of Applied Science, The University of British Columbia, Vancouver, British Columbia, Canada
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Schwendicke F, Cejudo Grano de Oro J, Garcia Cantu A, Meyer-Lueckel H, Chaurasia A, Krois J. Artificial Intelligence for Caries Detection: Value of Data and Information. J Dent Res 2022; 101:1350-1356. [PMID: 35996332 PMCID: PMC9516598 DOI: 10.1177/00220345221113756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
If increasing practitioners’ diagnostic accuracy, medical artificial intelligence (AI)
may lead to better treatment decisions at lower costs, while uncertainty remains around
the resulting cost-effectiveness. In the present study, we assessed how enlarging the data
set used for training an AI for caries detection on bitewings affects cost-effectiveness
and also determined the value of information by reducing the uncertainty around other
input parameters (namely, the costs of AI and the population’s caries risk profile). We
employed a convolutional neural network and trained it on 10%, 25%, 50%, or 100% of a
labeled data set containing 29,011 teeth without and 19,760 teeth with caries lesions
stemming from bitewing radiographs. We employed an established health economic modeling
and analytical framework to quantify cost-effectiveness and value of information. We
adopted a mixed public–private payer perspective in German health care; the health outcome
was tooth retention years. A Markov model, allowing to follow posterior teeth over the
lifetime of an initially 12-y-old individual, and Monte Carlo microsimulations were
employed. With an increasing amount of data used to train the AI sensitivity and
specificity increased nonlinearly, increasing the data set from 10% to 25% had the largest
impact on accuracy and, consequently, cost-effectiveness. In the base-case scenario, AI
was more effective (tooth retention for a mean [2.5%–97.5%] 62.8 [59.2–65.5] y) and less
costly (378 [284–499] euros) than dentists without AI (60.4 [55.8–64.4] y; 419 [270–593]
euros), with considerable uncertainty. The economic value of reducing the uncertainty
around AI’s accuracy or costs was limited, while information on the population’s risk
profile was more relevant. When developing dental AI, informed choices about the data set
size may be recommended, and research toward individualized application of AI for caries
detection seems warranted to optimize cost-effectiveness.
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Affiliation(s)
- F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Cejudo Grano de Oro
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Garcia Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Bern, Switzerland
| | - A Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - J Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Gomez Rossi J, Rojas-Perilla N, Krois J, Schwendicke F. Cost-effectiveness of Artificial Intelligence as a Decision-Support System Applied to the Detection and Grading of Melanoma, Dental Caries, and Diabetic Retinopathy. JAMA Netw Open 2022; 5:e220269. [PMID: 35289862 PMCID: PMC8924723 DOI: 10.1001/jamanetworkopen.2022.0269] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of artificial intelligence (AI) for supporting clinicians in detecting and grading diseases in dermatology, dentistry, and ophthalmology. IMPORTANCE AI has been referred to as a facilitator for more precise, personalized, and safer health care, and AI algorithms have been reported to have diagnostic accuracies at or above the average physician in dermatology, dentistry, and ophthalmology. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation analyzed data from 3 Markov models used in previous cost-effectiveness studies that were adapted to compare AI vs standard of care to detect melanoma on skin photographs, dental caries on radiographs, and diabetic retinopathy on retina fundus imaging. The general US and German population aged 50 and 12 years, respectively, as well as individuals with diabetes in Brazil aged 40 years were modeled over their lifetime. Monte Carlo microsimulations and sensitivity analyses were used to capture lifetime efficacy and costs. An annual cycle length was chosen. Data were analyzed between February 2021 and August 2021. EXPOSURE AI vs standard of care. MAIN OUTCOMES AND MEASURES Association of AI with tooth retention-years for dentistry and quality-adjusted life-years (QALYs) for individuals in dermatology and ophthalmology; diagnostic costs. RESULTS In 1000 microsimulations with 1000 random samples, AI as a diagnostic-support system showed limited cost-savings and gains in tooth retention-years and QALYs. In dermatology, AI showed mean costs of $750 (95% CI, $608-$970) and was associated with 86.5 QALYs (95% CI, 84.9-87.9 QALYs), while the control showed higher costs $759 (95% CI, $618-$970) with similar QALY outcome. In dentistry, AI accumulated costs of €320 (95% CI, €299-€341) (purchasing power parity [PPP] conversion, $429 [95% CI, $400-$458]) with 62.4 years per tooth retention (95% CI, 60.7-65.1 years). The control was associated with higher cost, €342 (95% CI, €318-€368) (PPP, $458; 95% CI, $426-$493) and fewer tooth retention-years (60.9 years; 95% CI, 60.5-63.1 years). In ophthalmology, AI accrued costs of R $1321 (95% CI, R $1283-R $1364) (PPP, $559; 95% CI, $543-$577) at 8.4 QALYs (95% CI, 8.0-8.7 QALYs), while the control was less expensive (R $1260; 95% CI, R $1222-R $1303) (PPP, $533; 95% CI, $517-$551) and associated with similar QALYs. Dominance in favor of AI was dependent on small differences in the fee paid for the service and the treatment assumed after diagnosis. The fee paid for AI was a factor in patient preferences in cost-effectiveness between strategies. CONCLUSIONS AND RELEVANCE The findings of this study suggest that marginal improvements in diagnostic accuracy when using AI may translate into a marginal improvement in outcomes. The current evidence supporting AI as decision support from a cost-effectiveness perspective is limited; AI should be evaluated on a case-specific basis to capture not only differences in costs and payment mechanisms but also treatment after diagnosis.
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Affiliation(s)
- Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Natalia Rojas-Perilla
- Department of Economics, Freie Universität Berlin, Germany
- Department of Analytics in the Digital Era, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Fissure sealing and caries development in Norwegian children. Eur Arch Paediatr Dent 2022; 23:905-910. [PMID: 35798927 PMCID: PMC9750898 DOI: 10.1007/s40368-022-00729-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To explore the use of fissure sealing as a caries preventive method by describing characteristics of children who had received sealants and to study associations between sealing and caries prevalence at 12 years of age. METHODS The study included 3075 children examined at 5 and 12 years of age. Data were collected by clinical examination and questionnaire to parents. The questionnaire provided information on child characteristics and oral health behaviour in children at 5 years of age. Data on sealing and caries prevalence were obtained from dental records. Bi- and multivariate logistic regressions were performed. The Regional Committee for Medical Research Ethics approved the study (2.200.54 and 2013/1881). RESULTS Of the children, 12% had received sealants on permanent teeth before 12 years of age. Children with dentin caries at 5 years of age (OR 2.0, CI 1.5-2.7) had a higher probability of having received sealants than children without caries. Having sealants (OR 2.8, CI 2.2-3.6), enamel caries (OR 1.5, CI 1.2-1.9), dentin caries (OR 2.9, CI 2.3-3.6) and using fluoride lozenges less than daily (OR 1.5, CI 1.3-1.8) at 5 years of age were associated with having dentin caries prevalence at 12 years of age. CONCLUSION Few children had received fissure sealing. Although sealing was used as a caries preventive method in children who had experienced caries in primary teeth, these children continued developing caries in their permanent teeth.
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León S, Giacaman RA. Proposal for a Conceptual Framework for the Development of Geriatric Dentistry. J Dent Res 2021; 101:247-252. [PMID: 34581227 DOI: 10.1177/00220345211042268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health-related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.
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Affiliation(s)
- S León
- Gerodontology and Cariology Units, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile.,Chilean Society for Geriatric Dentistry, Talca, Chile.,Interuniversity Center on Healthy Aging, Chile
| | - R A Giacaman
- Gerodontology and Cariology Units, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile.,Chilean Society for Geriatric Dentistry, Talca, Chile.,Interuniversity Center on Healthy Aging, Chile
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Kühnisch J, Janjic Rankovic M, Kapor S, Schüler I, Krause F, Michou S, Ekstrand K, Eggmann F, Neuhaus KW, Lussi A, Huysmans MC. Identifying and Avoiding Risk of Bias in Caries Diagnostic Studies. J Clin Med 2021; 10:3223. [PMID: 34362007 PMCID: PMC8347423 DOI: 10.3390/jcm10153223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Caries diagnostic studies differ with respect to their design, included patients/tooth samples, use of diagnostic and reference methods, calibration, blinding and data reporting. Such heterogeneity makes comparisons between studies difficult and could represent a substantial risk of bias (RoB) when it is not identified. Therefore, the present report aims to describe the development and background of a RoB assessment tool for caries diagnostic studies. The expert group developed and agreed to use a RoB assessment tool during three workshops. Here, existing instruments (e.g., QUADAS 2 and the Joanna Briggs Institute Reviewers' Manual) influenced the hierarchy and phrasing of the signalling questions that were adapted to the specific dental purpose. The tailored RoB assessment tool that was created consists of 16 signalling questions that are organized in four domains. This tool considers the selection/spectrum bias (1), the bias of the index (2) and reference tests (3), and the bias of the study flow and data analysis (4) and can be downloaded from the journal website. This paper explores possible sources of heterogeneity and bias in caries diagnostic studies and summarizes the relevant methodological aspects.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopaedics, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry, University Hospital, 07743 Jena, Germany;
| | - Felix Krause
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Stavroula Michou
- Department of Odontology, University Copenhagen, 2200 Copenhagen, Denmark; (S.M.); (K.E.)
| | - Kim Ekstrand
- Department of Odontology, University Copenhagen, 2200 Copenhagen, Denmark; (S.M.); (K.E.)
| | - Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland; (F.E.); (K.W.N.)
| | - Klaus W. Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland; (F.E.); (K.W.N.)
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, 3012 Bern, Switzerland;
- Department of Operative Dentistry and Periodontology, University Medical Centre, 79098 Freiburg, Germany
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Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, Fontana M, Gomez Rossi J, Göstemeyer G, Levey C, Müller A, Ricketts D, Robertson M, Santamaria RM, Innes NP. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev 2021; 7:CD013039. [PMID: 34280957 PMCID: PMC8406990 DOI: 10.1002/14651858.cd013039.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Thomas Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - Waraf Al-Yaseen
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lars Bjørndal
- Cariology and Endodontics, Section of Clinical Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janet E Clarkson
- Division of Oral Health Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Michigan, USA
| | - Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Colin Levey
- Division of Restorative Dentistry, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ruth M Santamaria
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Nicola Pt Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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12
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Schwendicke F, Rossi JG, Göstemeyer G, Elhennawy K, Cantu AG, Gaudin R, Chaurasia A, Gehrung S, Krois J. Cost-effectiveness of Artificial Intelligence for Proximal Caries Detection. J Dent Res 2020; 100:369-376. [PMID: 33198554 PMCID: PMC7985854 DOI: 10.1177/0022034520972335] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists’ mean accuracy was significantly lower at 0.71 (minimum–maximum: 0.61–0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19–0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69–0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%–97.5%: 61–65] y) and less costly (298 [244–367] euro) than assessment without AI (62 [59–64] y; 322 [257–394] euro). The ICER was −13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.
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Affiliation(s)
- F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J G Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A G Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - R Gaudin
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - S Gehrung
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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13
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Şen S, Erber R, Deurer N, Orhan G, Lux CJ, Zingler S. Demineralization detection in orthodontics using an ophthalmic optical coherence tomography device equipped with a multicolor fluorescence module. Clin Oral Investig 2019; 24:2579-2590. [PMID: 31848715 DOI: 10.1007/s00784-019-03116-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Demineralizations such as white spot lesions are among the most prevalent side effects during orthodontic treatment. Fluorescence devices, including quantitative light-induced fluorescence (QLF), exploiting the intrinsic fluorescence of enamel and teeth and most recently optical coherence tomography (OCT) were introduced for early demineralization detection. In addition to near-infrared OCT scanning, multicolor modules allow for imaging with different laser wavelengths and the detection of reflective- and fluorescent light. The aim of this study was to evaluate a modified multicolor ophthalmic OCT device for the detection of early carious lesions in vitro and in vivo. MATERIALS AND METHODS Twenty-seven extracted lesion free human teeth were randomly assigned to three different demineralization protocols. Carious lesion detection was performed using macrophotography, OCT, and reflectance/fluorescence imaging using green laser and blue laser light. In addition, teeth of 5 orthodontic patients were OCT scanned, and fluorescence imaging using blue laser light was performed to assess demineralization after orthodontic therapy. RESULTS Both in vitro and in vivo, OCT allowed for precise determination of lesion depth and enamel loss. Fluorescence imaging using blue laser light was most sensitive for the detection of early demineralization in vitro and in vivo. However, established and severe demineralizations were also reliably detected by macrophotography in vitro and in vivo. CONCLUSION Demineralization can be detected with high sensitivity using blue fluorescence imaging with multicolor OCT devices. CLINICAL RELEVANCE In the future, OCT fluorescence imaging might be considered for longitudinal monitoring of dental hard tissue during orthodontic treatment in clinical trials.
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Affiliation(s)
- Sinan Şen
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Ralf Erber
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Nadine Deurer
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gül Orhan
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christopher J Lux
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Sebastian Zingler
- Department of Orthodontics and Dentofacial Orthopaedics, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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14
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Bohns FR, Leitune VCB, Balbinot GDS, Samuel SMW, Collares FM. Mineral deposition promoted by resin-based sealants with different calcium phosphate additions. Braz Oral Res 2019; 33:e101. [PMID: 31778472 DOI: 10.1590/1807-3107bor-2019.vol33.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/01/2019] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the influence of different calcium phosphates (CaPs) on the physical, biological, and remineralizing properties of experimental resin-based sealants (RBSs). Triethylene-glycol dimethacrylate (90wt%) and bisphenol A-glycidyl methacrylate (10wt%) were used to produce resin-based sealants. Hydroxyapatite (SHAp), α-tricalcium phosphate (Sα-TCP) and octacalcium phosphate (SOCP) were added to the sealants in a 10wt% concentration. One group without CaPs was used as the control group (SCG). The degree of conversion (DC) was assessed with Fourier-transformed infrared spectroscopy, whereas cytotoxicity was tested with the HaCaT keratinocyte cell line. The ultimate tensile strength (UTS) was used to assess the mechanical strength of the experimental RBSs. Sealed enamel was used for colorimetric assay. Mineral deposition was assessed with Raman spectroscopy after 7, 14, and 28 days of sample immersion in artificial saliva. Scanning electron microscopy was used to analyze the surface morphology after 28 days of immersion. The addition of 10wt% of fillers significantly reduced the DC of sealants. SOCP groups showed reduced cell viability. Higher UTS was found for Sα-TCP and SHAp. The color analysis showed that SGC and demineralized teeth presented higher mismatches with the sound tissue. Mineral deposition was observed for SHAp and Sα-TCP after 7 days, with increased phosphate content and mineral deposits for SHAp after 28 days. RBS with the addition of 10% HAp promoted increased mineralization in vitro after 28 days, and did not affect cell viability, DC, mechanical properties, or RBS color in the enamel.
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Affiliation(s)
- Fabio Rocha Bohns
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Dental Materials Laboratory, Porto Alegre, RS, Brazil
| | - Vicente Castelo Branco Leitune
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Dental Materials Laboratory, Porto Alegre, RS, Brazil
| | - Gabriela de Souza Balbinot
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Dental Materials Laboratory, Porto Alegre, RS, Brazil
| | - Susana Maria Werner Samuel
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Dental Materials Laboratory, Porto Alegre, RS, Brazil
| | - Fabricio Mezzomo Collares
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Dental Materials Laboratory, Porto Alegre, RS, Brazil
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15
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Keys T, Burrow MF, Rajan S, Rompre P, Doméjean S, Muller‐Bolla M, Manton DJ. Carious lesion management in children and adolescents by Australian dentists. Aust Dent J 2019; 64:282-292. [DOI: 10.1111/adj.12710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- T Keys
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
| | - MF Burrow
- Faculty of Dentistry University of Hong Kong Pokfulam Hong Kong SAR
| | - S Rajan
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
| | - P Rompre
- Faculty of Dental Medicine Université de Montréal Montréal Quebec Canada
| | - S Doméjean
- UFR d’Odontologie, Centre de Recherche en Odontologie Clinique Univ Clermont Auvergne Clermont‐Ferrand France
- CHU Estaing Clermont‐Ferrand Service d’Odontologie Clermont‐Ferrand France
| | - M Muller‐Bolla
- Centre Hospitalier universitaire de Nice Département Odontologie Pédiatrique, UFR d’Odontologie de Nice‐Sophia Antipolis Université Côte d’Azur Paris Descartes France
| | - DJ Manton
- Melbourne Dental School The University of Melbourne Parkville Victoria Australia
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16
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Boron Nitride Nanotubes as Filler for Resin-Based Dental Sealants. Sci Rep 2019; 9:7710. [PMID: 31118474 PMCID: PMC6531453 DOI: 10.1038/s41598-019-44246-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/13/2019] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to evaluate the influence of boron-nitride nanotubes (BNNTs) on the properties of resin-based light-curing dental sealants (RBSs) when incorporated at different concentration. RBSs were formulated using methacrylate monomers (90 wt.% TEGDMA, 10 wt.% Bis-GMA). BNNTs were added to the resin blend at 0.1 wt.% and 0.2 wt.%. A Control group without filler was also designed. Degree of conversion, ultimate tensile strength, contact angle, surface free energy, surface roughness and color of the RBSs were evaluated for the tested materials. Their cytotoxicity and mineral deposition ability (Bioactivity) were also assessed. A suitable degree of conversion, no effect in mechanical properties and no cytotoxic effect was observed for the experimental materials. Moreover, the surface free energy and the surface roughness decreased with the addition of BNNTs. While the color analysis showed no difference between specimens containing BNNTs and the control group. Mineral deposition occurred in all specimens containing BNNTs after 7d. In conclusion, the incorporation of BNNTs may provide bioactivity to resin-based dental sealants and reduce their surface free energy.
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17
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Qu Z, Zhang S, Krauth C, Liu X. A systematic review of decision analytic modeling techniques for the economic evaluation of dental caries interventions. PLoS One 2019; 14:e0216921. [PMID: 31091279 PMCID: PMC6519822 DOI: 10.1371/journal.pone.0216921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 05/01/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Dental caries occur through a multifactorial process that may influence all tooth surfaces throughout an individual's life. The application of decision analytical modeling (DAM) has gained an increasing level of attention in long-term outcome assessment and economic evaluation of interventions on caries in recent years. The objective of this study was to systematically review the application of DAM and assess their methodological quality in the context of dental caries. METHODS A systematic review of the literature published to 31st December 2018 was conducted in Medline, EMBASE, NHSEED, and Web of Science electronic databases. The main information and model characteristics of studies was extracted with the methodological quality of included studies reviewed and assessed using the Philips' checklist. RESULTS Twenty five studies from different settings were included. Modeling techniques mainly comprised main type of modeling including Markov models (n = 12), Markov/microsimulation mixed model (n = 7), systematic dynamic models (n = 3), microsimulation models (n = 2) and decision tree (n = 1). The mean number of criteria fulfilled was 25.1 out of 60 items, which varied between year of study and research groups. The percentage of criteria fulfilled for data dimension was lower than for the structure and consistency dimension. Critical issues were data quality, incorporation of utility values, and uncertainty analysis in modeling. CONCLUSION The current review revealed that the methodological quality of DAM in dental caries economic evaluations is unsatisfied. Future modeling studies should adhere more closely to good practice guidelines, especially with respect to data quality evaluation, utility values incorporation, and uncertainty analysis in DAM based studies.
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Affiliation(s)
- Zhi Qu
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.,Core Facility Quality Management and Health Technology Assessment for Transplantation, Hannover Medical School, Hannover, Germany
| | - Shanshan Zhang
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Xuenan Liu
- Department of Preventive Dentistry, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
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18
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Abstract
Over the past 30 years and fueled by both a rapidly evolving understanding of dental diseases and technological advances in diagnostics and therapy, dentistry has been changing dramatically. Managing dental caries and carious lesions had, for nearly a century, encompassed only a small number of basic concepts that were applied to virtually all patients and lesions, namely, invasive removal of any carious tissue regardless of its activity or depth and its replacement with restorative materials (amalgams or crowns for most of the past) or tooth removal and prosthetic replacement. Grounded in a deeper understanding of the disease "caries," its management-aiming to control the causes of the disease, to slow down or alleviate existing disease, and, only as a last resort, to remove its symptoms using a bur or forceps-has become more complex and diverse. In parallel and at nearly unprecedented speed, our patients are changing, as mirrored by ongoing debates as to the demographic and, with it, the social future of most high-income countries. This article describes how these changes will have a profound future impact on how we practice dental medicine in the future. It will deduce, from both demographic and epidemiologic trends, why there is the need to apply not one but rather the whole range of existing evidence-based concepts in an individualized (personalized) manner, hence increasing the effectiveness and efficiency of dental management strategies, and also describe how these strategies should be tailored according not only to our patients (their age and risk profiles) but also to the specific tooth (or site or lesion).
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19
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Tonetti MS, Bottenberg P, Conrads G, Eickholz P, Heasman P, Huysmans MC, López R, Madianos P, Müller F, Needleman I, Nyvad B, Preshaw PM, Pretty I, Renvert S, Schwendicke F, Trombelli L, van der Putten GJ, Vanobbergen J, West N, Young A, Paris S. Dental caries and periodontal diseases in the ageing population: call to action to protect and enhance oral health and well-being as an essential component of healthy ageing - Consensus report of group 4 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2018; 44 Suppl 18:S135-S144. [PMID: 28266112 DOI: 10.1111/jcpe.12681] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over the last two decades, progress in prevention and treatment of caries and periodontal diseases has been translated to better oral health and improved tooth retention in the adult population. The ageing population and the increasing expectations of good oral health-related quality of life in older age pose formidable challenges to clinical care and healthcare systems. AIMS The objective of this workshop was to critically review scientific evidence and develop specific recommendations to: (i) prevent tooth loss and retain oral function through prevention and treatment of caries and periodontal diseases later in life and (ii) increase awareness of the health benefits of oral health as an essential component of healthy ageing. METHODS Discussions were initiated by three systematic reviews covering aspects of epidemiology of caries and periodontal diseases in elders, the impact of senescence on caries and periodontal diseases and the effectiveness of interventions. Recommendations were developed based on evidence from the systematic reviews and expert opinion. RESULTS Key messages included: (i) the ageing population, trends in risk factors and improved tooth retention point towards an expected increase in the total burden of disease posed by caries and periodontal diseases in the older population; (ii) specific surveillance is required to monitor changes in oral health in the older population; (iii) senescence impacts oral health including periodontitis and possibly caries susceptibility; (iv) evidence indicates that caries and periodontal diseases can be prevented and treated also in older adults; (v) oral health and functional tooth retention later in life provides benefits both in terms of oral and general quality of life and in terms of preventing physical decline and dependency by fostering a healthy diet; (vi) oral healthcare professionals and individuals should not base decisions impacting tooth retention on chronological age but on level of dependency, life expectancy, frailty, comfort and quality of life; and (vii) health policy should remove barriers to oral health care for vulnerable elders. CONCLUSIONS Consensus was reached on specific actionable priorities for public health officials, oral healthcare professionals, educators and workforce planners, caregivers and relatives as well as for the public and ageing patients. Some priorities have major implications for policymakers as health systems need to adapt to the challenge by systemwide changes to enable (promote) tooth retention later in life and management of deteriorating oral health in increasingly dependent elders.
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Affiliation(s)
- Maurizio S Tonetti
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China.,European Research Group on Periodontology, Genova, Italy
| | | | - Georg Conrads
- Division of Oral Microbiology and Immunology, Department of Conservative Dentistry, Periodontology and Preventive Dentistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Eickholz
- Department of Periodontology, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Peter Heasman
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Marie-Charlotte Huysmans
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rodrigo López
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Phoebus Madianos
- Department of Periodontology, National and Kapodistrian University of Athens, Athens, Greece
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ian Needleman
- International Centre for Evidence-Based Oral Health, Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Bente Nyvad
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Philip M Preshaw
- Department of Restorative Dentistry, University of Newcastle, Newcastle, UK
| | - Iain Pretty
- Division of Dentistry, University of Manchester, Manchester, UK
| | - Stefan Renvert
- Department of Periodontology, Kristianstad University, Kristianstad, Sweden
| | - Falk Schwendicke
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany
| | - Leonardo Trombelli
- Research Center for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Gert-Jan van der Putten
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques Vanobbergen
- Community Dentistry and Oral Public Health, Ghent University, Ghent, Belgium
| | - Nicola West
- Department of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Alix Young
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sebastian Paris
- Department of Operative Dentistry, Charitè - Universitätsmedizin Berlin, Berlin, Germany
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Restoring root-canal treated molars: Cost-effectiveness-analysis of direct versus indirect restorations. J Dent 2018; 77:37-42. [PMID: 30006116 DOI: 10.1016/j.jdent.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Root-canal treated molars can be directly restored, usually using resin-based-composite restorations (RBCs), or indirectly restored using full or partial crowns (FCs/PCs). Both the initial treatment costs and the risks of restorative and endodontic complications differ between RBCs and FCs/PCs. We aimed to assess the cost-effectiveness of RBCs versus FCs/PCs for restoring root-canal treated molars. METHODS A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from large cohort studies or systematic reviews. Costs were estimated using fee-items catalogues of public and private German insurance. A Markov-model was constructed to follow up a root-canal treated molar receiving different restorations in an initially 50-year-old patient over his lifetime. Monte Carlo-microsimulations were performed to assess lifetime costs and effectiveness (tooth retention time), and the resulting cost-effectiveness. RESULTS RBCs were less costly than FCs/PCs (749 Euro versus 782 Euro), but also less effective (22 years versus 24 years), the incremental-cost-effectiveness-ratio was 10.80 Euro/year. This ratio increased if costs for direct restorations decreased, or costs for indirect restorations increased. If no teeth were replaced, RBC was far more cost-effective (the incremental cost-effectiveness ratios was 52.95 Euro/year). If all teeth were replaced, FC was both more effective and less costly. CONCLUSIONS RBCs showed lower costs, but also lower effectiveness than FCs/PCs. Consequently, the cost-effectiveness of both strategies depended on the willingness-to-pay of patients or other payers, i.e. their willingness to invest in higher effectiveness. Clinically, a large number of tooth, patient and dentist-related factors will impact on decision-making and should be considered. CLINICAL SIGNIFICANCE We found composite restorations to be less costly, but also less effective than indirect restorations for root-canal treated teeth. Over a long-term period, the initial treatment costs and associated cost-differences between strategies may be outweighed by costs of follow-up treatments.
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Schwendicke F, Elhennawy K, El Shahawy O, Maher R, Gimenez T, Mendes FM, Willis BH. Visual and radiographic caries detection: a tailored meta-analysis for two different settings, Egypt and Germany. BMC Oral Health 2018; 18:105. [PMID: 29884157 PMCID: PMC5993995 DOI: 10.1186/s12903-018-0561-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
Background Diagnostic meta-analyses on caries detection methods should assist practitioners in their daily practice. However, conventional meta-analysis estimates may be inapplicable due to differences in test conduct, applied thresholds and assessed population between settings. Our aim was to demonstrate the impact of tailored meta-analysis of visual and radiographic caries detection to different settings using setting-specific routine data. Methods Published systematic reviews and meta-analyses on the accuracy of visual and radiographic caries detection were used. In two settings (a private practice in Germany and a public health clinic in Egypt), routine data of a total of 100 (n = 50/practice) consecutive 12–14 year-olds were collected. Test-positive rates of visual and radiographic detection for initial and advanced carious lesions on occlusal or proximal surfaces of molars were used to tailor meta-analyses. If prevalence data were available, these were also used for tailoring. Results From the original reviews, 210 and 100 heterogeneous studies on visual and radiographic caries detection were included in our meta-analyses. For radiographic detection, sensitivity and specificity estimates derived from conventional and tailored meta-analysis were similar. For visual detection of advanced occlusal carious lesions, the conventional meta-analysis yielded a sensitivity and specificity (95% CI) of 64.6% (57–71) and 90.9% (88–93), whereas the tailored estimates for Egypt were 75.1% (70–81) and 84.9% (82–89), respectively, and 43.7% (37–51) and 96.5% (95–97) for Germany, respectively. Conclusion Conventional test accuracy meta-analyses may yield aggregate estimates which are inapplicable to specific settings. Routine data may be used to produce a meta-analysis estimate which is tailored to the setting and thereby improving its applicability. Electronic supplementary material The online version of this article (10.1186/s12903-018-0561-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Karim Elhennawy
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Osama El Shahawy
- Department of Pediatric Dentistry, Cairo University, Giza, Egypt.,Department of Pediatric Dentistry, Cairo University, 11 el Saraya Street, Manial, Cairo, Egypt
| | - Reham Maher
- Department of Pediatric Dentistry, Cairo University, Giza, Egypt.,Department of Pediatric Dentistry, Cairo University, 11 el Saraya Street, Manial, Cairo, Egypt
| | - Thais Gimenez
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Av. Lineu Prestes, São Paulo, 2227, Brazil
| | - Fausto M Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Av. Lineu Prestes, São Paulo, 2227, Brazil
| | - Brian H Willis
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Schwendicke F, Innes N, Levey C, Lamont T, Göstemeyer G. Comparator choice in cariology trials limits conclusions on the comparative effectiveness of caries interventions. J Clin Epidemiol 2017; 89:209-217. [DOI: 10.1016/j.jclinepi.2017.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Accepted: 05/29/2017] [Indexed: 11/25/2022]
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Managing molars with severe molar-incisor hypomineralization: A cost-effectiveness analysis within German healthcare. J Dent 2017; 63:65-71. [DOI: 10.1016/j.jdent.2017.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/21/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022] Open
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Schwendicke F, Splieth CH, Thomson WM, Reda S, Stolpe M, Foster Page L. Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk. Community Dent Oral Epidemiol 2017; 46:8-16. [DOI: 10.1111/cdoe.12320] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Christian H. Splieth
- Department of Preventive and Pediatric Dentistry; Universitätsmedizin Greifswald; Greifswald Germany
| | - William Murray Thomson
- Department of Oral Sciences; Faculty of Dentistry; University of Otago; Otago New Zealand
| | - Seif Reda
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - Lyndie Foster Page
- Department of Oral Sciences; Faculty of Dentistry; University of Otago; Otago New Zealand
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Pitts NB, Zero DT, Marsh PD, Ekstrand K, Weintraub JA, Ramos-Gomez F, Tagami J, Twetman S, Tsakos G, Ismail A. Dental caries. Nat Rev Dis Primers 2017; 3:17030. [PMID: 28540937 DOI: 10.1038/nrdp.2017.30] [Citation(s) in RCA: 740] [Impact Index Per Article: 105.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Caries can occur throughout life, both in primary and permanent dentitions, and can damage the tooth crown and, in later life, exposed root surfaces. The balance between pathological and protective factors influences the initiation and progression of caries. This interplay between factors underpins the classification of individuals and groups into caries risk categories, allowing an increasingly tailored approach to care. Dental caries is an unevenly distributed, preventable disease with considerable economic and quality-of-life burdens. The daily use of fluoride toothpaste is seen as the main reason for the overall decline of caries worldwide over recent decades. This Primer aims to provide a global overview of caries, acknowledging the historical era dominated by restoration of tooth decay by surgical means, but focuses on current, progressive and more holistic long-term, patient-centred, tooth-preserving preventive care.
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Affiliation(s)
- Nigel B Pitts
- Dental Innovation and Translation Centre, King's College London Dental Institute, Floor 17 Tower Wing, Guy's Hospital, Great Maze Pond Road, London SE1 9RT, UK
| | - Domenick T Zero
- Department of Cariology Operative Dentistry and Dental Public Health, Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Phil D Marsh
- Department of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - Kim Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Jane A Weintraub
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina, USA
| | - Francisco Ramos-Gomez
- UCLA Center Children's Oral Health - UCCOH and Section of Pediatric Dentistry, UCLA School of Dentistry, University of California Los Angeles, Los Angeles, California, USA
| | - Junji Tagami
- Cariology and Operative Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Svante Twetman
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Amid Ismail
- Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
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26
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Schwendicke F, Stolpe M. Cost-effectiveness of Different Post-retained Restorations. J Endod 2017; 43:709-714. [PMID: 28343930 DOI: 10.1016/j.joen.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/16/2016] [Accepted: 01/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Dentists can choose between metal and fiber post systems to provide post-retained restorations. The risk of tooth loss and other complications differs between different post systems, as do the initial treatment costs. We aimed to assess the cost-effectiveness of (1) cast metal (MC), (2) preformed metal (MP), (3) glass fiber (GF), and (4) carbon fiber (CF) post-retained restorations. METHODS A mixed public-private payer's perspective within German healthcare was taken. Risks of complications were extracted from systematic reviews. Costs were estimated by using fee items and 2016 material costs. A Markov model was constructed to follow up an endodontically treated molar receiving a post-retained crown in an initially 50-year-old patient during his lifetime. Monte Carlo microsimulations were performed to assess lifetime costs and tooth retention time. RESULTS MPs were least costly (€692€), retaining teeth for 26.7 years. GFs were more costly (€745€), retaining teeth for 27.6 years. MCs were minimally more effective but also more costly than GFs (€774€). CFs were less effective and most expensive (€825€, 26.7 years). For payers willing to invest more than €60€ per tooth retention year, GF was cost-effective. Payers willing to invest an additional €670€ found MC to be cost-effective. These findings were found robust in sensitivity analyses. CONCLUSIONS For payers not willing to invest additional money for longer tooth retention, MP seemed most suitable to retain restorations. For payers with additional willingness to pay, GF seemed suitable, retaining teeth for longer. MC was only cost-effective under very high willingness to pay. CF is not recommendable on the basis of their cost-effectiveness.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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27
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Hill H, Macey R, Brocklehurst P. A Markov model assessing the impact on primary care practice revenues and patient's health when using mid-level providers, lesson learned from the United Kingdom. J Public Health Dent 2017; 77:334-343. [PMID: 28272806 DOI: 10.1111/jphd.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 01/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of using mid-level providers for dental "check-up" examinations and the treatment of caries in different NHS settings in the United Kingdom. Mid-level providers are a broad category that describes non-dentist members of dental teams. This study focused on the potential use of Dental Hygiene Therapists undertaking dental "check-up" examinations and simple restorative treatment, instead of dentists. METHODS A Markov model was used to construct the natural history of caries development in adults that visit a dental practice every six months over a five-year period. Three cost perspectives are taken: those borne to dental healthcare providers in England and Wales, Northern Ireland and Scotland. These represent three separate forms of retrospective payment system that are currently in use in the United Kingdom. The cost outcome was the average amount of retained practice earnings required to provide healthcare per patient visit. The health outcome was the average length of time in a cavity-free state and the cost-effectiveness outcome was incremental cost for six months in a cavity-free state. RESULTS No statistical difference was found between dentists and mid-level providers in the length of time in a cavity-free state but the use of the latter saved money in all three NHS health system jurisdictions. This ranged from £7.85 (England and Wales) to £9.16 (Northern Ireland) per patient visit ($10.20 to $11.90, respectively) meaning the incremental cost for six month in a cavity-free state ranged from £261.67 ($339.93) in England and Wales to £305.33 ($369.68) in Northern Ireland. Further, changes in baseline assumptions and parameter values did not change mid-level providers being the dominant service intervention. CONCLUSION In a time of limited funds for dental services, these results suggest that resources in public funded systems could be saved using mid-level providers in dental practices, without any health risk to patients or capital investment.
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Affiliation(s)
- Harry Hill
- School of Dentistry, The University of Manchester, Manchester, UK.,Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Richard Macey
- Centre for Endrocinology and Diabetes, The University of Manchester, Manchester, UK
| | - Paul Brocklehurst
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
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28
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Geibel MA, Carstens S, Braisch U, Rahman A, Herz M, Jablonski-Momeni A. Radiographic diagnosis of proximal caries-influence of experience and gender of the dental staff. Clin Oral Investig 2017; 21:2761-2770. [PMID: 28233170 DOI: 10.1007/s00784-017-2078-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the influence of experience and gender on the radiographic detection of proximal caries lesions and on therapeutic decisions. MATERIALS AND METHODS A survey of 220 examiners (students and employees at three universities and dentists in the field) was taken using a standardized written questionnaire concerning radiographic diagnosis and therapy planning. An expert opinion of four dentists was determined as radiographic reference. A mixed effect logistic regression model was used for statistical evaluation and the odds ratio and p values were calculated (α = 0.05). RESULTS Examiners with experience had an almost four times greater chance of a correct assessment, if proximal caries lesion was present or not, than examiners with low experience (OR 3.7 (95% CI 2.4-5.8)). No gender-specific differences were discovered (OR women vs. men 0.9 (95% CI 0.6-1.4)). There was a relationship between the severity of the burnout effect on the x-ray and false positive caries diagnosis. Overall, 43% of respondents would plan invasive treatment in the enamel on a patient at low risk of caries and 78% on a high-risk patient. The results showed that the more experienced practitioners would be more likely to postpone restorative therapy on proximal caries until the lesion reached a later stage. CONCLUSIONS The results of this study suggest that examiner's experience influences the radiographic diagnosis of proximal lesions. No gender-specific differences could be found. CLINICAL RELEVANCE Examiner's professional experience is an important factor when radiography is included for detection and treatment planning of proximal lesions.
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Affiliation(s)
- Margrit-Ann Geibel
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - S Carstens
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - U Braisch
- Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstraße 13, 89075, Ulm, Germany
| | - A Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - M Herz
- Department of Conservative Dentistry and Periodontology, Tuebingen University Hospital, Osianderstraße 2-8, 72076, Tuebingen, Germany
| | - A Jablonski-Momeni
- Department of Pediatric and Community Dentistry, Philipps University, Georg-Voigt-Straße 3, 35033, Marburg, Germany
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Innes NPT, Schwendicke F. Restorative Thresholds for Carious Lesions: Systematic Review and Meta-analysis. J Dent Res 2017; 96:501-508. [PMID: 28195749 DOI: 10.1177/0022034517693605] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current evidence supports noninvasive/nonrestorative treatment of "early" carious lesions: those confined to enamel or reaching the enamel-dentin junction. The extent that dentists' thresholds for intervening restoratively have changed with this evidence is unknown. This systematic review aimed to determine dentists' and therapists' current lesion threshold for carrying our restorative interventions in adults/children and primary/permanent teeth. Embase, Medline via PubMed, and Web of Science were searched for observational studies, without language, time, or quality restrictions. Screening and data extraction were independent and in duplicate. Random-effects meta-analyses with subgroup and meta-regression analysis were performed. Thirty studies, mainly involving dentists, met the inclusion criteria. There was heterogeneity in sampling frames, methods, and scales used to investigate thresholds. The studies spanned 30 y (1983-2014), and sample representativeness and response bias issues were likely to have affected the results. Studies measured what dentists said they would do rather than actually did. Studies represented 17 countries, focusing mainly on adults ( n = 17) and permanent teeth ( n = 24). For proximal carious lesions confined to enamel (not reaching the enamel-dentin junction), 21% (95% confidence interval [CI], 15%-28%) of dentists/therapists would intervene invasively. The likelihood of a restorative intervention almost doubled (risk ratio, 1.98; 95% CI, 1.68-2.33) in high caries risk patients. For proximal lesions extending up to the enamel-dentin junction, 48% (95% CI, 40%-56%) of dentists/therapists would intervene restoratively. For occlusal lesions with enamel discoloration/cavitation but no clinical/radiographic dentin involvement, 12% (95% CI, 6%-22%) of dentists/therapists stated they would intervene, increasing to 74% (95% CI, 56%-86%) with dentin involvement. There was variance between countries but no significant temporal trend. A significant proportion of dentists/therapists said they would intervene invasively (restoratively) on carious lesions where evidence and clinical recommendations indicate less invasive therapies should be used. There is great need to understand decisions to intervene restoratively and to find implementation interventions that translate research evidence into clinical practice.
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Affiliation(s)
- N P T Innes
- 1 Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - F Schwendicke
- 2 Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
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30
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Managing caries: the need to close the gap between the evidence base and current practice. Br Dent J 2017; 219:433-8. [PMID: 26564354 DOI: 10.1038/sj.bdj.2015.842] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.
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THE CARIES MANAGEMENT SYSTEM: UPDATING COST-EFFECTIVENESS WITH 4-YEAR POSTTRIAL DATA. Int J Technol Assess Health Care 2016; 32:107-15. [DOI: 10.1017/s0266462316000246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Long-term follow-up of the Caries Management System (CMS) protocol demonstrated that regular monitoring and noninvasive management of dental caries is effective in reducing the number of caries-related events over a 7-year period. This analysis complements the authors’ original economic evaluation of the CMS by re-evaluating the per-protocol cost-effectiveness of the CMS approach.Methods: An individual patient-simulation Markov model was developed previously, based on 3-year randomized-controlled trial (RCT) data, to simulate the incidence and progression of dental caries, and resultant interventions, and to evaluate the lifetime cost-effectiveness of the CMS versus standard dental care from the Australian private dental practitioner perspective (in which the baseline age distribution was similar to that of the Australian population). The 4-year posttrial follow-up data are used to re-evaluate the long-term cost-effectiveness of the CMS in a more real-life setting.Results: The reduction in caries risk was maintained among those practices within which the CMS protocols were adhered to. The per-protocol model appears to be reasonably accurate at predicting the risk of restorative events in the posttrial follow-up period. The per-protocol lifetime cost per restorative event avoided is AUD1,980 (USD1,409; 1 AUD = 0.71 USD).Conclusions: The current analysis confirms that the CMS approach is both effective, when the protocols are adhered to appropriately, and cost-effective compared with standard care in the Australian private practice setting.
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Twetman S. Visual Inspection Displays Good Accuracy for Detecting Caries Lesions. J Evid Based Dent Pract 2015; 15:182-4. [PMID: 26698004 DOI: 10.1016/j.jebdp.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Visual inspection for caries detection: a systematic review and meta-analysis. Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, Ekstrand DR, Mendes FM. J Dent Res 2015;94(7):895-904. REVIEWER Svante Twetman, DDS, PhD, Odont Dr PURPOSE/QUESTION To evaluate the overall accuracy of visual methods for detecting caries lesions. SOURCE OF FUNDING Brazilian government (Process 2012/17888-1). TYPE OF STUDY/DESIGN Systematic review with meta-analysis of data LEVEL OF EVIDENCE Level 1: Good-quality, patient-oriented evidence STRENGTH OF RECOMMENDATION GRADE Grade A: Consistent, good-quality patient-oriented evidence.
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Affiliation(s)
- Svante Twetman
- Professor, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200 Copenhagen N, Denmark.
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Schwendicke F, Brouwer F, Paris S, Stolpe M. Detecting Proximal Secondary Caries Lesions. J Dent Res 2015; 95:152-9. [DOI: 10.1177/0022034515617937] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
When choosing detection methods for secondary caries lesions, dentists need to weigh sensitivity, allowing early initiation of retreatments to avoid lesion progression, against specificity, aiming to reduce risks of false-positive diagnoses and invasive overtreatments. We assessed the cost-effectiveness of different detection methods for proximal secondary lesions using Monte Carlo microsimulations. A vital permanent molar with an occlusal-proximal restoration was simulated over the lifetime of an initially 20-y-old. Three methods were compared: biannual tactile detection, radiographic detection every 2 y, and biannual laser fluorescence detection. Methods were employed either on their own or in pairwise combinations at sensitive and specific thresholds estimated with systematically collected data. A mixed public-private payer perspective in the context of German health care was applied. Effectiveness was calculated as years of tooth retention. Net-benefit analyses were used to evaluate cost-effectiveness acceptability at different willingness-to-pay thresholds. Radiographic detection verified by tactile assessment (both at specific thresholds) was least costly (mean, 1,060 euros) but had limited effectiveness (mean retention time, 50 y). The most effective but also more costly combination was laser fluorescence detection verified by radiography, again at specific thresholds (1157 euros, 53 y, acceptable if willingness to pay >32 euro/y). In the majority of simulations, not combining detection methods or applying them at sensitive thresholds was less effective and more costly. Net benefits were not greatly altered by applying different discounting rates or using different baseline prevalence of secondary lesions. Current detection methods for secondary lesions should best be used in combination, not on their own, at specific thresholds to avoid false-positive diagnoses leading to costly and invasive overtreatment. The relevant characteristics, such as predictive value, of different methods should be assessed in longitudinal clinical studies.
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Affiliation(s)
- F. Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - F. Brouwer
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - S. Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - M. Stolpe
- Kiel Institute for the World Economy, Kiel, Germany
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Abstract
Secondary caries lesions are the main late complication of dental restorations, limiting their life span and generating costs by repeated reinterventions. Accurate detection of secondary lesions is crucial for estimating the true burden of the disease and allocating appropriate treatments. We aimed to assess the accuracy of detection methods for secondary caries lesions. Clinical or in vitro studies were included that investigated the accuracy of 5 detection methods—visual, tactile, radiography, laser fluorescence, quantitative light-induced fluorescence—of natural or artificially induced secondary lesions, as verified against an established reference test. Sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated and publication bias assessed. From 1,179 screened studies, 23 were included. Most studies were performed in vitro, on permanent posterior teeth, and had high risk of bias or applicability concerns. Lesions were on proximal (14 studies) or other surfaces and adjacent to amalgam (16 studies) or tooth-colored materials. Visual ( n = 11), radiographic ( n = 13), and laser fluorescence detection ( n = 8) had similar sensitivities (0.50 to 0.59) and specificities (0.78 to 0.83), with visual and laser fluorescence assessment being more accurate on nonproximal surfaces and adjacent to composites, respectively. Tactile assessment ( n = 7) had low accuracy. Light-induced fluorescence ( n = 3) was sensitive on nonproximal surfaces but had low specificities. Most analyses seemed to suffer from publication bias. Despite being a significant clinical and dental public health problem, detection of secondary caries lesions has been assessed by only a few studies with limited validity and applicability. Visual, radiographic and laser-fluorescence detection might be useful to detect secondary lesions. The validity of tactile assessment and quantitative light-induced fluorescence remains unclear at present.
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Affiliation(s)
- F. Brouwer
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - H. Askar
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - S. Paris
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - F. Schwendicke
- Department of Operative and Preventive Dentistry, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Schwendicke F, Paris S, Stolpe M. Detection and treatment of proximal caries lesions: Milieu-specific cost-effectiveness analysis. J Dent 2015; 43:647-55. [PMID: 25862278 DOI: 10.1016/j.jdent.2015.03.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/06/2015] [Accepted: 03/27/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Dental caries lesions are highly prevalent, concentrated in high-risk groups, and often affect proximal tooth surfaces. Choosing a caries detection method determines the available treatment options: radiographically detected early lesion stages might receive non-, micro-, or invasive treatments, whilst visually tactile detected lesions are often advanced and mostly require invasive treatment. Thus, the choice of detection method impacts on patients via the applied treatment. We compared the cost-effectiveness of combinations of detections and treatments of proximal lesions in different populations which did or did not receive prevention during adolescence. These cost-effectiveness comparisons of different detection-treatment combinations should aid clinical decision making and improve resource allocation. METHODS A Markov-model was constructed to follow a proximal posterior surface in a 12-year-old German over his lifetime. Prevalence, validity and transition probabilities were extracted from the literature. Microsimulations were performed to evaluate costs (Euro) per tooth-retention-time (years). RESULTS For populations with low risk, radiographic detection plus non-invasive treatment without (270 Euro, 61.5 years) and with prevention (312 Euro, 63.0 years), as well as radiographic detection plus micro-invasive treatment and prevention (373 Euro, 64.0 years) were cost-effective. For populations with high risk, radiographic detection plus micro-invasive treatment without (427 Euro, 58.5 years) and with prevention (436 Euro, 61.0 years) were cost-effective. Combinations involving invasive treatments had limited cost-effectiveness. CONCLUSIONS Caries detection methods should be evaluated regarding the cost-effectiveness resulting from their use in different populations. CLINICAL SIGNIFICANCE Caries detection methods are usually evaluated regarding their validity compared to a gold standard. We demonstrate that the cost-effectiveness stemming from using different detection methods additionally depends on the treatment options determined by different methods, and the examined population. Dentists' choice of a detection method should not only be guided by its validity, but also by its specific benefits in different populations.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany.
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany.
| | - Michael Stolpe
- Health Economy Unit, Kiel Institute for the World Economy, Kiellinie 66, 21405 Kiel, Germany.
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