Improving radiographic diagnosis of pulpo-periodontal complications in primary molars by training: Application in education and clinical research

INTRODUCTION

The objective of this study was to assess an original learning intervention to train students and paediatric dentistry teachers in radiographic diagnostic accuracy of pulpo-periodontal complications in primary molars.

MATERIALS AND METHODS

The learning intervention was based on 250 different randomly ordered radiographs of primary molars within three quizzes (A, B and C) for 5 sessions (S): quiz A (50 X-rays), B and C (100 X-rays) were, respectively, completed in S1 to assess the extent of agreement with 5 experts' diagnoses, in S2 and S3 (B at days 8 and 23) and in S4 and S5 (C at days 90 and 105). During S1 and at the end of S3 and S5, the participants (48 students and 16 teachers) were informed of correct diagnoses. A satisfaction questionnaire was completed by all the students. Alongside the descriptive analyses, generalised linear mixed model (GLMM) analyses assessed the odds of participants' correct diagnosis over the study duration.

RESULTS

At S1, the odds of diagnostic accuracy among students were significantly lower than those among the teachers. After receiving feedback at S1, GLMM analyses showed that among all the participants, accuracy improved over time with the odds of correct diagnoses higher in S2-5 than in S1; and there were similar increases across sessions between teachers and students, except in S3, where the improvement among teachers tended to be greater than that among the students. All students were satisfied though one-third reported that quizzes with 100 radiographs felt too long.

CONCLUSION

The online case-based learning was a good training format for dental education.

Restorative thresholds for primary and permanent molars in children: French dentist decisions

BACKGROUND

Worldwide, numerous surveys have investigated practices and knowledge about caries management in adults, but few are available for children.

AIM

The present cross-sectional survey aimed to assess the restorative thresholds (RTs) in primary and permanent molars in children used by a population of dentists treating children and practicing in France.

DESIGN

The study population consisted of French dentists treating children (Fr-DTCs) who were registered in the French Society of Pediatric Dentistry (n = 250). A specific questionnaire was developed. Descriptive and statistical analyses were performed.

RESULTS

Response rate was 80.4% (n = 201). Considering that an appropriate RT is at the stage of a moderate lesion (occlusal: International Caries Detection and Assessment System 4; approximal: lesion involving the external third of dentine), more than 50% of respondents showed a tendency for iatrogenic treatment, except for occlusal carious lesions in primary molars. Inappropriate invasive strategies were more often reported for occlusal lesions in permanent than primary molars. Moreover, for both molar types, these inappropriate RTs were more often chosen for approximal than occlusal lesions.

CONCLUSIONS

The present survey suggested that Fr-DTCs tend to overtreat in terms of caries management in both primary and permanent molars.

Dentists' decisions for deep carious lesions management in primary teeth

BACKGROUND

Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to deep carious lesion (DCL) management in permanent teeth, and there is a lack of data in primary teeth.

AIM

A cross-sectional questionnaire survey was undertaken to describe the management strategies for DCL of vital primary teeth, focusing on the different caries removal techniques, among dentists practicing pediatric dentistry (DPPDs) in France. Their behavior was compared to members one registered to European Academy of Pediatric Dentistry (EAPD).

DESIGN

A questionnaire was electronically administrated (2018-2019) to members of the Collège des Enseignants en Odontologie Pédiatrique (CEOP), the Société Française d'Odontologie Pédiatrique (SFOP), and the EADP. Descriptive and statistical analyses were performed.

RESULTS

Response rate was, respectively, for CEOP, SFOP, and EAPD about 74%, 29%, and 15%. About half of the respondents (53%) would perform a complete caries removal into one step when 12% would indicate a stepwise technique: 68% of the DPPDs practicing in France would perform complete caries removal in one step when the preferred option in the other EAPD members was the selective excavation (44%) (P < .001).

CONCLUSIONS

Complementary education of French dentists in the domain of caries management appears necessary regarding current recommendations.

Caries removal strategies for deep carious lesions in primary teeth: Systematic review

The study aimed to compare the efficacy of three caries removal techniques-complete caries removal (CCR), selective caries removal (SCR), and stepwise caries removal (SWR)-for deep carious lesions in vital temporary teeth by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). Electronic databases (PubMed [MEDLINE], Cochrane Library, EMBASE) were searched for corresponding references up to 31 May 2019. Possible outcomes were pulp exposure, pulpo-periodontal complications, or restorative failures. Three reviewers independently selected studies, extracted data, and assessed the risk of bias using RoB 2. Meta-analyses for intention-to-treat and per-protocol scenarios were performed using Revman5. Of 1374 potentially eligible articles, ten relevant references corresponding to eight studies were included. Pooled results showed decreased risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using USPHS criteria, after SCR compared with CCR only in intention-to-treat analysis. Risk of clinical or radiographic failure of pulpo-periodontal complications was unchanged when compared with SCR and CCR or SWR. SCR and SWR may result in lower pulp exposure risk than CCR. RCTs with lower risk of bias, higher power, and longer follow-up are required to choose between these three caries removal techniques for deep carious lesions in vital temporary teeth.