Bader J D, Shugars D A, Bonito A J
Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 37599-7590, USA.
J Dent Educ. 2001 Oct;65(10):960-8.
A systematic review of the English-language literature was conducted to address three related questions concerning the diagnosis and management of dental caries: a) the performance (sensitivity, specificity) of currently available diagnostic methods for carious lesions, b) the efficacy of approaches to the management of noncavitated or initial carious lesions, and c) the efficacy of preventive methods among individuals who have experienced or are expected to experience elevated incidence of carious lesions. From 1,328 caries diagnostic and 1,435 caries management reports originally identified, thirty-nine diagnostic studies and twenty-seven management studies were included in the final evidence tables. Point estimates or reasonable range estimates for the diagnostic validity of methods for the diagnosis of carious lesions could not be established from the literature reviewed. There are insufficient numbers of reports of diagnostic performance involving primary teeth, anterior teeth, and root surfaces. For posterior occlusal and proximal surfaces, quality issues and the variation among studies precludes establishing such estimates. The apparent differences in sensitivity among methods are generally smaller than the variation reported within methods. The literature on the management of noncavitated carious lesions consisted of five studies describing seven experimental interventions. Because these interventions varied extensively in terms of management methods tested as well as other study characteristics, no conclusions about the efficacy of these methods were possible. The literature on the management of individuals at elevated risk of carious lesions consisted of twenty-two studies describing twenty-nine experimental interventions. The strength of the evidence for the efficacy of fluoride varnish for prevention of dental caries in high-risk subjects was fair, and the evidence for all other methods was incomplete. Because the evidence for efficacy for some methods, including chlorhexidine, sucrose-free gum, and combined chlorhexidine-fluoride methods, is suggestive but not conclusive, these interventions represent fruitful areas for further research.
为解决有关龋齿诊断和管理的三个相关问题，开展了一项对英文文献的系统综述：a）当前可用的龋齿病变诊断方法的性能（敏感性、特异性）；b）非龋洞或初期龋齿病变管理方法的疗效；c）在已发生或预计龋齿发病率升高的个体中预防方法的疗效。从最初确定的1328篇龋齿诊断报告和1435篇龋齿管理报告中，最终证据表纳入了39项诊断研究和27项管理研究。从所综述的文献中无法确定龋齿病变诊断方法诊断有效性的点估计值或合理范围估计值。涉及乳牙、前牙和牙根面的诊断性能报告数量不足。对于后牙咬合面和邻面，质量问题以及研究之间的差异使得无法确定此类估计值。方法之间敏感性的明显差异通常小于方法内部报告的差异。关于非龋洞性龋齿病变管理的文献包括五项描述七种实验性干预措施的研究。由于这些干预措施在测试的管理方法以及其他研究特征方面差异很大，因此无法得出关于这些方法疗效的结论。关于龋齿病变高危个体管理的文献包括22项描述29种实验性干预措施的研究。氟化物漆预防高危人群龋齿疗效的证据强度为中等，而所有其他方法的证据不完整。由于包括洗必泰、无糖口香糖以及洗必泰 - 氟化物联合方法在内的一些方法疗效的证据具有提示性但不确凿，这些干预措施是进一步研究的富有成果的领域。
