Bussaneli Diego Girotto, Boldieri Thalita, Diniz Michele Baffi, Rivera Luciana Monti Lima, Santos-Pinto Lourdes, Cordeiro Rita De Cássia Loiola
Department of Pediatric Dentistry and Orthodontics, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, SP, Brazil.
Department of Pediatric Dentistry, School of Dentistry, UNICSUL - Cruzeiro do Sul University, São Paulo, SP, Brazil.
Int J Paediatr Dent. 2015 Nov;25(6):418-27. doi: 10.1111/ipd.12148. Epub 2014 Dec 15.
To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars.
Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables.
Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B.
The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.
评估检查者的临床经验对乳牙龋损检测及治疗决策的影响。
三名经验丰富的牙医（A组）和三名本科生（B组）使用国际龋病检测与评估系统（ICDAS）标准及咬合翼片（BW），对77颗咬合面健康或龋坏的乳牙进行两次检查。对于治疗决策（TD），检查者给出评分，并结合X线片对牙齿进行分析。通过组织学方法验证病损的存在及深度，并评估可重复性。计算ICDAS和BW的敏感性、特异性、准确性及ROC曲线下面积值。通过列联表分析ICDAS、BW与TD之间的关联。
B组检查者间在ICDAS、BW及TD方面的一致性极佳，A组为中等。两组在使用ICDAS和BW检测龋损方面表现相似且令人满意。在治疗决策方面，A组的治疗方式比B组侵入性更小。
检查者的经验对乳牙咬合面病损的临床及影像学检测并非决定性因素，但会影响初始病损的治疗决策。
