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Impact of the radiographic method on treatment decisions related to dental caries in primary molars: a before–after study

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Abstract

Objectives

To evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars.

Materials and methods

A total of 126 children aged 3–6 years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes.

Results

Changes from “no treatment” decided with visual inspection to “non-operative treatment” after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to “operative treatment” were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars.

Conclusions

The impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces.

Clinical relevance

The benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

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Acknowledgments

We are very grateful to Dr. Richard Hogan for the review in the English language. Authors would like also to thank all persons from the CARDEC collaborative group. Staff members are important for promoting, organizing and conducting all procedures related to this study and to the entire clinical trial. A list of these persons and their roles can be accessed at https://is.gd/FrqlYo

Funding

This study was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq (Grant nos 471817/2012-0 and 306304/2015-5), Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (Grant no 2012/24243-7), and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).

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Authors and Affiliations

  1. Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Av. Lineu Prestes, 2227, São Paulo, 05508-000, Brazil

    Laura R. A. Pontes, Tatiane F. Novaes, Juan S. Lara, Bruna L. P. Moro, Thais Gimenez, Daniela P. Raggio, Mariana M. Braga & Fausto M. Mendes

  2. School of Dentistry, Cruzeiro do Sul University, R. Galvao Bueno, 868, São Paulo, 01506-000, Brazil

    Tatiane F. Novaes

  3. Dental Health Unit, The University of Manchester, Higher Cambridge St, Manchester, M15 6FH, UK

    Juan S. Lara

  4. School of Dentistry, Ibirapuera University, Av. Interlagos, 1329, São Paulo, 04661-100, Brazil

    Thais Gimenez

Authors
  1. Laura R. A. Pontes
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  2. Tatiane F. Novaes
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  3. Juan S. Lara
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  4. Bruna L. P. Moro
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  5. Thais Gimenez
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  6. Daniela P. Raggio
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  7. Mariana M. Braga
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  8. Fausto M. Mendes
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Corresponding author

Correspondence to Fausto M. Mendes.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by Committee for Ethics in Research of School of Dentistry, University of São Paulo, in May 29, 2012, with Protocol number 02952612.4.0000.0075. This research is nested within a clinical trial performed to test different strategies for caries diagnosis in children. The main clinical trial, CARies Detection in Children (CARDEC-1), is registered at Clinicaltrials.gov (NCT02078453).

Informed consent

Participants’ guardians signed an informed consent prior to the participation of the children in the study.

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Pontes, L.R.A., Novaes, T.F., Lara, J.S. et al. Impact of the radiographic method on treatment decisions related to dental caries in primary molars: a before–after study. Clin Oral Invest 23, 4075–4081 (2019). https://doi.org/10.1007/s00784-019-02844-w

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  • DOI: https://doi.org/10.1007/s00784-019-02844-w

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