Impact of radiographic examination on the diagnosis and treatment decision of caries lesions in primary teeth

Abstract

Despite most of clinical guidelines indicate that dentists perform two bitewings to detect caries lesions in primary molars of asymptomatic children, the evidence for this is mainly based on cross-sectional studies performed in laboratory or using convenience sample. However, the benefits and impact of radiographic examination on the diagnosis and treatment decision making of caries lesions in primary teeth has not been evaluated considering outcomes related to the patients, such as, need of operative treatment in the follow-up appointments, cost and quality of life of the patients. Thus, the aim of the present study will be to evaluate the impact of radiographic examination to detect caries lesions in primary teeth compared to performing the clinical examination alone, considering different outcomes related to the children's health and welfare. For this, we will develop three studies with different experimental designs, with the following specific objectives: (1) to evaluate the validity of radiographic examination adjunct to the visual inspection in detecting proximal caries lesions in primary molars of children with low and high caries experience, using a cross-sectional study; (2) to evaluate the impact of radiographic examination adjunct to the visual inspection on the diagnosis and treatment decision of caries lesions in primary molars, through a before and after study; (3) to evaluate the impact of radiographic examination adjunct to the visual inspection in detecting caries lesions in primary teeth on the future needs of operative treatment and on the oral health related quality of life of children, using a randomized clinical trial. To reach our aims, 250 children aged from 3 to 6 years, reaching dental treatment in our school, will be randomly allocated in two groups according to different diagnostic strategies used to detect caries lesions: visual inspection alone to make the treatment decision plan (control group) or visual inspection with adjunct radiographic examination (experimental group). Two examiners will make the treatment decision plan, and then, the children will be treated and followed-up for 2 years (follow-up evaluations after 12 and 24 months after the conclusion of the dental treatment). The primary endpoint will be the number of surfaces with operative treatment necessity in the follow-up. This outcome will be used to reach the objective (3). After making the treatment plan, the children allocated in the control group will be evaluated according the performance of the methods (visual inspection alone and associated with radiographic examination), and another treatment plan will be performed after evaluating the dental radiographs. The performance of two diagnostic strategies to detect proximal caries lesions will be validated using temporary separation with orthodontic rubbers, and the treatment plans will be compared. These procedures are related to the studies (1) and (2), respectively. (AU)