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Impact of initial caries lesions detection and caries activity assessment in primary teeth: randomized controlled study (CARDEC-02) with 1-year follow-up

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Isabela Floriano Nunes Martins
Total Authors: 1
Document type: Doctoral Thesis
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
Defense date:
Examining board members:
Mariana Minatel Braga Fraga; Maximiliano Sérgio Cenci; Kim Rud Ekstrand; Fausto Medeiros Mendes; Daniela Prócida Raggio
Advisor: Mariana Minatel Braga Fraga

Currently, it is believed that caries detection since the earliest stages and caries activity assessment could guide the best option of treatment for the patient and consequently minimize additional costs in a short and long-term analysis. The objective of this study was to evaluate how detecting of any stage of caries lesions (all severities) and caries activity assessment could impact in terms of 1) time, cost and discomfort reported by the child in caries examination session; 2) expected changes in treatment planning in concerning the diagnostic strategy and 3) the need, after one year, for new operative intervention (primary outcome), impact on child\'s quality of life and their parents\' satisfaction. For this randomized controlled clinical study with parallel groups (CARDEC-02, NCT02473107), children aged 3-6 years with complete primary dentition, who sought for dental care in Barueri-SP, were examined, except those that could not be followed or consent was not obtained. Children were randomized in blocks, by a sequence generated according to the diagnostic strategy: GA (detection of moderate and advanced lesions only (ICDAS scores 3 to 6) without evaluation of activity) and GB (detection and activity assessment of lesions at all severities (ICDAS scores 1 to 6)). The treatment plan for each child was made and carried out according to the strategy. Children were followed for 6 and 12 months. For objective 1, the time spent and the materials used in each caries diagnosis session were recorded. For objective 2, children from the GA group were examined twice (n = 130), considering or not initial lesions and activity status. The treatment planned by each strategy was then compared. The impact on the cost of treatment (per child) was estimated, in Brazilian Real, considering published values (Schwendicke et al., 2015). For objective 3, the primary endpoint was the number of surfaces with operative treatment needs (presence of dentine cavitated lesions, replacement of restorations, endodontic treatment and/or extraction) during the 12-month follow-up. Time and cost of procedures, quality of life and satisfaction were also collected during follow-up. 260 patients (age: 4.5 ± 0.9 years, dmf-s: 3.8 ± 6.5) were included. 221 children were re-evaluated after 1 year. Detecting all lesions consumed longer time (39s), however this did not cause any difference in the cost of exams. In the before-and-after analysis, the detection of initial lesions would increase the need for non-operative treatment in 35% and the activity assessment would save operative treatment in 5% of the patients. After one year, operative intervention requirements were similar between groups (GA 2.7 ± 4.7, GB 2.8 ± 5.1; p = 0.881), as well as the cumulative cost per child from the treatment of each strategy (GA R$ 213.11 ± 218.48, GB R$ 223.64 ± 225.72; p = 0.702). Both strategies had similar results regarding impact on the patient\'s quality of life and satisfaction of their parents. It was concluded, therefore, that the detection of initial lesions and activity assessment in primary teeth cause minimal impact after one year of follow-up. (AU)

FAPESP's process: 13/27206-8 - Cost-effectiveness, applicability and impact on quality of life of the caries lesions detection and assessment in primary teeth: a randomized controlled trial
Grantee:Isabela Floriano Nunes Martins
Support Opportunities: Scholarships in Brazil - Doctorate