Clinical diagnosis of fissure caries with conventional and laser-induced fluorescence techniques

We studied the in vivo validity of dentinal fissure caries diagnosis by visual examination, bitewing radiography, and use of a laser-induced fluorescence device (DIAGNOdent). A total of 144 and second molars with macroscopically intact occlusal surfaces in 41 Chinese young adults were examined visually, by bitewing radiography, and by DIAGNOdent. Visual examination after pit and fissure opening was used as the reference standard. The sensitivity and specificity of detecting caries that had extended into the dentin were, respectively, 0.89 and 0.44 by visual detection of opacity or discoloration after air drying, 0.13 and 1.00 by bitewing radiography to detect radiolucency extending into the dentin, and 0.70 and 0.84 by DIAGNOdent testing with a cut-off score of 40. Caries detection by a combination of visual examination and DIAGNOdent had a sensitivity of 0.67 and specificity of 0.94. Receiver operating characteristic analysis showed that this combined approach was superior to the other methods. © Springer-Verlag London Limited 2009.published_or_final_versionSpringer Open Choice, 01 Dec 201

Precision of clinical diagnosis of fissure caries by different methods

Session - Cariology ResearchAIM: To describe the precision of diagnosis of fissure caries into dentine by clinical examination, taking bitewing radiograph, and using a qualitative laser-induced fluorescence detection device. MATERIALS AND METHODS: Subjects were recruited from university students who had signs of early caries in the fissures of their molars found in an oral health screening programme. Two calibrated dentists performed a visual and then tactile examination by using portable fiber-optic light, dental mirrors and sharp explorers. Bitewing radiographs were taken and scanned into a computer. The images were viewed for signs of dental caries. Status of the fissures in the molars were assessed using a laser-induced fluorescence detection device (DIAGNOdent, KaVo). Biopsy was performed during the restorative treatment of the clinically diagnosed carious fissures and this was used as the reference standard. The sensitivity and specificity of different diagnostic methods, as well as the optimal cut-off point for DIAGNOdent reading were calculated. RESULTS: This study involved 145 first and second permanent molars in 41 subjects. The sensitivity & specificity of using visual examination, tactile probing, DIAGNOdent reading (>35) and bitewing radiograph to diagnose fissure caries into dentine were 16 & 100, 89 & 44, 75 & 75 and 2 & 100, respectively. The diagnosis by a combination of tactile probing and DIAGNOdent reading had a sensitivity & specificity of 71 &90. CONCLUSION: Tactile probing had a high sensitivity but a low specificity for detecting fissure caries into dentine while visual examination and bitewing radiograph had the reverse. Caries diagnosis based on the combined findings from tactile probing and qualitative laser-induced fluorescence detection had a good level for both sensitivity and specificity.link_to_OA_fulltextThe 21st International Association for Dental Research (Southeast Asia Division) & 18th Southeast Asia Association for Dental Education (SAADE) Annual Scientific Meeting, Bali, Indonesia, 6-8 September 2007

Clinical visual detection of fissure caries with and without DIAGNODent

PURPOSE: To study the validity of detection of obscure fissure caries extending into dentine by clinical visual examination, Diagnodent or their combination. MATERIAL AND METHODS: Clinical visual examination on fissures of molars with no obvious cavitation was performed on university students with air drying and under optimal lighting. DIAGNOdent was used to detect dentine fissure caries. Biopsy was then performed during restorative treatment of the studied fissures. This was used as reference standard. The sensitivity and specificity of clinical visual examination, Diagnodent with different cut-off points and their combinations were evaluated. RESULTS: A total of 145 first and second permanent molars in 41 students aged 20±2 years were examined. The sensitivity and specificity of clinical visual detection of caries extending into dentine were 0.89 and 0.44 respectively. The sensitivity and specificity using DIAGNODent with the recommended cut-off point 20 were 0.94 and 0.14 respectively. When the cut off point was increased to 35, the sensitivity & specificity values were both changed to 0.75. Caries detection by a combination of clinical visual examination and DIAGNOdent reading 35 had the highest sum of sensitivity & specificity (0.71 + 0.90). CONCLUSION: The validity of caries detection on obscure fissure caries extending into dentine using DIAGNODent with the commended cut-off point 20 was not substantially better than by clinical visual examination. A combination of clinical visual examination and Diagnodent with a cut-off point 35 gave a satisfactory level on both sensitivity and specificity of detection of fissure caries extending into dentine.The World Federation for Laser Dentistry (WFLD) Congress, Hong Kong, 28-30 July 2008

Screening for diabetic retinopathy with or without a copayment in a randomized controlled trial: Influence of the inverse care law

Objective: To examine whether the inverse care law operates in a screening program for diabetic retinopathy (DR) based on fee for service in Hong Kong. Design: Randomized controlled trial. Participants: All those with type 1 or 2 diabetes from 2 clinics were recruited. Intervention: Diabetic retinopathy screening with a small copayment versus free access in a publicly funded family medicine service. Main Outcome Measures: Uptake of screening and severity of DR detected. Association between these outcome variables and independent variables were determined using multivariate logistic regression models and reported as odds ratios (ORs). Results: After randomization, 1387 subjects in the free group and 1379 subjects in the pay group were eligible for screening, and 94.9% (1316/1387) and 92.6% (1277/1379), respectively, agreed to participate in the study. The offer of screening was accepted by 94.8% (1247/1316) in the free group and 91.2% (1164/1277) in the pay group, and the final uptake ratios were 88.5% (1165/1316) and 82.4% (1052/1277), respectively (Pearson chi = 19.74, P<0.001). Being in the pay group was associated with a lower uptake of screening than being in the free group (OR, 0.59; confidence interval [CI], 0.47-0.74) and a lower detection rate of DR (OR, 0.73; CI, 0.60-0.90) after adjustment for potential confounding factors. Subjects with higher socioeconomic status were more likely to attend screening and had a lower prevalence of DR detected. Conclusions: The inverse care law seems to operate in a preventive intervention when a relatively small copayment is applied. There is a case for making effective preventive services free of charge. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 American Academy of Ophthalmology.link_to_subscribed_fulltex

Systematic screening for diabetic retinopathy in Hong Kong

Oral Presentations: Session 3 - Reproduction & Development and Public Health: 3.1

Screening for diabetic retinopathy in Hong Kong: a cost-effectiveness analysis

Poster PresentationConference Theme: Global Public Health Challenge