Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth – the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial

Abstract\ud \ud Background\ud Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare.\ud \ud \ud Methods/Design\ud To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars.\ud \ud \ud Discussion\ud Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth.\ud \ud \ud Trial registration\ud \ud \ud NCT02078453\ud \ud . Registered 4 March 2015.This trial is funded by the Fundação de Amparo à Pesquisa do Estado de\ud São Paulo – FAPESP (Grant # 2012/24243-7), CNPQ (Grants # 471817/2012-0\ud and 471817/2012-0) and CAPES, Brazilian funding agencies. The authors\ud wish to thank the participants of the Post-Graduation in Pediatric Dentistry\ud Seminar of FOUSP for the critical comments

Development and evaluation of extension course in Atraumatic Restorative Treatment (ART) using distance education

O objetivo deste estudo longitudinal prospectivo foi desenvolver um curso de extensão usando recursos da educação a distância (EAD) e avaliar seu potencial no desenvolvimento das competências necessárias para a execução do Tratamento Restaurado Atraumático (ART) nos cirurgiões-dentistas. O curso aborda filosofia e técnica do ART utilizando diferentes recursos como computação gráfica em três dimensões, filmagens clínicas, imagens de fotografias e radiografias intrabucais e entrevistas com especialistas no assunto. O curso tem aproximadamente 40 minutos e é apresentado em formato de DVD, que em função disso, proporciona alta acessibilidade e baixa interatividade. A amostra consistiu de 68 cirurgiões-dentistas divididos em 2 grupos: Grupo Diadema - 44 profissionais da população de cirurgiõesdentistas da rede pública de Diadema/SP (perda amostral de 38,9%) e Grupo USP- 24 profissionais da rede pública de 7 cidades próximas à São Paulo envolvidos em parceria científica entre as prefeituras e a disciplina de Odontopediatria da FOUSP (perda amostral 7,7%). Inicialmente os cirurgiões-dentistas responderam questionário que abordou conhecimento prévio, credibilidade e interesse na capacitação relativos ao ART. Na seqüência, os participantes foram submetidos ao processo de avaliação que consistiu na aplicação de prova setorizada (setores 1, 2 e 3) em dois momentos distintos: antes e depois dos profissionais terem passado pela capacitação à distância (avaliação inicial e final). A correção das provas foi realizada por 2 pesquisadoras (grau de concordância inter-examinadores CCI=0,970; 95%IC=0,916-0,989 e intraexaminadora CCI=0,991; 95%IC=0,975-0,996). Os 2 grupos apresentavam nível semelhante de conhecimento inicial (teste t de Student p>0,05) e mostraram ganho de conhecimento, após terem sido submetidos ao curso de extensão, para os 3 setores da prova isoladamente e média geral (teste t de student pareado p0,05). No modelo múltiplo de regressão linear, considerando as notas da avaliação inicial, foi observado associação para profissionais acima de 46 anos de idade (= -0,807; p0,01), para os participantes que entendiam o ART como tratamento restaurador definitivo (= 0,581; p0,01) e para os cirurgiões-dentistas com experiência clínica reduzida em ART (= -0,592; p0,05). Quando considerado o desempenho dos cirurgiões-dentistas na avaliação final, houve associação para os profissionais do grupo Diadema (= -0,652; p0,01), para as mulheres (= 0,700; p0,05), para os profissionais acima de 46 anos (= -0,788; p0,05) e para os participantes que consideravam o ART como tratamento restaurador definitivo (= 0,515; p0,05). Concluiu-se que cursos de extensão profissional a distância desenvolvidos adequadamente apresentam potencial para promover, nos cirurgiõesdentistas, as competências necessárias para a correta execução de técnicas odontológicas baseadas em evidências, como por exemplo, o ART. Além disso, adultos jovens, do sexo feminino, que apresentam conhecimento prévio adequado e interesse no aprimoramento tendem a apresentar melhor desempenho frente a esta modalidade de ensino.The aim of this prospective longitudinal study was to develop an extension course based on distance learning and evaluate its potential in developing necessary skills for Atraumatic Restorative Treatment (ART) implementation. The course teaches philosophy and technique using different resources such as computer graphics in three dimensions, clinical films, photographs and radiographs, and interviews with experts. The course takes approximately 40 minutes and is presented in DVD format providing high availability and low interactivity. The study sample consisted of 68 dentists and was assigned into 2 groups: Diadema Group - 44 professionals from public health system in Diadema / SP (dropout 38.9%) and USP Group - 24 professionals from 7 different cities close to São Paulo involved in a scientific partnership between municipalities and discipline of Pediatric Dentistry from FOUSP (7.7% dropout). Initially the dentists answered a questionnaire focused in baseline knowledge, credibility and interest in receive training in ART. Subsequently, participants underwent an assessment process that consisted of sectorized evaluation (sectors 1, 2 and 3) at two different times: before and after the extension course (baseline and final assessment). The correction of the tests was performed by two researchers (inter-examiner agreement ICC = 0.970, 95% CI = 0.916 to 0.989 and intraexaminer agreement ICC = 0.991, 95% CI = 0.975 to 0.996). The two groups had similar initial knowledge (Student´s t test p> 0.05) and showed knowledge increase, after extension course, for each of three sectors and in the sum (Student\'s paired t test p 0.05). In the multiple linear regression model, considering the grades from initial evaluation, it was observed association for professional over 46 year olds ( = -0.807, p 0.01), for participants that had in mind that ART was a definitive treatment ( = 0.581, p 0.01) and for dentists with reduced clinical experience in ART ( = -0.592, p 0.05). When considering the dentists´ performance in the final evaluation, there was an association for professionals in the Diadema group ( = -0.652, p 0.01), for women ( = 0.700, p 0.05), for professionals over 46 years old ( = -0.788, p 0.05) and for participants who pointed out ART as a definitive restorative treatment ( = 0.515, p 0.05). It was concluded that distance education has the potential to promote the skills to perform correctly evidence based dental techniques, such as ART. Besides that, young adult, female, with appropriate basis knowledge and interest in professional development improve the students´ performances on distance education