|Year : 2015 | Volume
| Issue : 3 | Page : 132-135
The diagnosis and therapeutic protocols of approximal caries by final-year dental students at Al-Quds University, Palestine
Tarek H Rabi
Department of Operative Dentistry, Al Quds University, Jerusalem, Palestine
|Date of Web Publication||21-Aug-2015|
Tarek H Rabi
Al Quds University, Jerusalem
Source of Support: None, Conflict of Interest: None
Introduction: In this study, the major criterion used by 69 final-year dental students of Al-Quds University, Palestine, to ascertain the presence of approximal carious lesions through radiographs, and their subsequent treatment plan is outlined. Methods: This study was designed to be cross-sectional, whereby a questionnaire containing schematic radiographic diagrams of approximal carious lesions in molars of deciduous and permanent dentition were depicted. Th e extent of caries was divided into fi ve groups indicating different levels of enamel and dentin involvement: Caries extending to the external one-third of enamel, external two-thirds of enamel, up to the dentino-enamel junction (DEJ), external one-third of dentin, and two-thirds of dentin. Results: The absolute and relative frequencies of the study group's responses were recorded. Th e treatment decisions taken for caries in deciduous and permanent dentition were neither affected by age nor gender. Of the 69 subjects, 26.1% (18/69) chose to treat the approximal caries when it had spread to the DEJ in the deciduous dentition and 39.1% (27/69) chose to treat caries at the DEJ in the permanent dentition, showing a significant statistical variation in response. When studying the difference in response to treating deciduous and permanent dentitions, treating a lesion at the DEJ and within the outer third of dentin in deciduous dentition was lower than the latter in permanent dentition, with a treatment response of 26.1% (18/69) for deciduous and 39.1% (27/69) for permanent dentition for a lesion at the DEJ, and 24.3% (17/69) in deciduous and 33.3% (23/69) for permanent dentition for a lesion in the outer third of dentin. Conclusion: These results show a significant difference in the choice to treat approximal caries in deciduous and permanent dentitions, indicating a greater preference for treating caries within dentin in permanent dentition than in deciduous dentition.
Keywords: Approximal caries, dental students, Palestinian dental students, therapeutic protocol
|How to cite this article:|
Rabi TH. The diagnosis and therapeutic protocols of approximal caries by final-year dental students at Al-Quds University, Palestine. Eur J Gen Dent 2015;4:132-5
|How to cite this URL:|
Rabi TH. The diagnosis and therapeutic protocols of approximal caries by final-year dental students at Al-Quds University, Palestine. Eur J Gen Dent [serial online] 2015 [cited 2021 Apr 17];4:132-5. Available from: https://www.ejgd.org/text.asp?2015/4/3/132/163337
| Introduction|| |
In dentistry, the diagnosis of approximal carious lesions is a combination of radiographic and clinical assessment and has been the same for many years.  Radiographic examination of any approximal lesion is crucial to determining its extent. The progression of any carious lesion in dentin can be unexpectedly rapid, and treatment protocols are reflected in the knowledge of the same.  It is possible, however, for the progression of caries to be slow or even reversible in enamel ,, and that the treatment of any lesion limited to radiolucency in enamel alone may be deemed unnecessary. , Any dental professional must have a thorough understanding of the caries process, the different methods of its diagnosis and the various treatment options available, especially those treating pediatric dental patients.  Each dental professional must be trained and competent to make an accurate diagnosis of any dental disease and form a suitable treatment plan in each case in order to achieve optimum dental health.  It is understood that a dentist can accurately diagnose and treat any carious lesion, and many studies have been conducted on this matter. Focus is now being brought to final-year dental students, who are reaching the end of their dental studies and training, to examine their judgment and level of understanding of accurate diagnosis and treatment planning of carious lesions. ,,
The purpose of this study is to examine the treatment protocols selected by final-year dental students when presented with schematic radiographic diagrams of approximal carious lesions in deciduous and permanent dentitions.
| Materials and Methods|| |
The study design was cross-sectional, using a questionnaire to collect the required data that were distributed among final-year dental students. The questionnaire was adopted from the study "Evaluation of final-year dental students concerning therapeutic decision making for proximal caries" by Bervian et al., carried out in the state of Rio Grande do Sul, Southern
Brazil. Each student signed a form of free informed consent in order to validate the findings of the study.
The subjects were students of dentistry in their last semester of final-year of dental school (2013-2014), having received theoretical and clinical knowledge in dental radiology, operative dentistry, and pediatric dentistry.
The questionnaire [Figure 1] asked for the age and gender of each final-year dental student to record for statistical analysis. Names were not necessary to mention. They were given radiographic images of approximal carious lesions spread over five levels of enamel and dentin, one for each, deciduous, and permanent dentition. The five levels of caries were as follows:
- Lesion involving the external third of enamel
- Lesion involving two-thirds of enamel
- Lesion up to the dentino-enamel junction (DEJ)
- Lesion involving the external third of the dentin
- Lesion involving two-thirds of the dentin.
The image of the deciduous molar was that of a 6-year-old patient with decayed, missing, and filled deciduous infant teeth (dmft) =1, and the permanent molar was that of a 15-year-old patient with decayed, missing, filled, tooth (DMFT) =1. The same question was asked for each image:
- Question 1: From which stage onward do you believe immediate restorative treatment is required in the deciduous dentition?
- Question 2: From which stage onward do you believe immediate restorative treatment is required in the permanent dentition?
The students simply have to answer at which level of caries they would decide to restore the approximal carious lesion in each of the two cases.
The results were then collected and analyzed as statistical data.
The restorative treatment decisions made by the 69 dental students were recorded as relative and absolute frequencies. There was a complete dichotomy of the resultant answers; therefore the five levels of caries extension within the molars in question were categorized as:
- Lesions extending up to the DEJ
- Lesions penetrating from the external third of the dentin onward.
The Chi-square and McNemar tests were carried out to determine differences in restorative choice between age groups and the gender of the dental students. Results were then tabulated.
| Results|| |
The responses of 69 final-year dental students were analyzed, with a response rate of 100%. Of the total of 69 students, 78.2% (n = 54) were females and 21.7% (n = 15) were males. The ages of the subjects ranged between 21 and 26 years, with a mean age of 22.35 years and a standard deviation of 1.012. [Figure 2] and [Table 1] show the age range of all the 69 subjects and their respective responses.
When examining at what level each of the 69 students chose to opt for restorative treatment of the deciduous dentition, the results were as follows: External 1/3 rd of enamel: n = 9 (13%); 2/3 rd of enamel n = 12 (17.4%); DEJ: n = 18 (26.1%); external 1/3 rd of dentin n = 17 (24.6%); 2/3 rd of dentin n = 13 (18.8%).
The results of the permanent dentition responses were as follows: External 1/3 rd of enamel: n = 3 (4.3%); 2/3 rd of enamel n = 6 (8.7%); DEJ: n = 27 (39.1%); external 1/3 rd of dentin n = 23 (33.3%); 2/3 rd of dentin n = 10 (14.5%) [Table 2] and [Table 3].
|Table 2: According to the attached picture from which stage onward do you believe immediate restorative treatment is required in deciduous dentition?|
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|Table 3: According to the attached picture from which stage onward do you believe immediate restorative treatment is required in permanent dentition?|
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There was no difference in response to the age and gender of the subjects. [Table 4] and [Table 5] show the responses of the 54 females and 15 males along with their respective treatment decisions.
|Table 4: Responses to treatment of approximal lesions of the male and female subjects|
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|Table 5: Responses to treatment of approximal lesions of the male and female subjects|
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| Discussion|| |
The variations that exist between the diagnosis and treatment planning of carious lesions can be attributed to distinctive diagnostic and treatment aids used by different dental practitioners. , Using a clinical scenario as in this study, it is absolutely possible to examine what therapeutic measure a final-year dental student would choose to treat approximal caries in both, the deciduous and permanent dentitions. The study conducted was thus to ascertain the responses of final-year dental students in relation to their therapeutic decision-making abilities. The questionnaire clearly specified the age and location of caries of each patient along with their respective dmft and DMFT of the deciduous and permanent cases. This information alone was deemed sufficient to enable any dental student to determine an appropriate restorative treatment plan. When studying the difference in response to treating deciduous and permanent dentitions, the choice to restore two-thirds of enamel caries in deciduous dentition was higher than the latter in permanent dentition, with a treatment response of 17.4% (12/69) and 8.7% (6/69) in deciduous and permanent dentitions, respectively. These results show a greater preference for treating deciduous caries limited to enamel and permanent dentition caries within dentin. On the other hand, the response to treating a lesion at the DEJ and within the outer third of dentin in deciduous dentition was lower than the latter in permanent dentition, with a preference of 26.1% (18/69) for deciduous and 39.1% (27/69) for permanent dentition for a lesion at the DEJ, and 24.3% (17/69) in deciduous and 33.3% (23/69) for permanent dentition for a lesion in the outer third of dentin. These results show a significant difference in the choice to treat approximal caries in deciduous and permanent dentitions, indicating a greater preference for treating caries within dentin in permanent dentition than in deciduous dentition, and a higher preference for treating enamel caries in deciduous dentition than in permanent dentition.
These findings indicate a generalized preference for treating caries within enamel in deciduous dentition among final-year dental students and a greater preference for treating caries within dentin in permanent dentition.
Although most demineralized tissue shows on radiographs, this diagnostic criterion is not sufficient. Other clinical symptoms need to be taken into account in order to further validate the results of the study. , A larger sample would give more accurate results, involving subjects from various dental schools. Consideration may be given to including patients over a wider range of ages, with or without systemic conditions, and even those with caries on occlusal and labial/buccal or lingual/palatal surfaces. The need for improving diagnosis and setting a basic diagnostic guideline  for students is apparent, aiming to reduce biases produced clinically.
No single study can be deductive of any given result, and further improvements in study design and sample selection may lead to more definitive results in future studies of a similar nature.
| Conclusion|| |
The current study showed that final-year dental students were capable of diagnosing approximal caries from radiographic images and were independently able to determine at what stage to treat caries in both deciduous and permanent dentitions. Fewer preferred treating the lesion early when it was limited to the enamel alone while the majority of the subjects opted to treat caries when it had reached and surpassed the DEJ in permanent dentitions.
Further education needs to be provided as to whether improved diagnostic aids and treatment protocols need to be implemented for final-year dental students in the process of their diagnostic and radiological training.
| References|| |
Bervian J, Tovo MF, Feldens CA, Brusco LC, Rosa FM. Evaluation of final-year dental students concerning therapeutic decision making for proximal caries. Braz Oral Res 2009;23:54-60.
Bille J, Thylstrup A. Radiographic diagnosis and clinical tissue changes in relation to treatment of approximal carious lesions. Caries Res 1982;16:1-6.
Zamir T, Fisher D, Fishel D, Sharav Y. A longitudinal radiographic study of the rate of spread of human approximal dental caries. Arch Oral Biol 1976;21:523-6.
Gröndahl HG, Hollender L, Malmcrona E, Sundquist B. Dental caries and restorations in teenargers. II. A longitudinal radiographic study of the caries increment of proximal surfaces among urban teenagers in Sweden. Swed Dent J 1977;1:51-7.
Gröndahl HG, Hollender L, Malmcrona E, Sundquist B. Dental caries and restorations in teenagers. I. Index and score system for radiographic studies of proximal surfaces. Swed Dent J 1977;1:45-50.
Pitts NB. Monitoring of caries progression in permanent and primary posterior approximal enamel by bitewing radiography. Community Dent Oral Epidemiol 1983;11:228-35.
Nuttall NM. Letter to editor. Br Dent J 1983;155:370.
White BA, Maupomé G. Clinical decision-making for dental caries management. J Dent Educ 2001;65:1121-5.
Elderton RJ, Duthie N. Opinions on the undergraduate dental education in Scotland received by recently qualified dentists. Med Sci Res 1987;15:751-8.
Maupomé G, Sheiham A. Radiographic criteria employed to diagnose and treat approximal caries by final-year dental students in Mexico City. Community Dent Oral Epidemiol 1997;25:242-6.
Maupomé G, Sheiham A. Decisions on diagnosis and management of approximal caries by final-year dental students. Dentomaxillofac Radiol 1997;26:107-11.
Tveit AB, Espelid I, Skodje F. Restorative treatment decisions on approximal caries in Norway. Int Dent J 1999;49:165-72.
Kay EJ, Watts A, Paterson RC, Blinkhorn AS. Preliminary investigation into the validity of dentists' decisions to restore occlusal surfaces of permanent teeth. Community Dent Oral Epidemiol 1988;16:91-4.
Elderton RJ, Nuttall NM. Variation among dentists in planning treatment. Br Dent J 1983;154:201-6.
De Araujo FB, de Araujo DR, dos Santos CK, de Souza MA. Diagnosis of approximal caries in primary teeth: Radiographic versus clinical examination using tooth separation. Am J Dent 1996;9:54-6.
Flack VF, Atchison KA, Hewlett ER, White SC. Relationships between clinician variability and radiographic guidelines. J Dent Res 1996;75:775-82.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]