PURPOSECase-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence. This simulated EDR provides case-based information in support of a set of defined evidence-based learning objectives.METHODSThe development of this complex simulation model required coordinated efforts to create several components: identify behavior changes, case authoring mechanism, create virtual patient visits, require users to make treatment plan decisions related to learning objectives, and a feedback mechanism to help users recognize departures from those learning objectives. This simulation was evaluated in a 2-arm, clinic-randomized, controlled pilot study examining the extent to which DDSim changed dentists' planned treatment to conform to evidence-based treatment guidelines relative to change in dentists not exposed to DDSim. Outcomes were measured by comparing preintervention and postintervention patient EDR treatment data.RESULTSChanges in behavior over time did not favor intervention or control clinics.CONCLUSIONDDSim provides a standardized learning platform that cannot be achieved through the use of live patients. Both live patients and case-based simulations can be used to transfer knowledge and skill development. DDSim offers the advantage of providing a platform for developing treatment planning skills in a low-risk environment. However, further research examining behavior change is needed.

Journal of Dental EducationVolume 84, Issue 11 p. 1183-1184 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 84 Number 11/November 2020 First published: 12 November 2020 https://doi.org/10.1002/jdd.12492AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume84, Issue11November 2020Pages 1183-1184 RelatedInformation

Background. A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin. Methods. Eighty-two dentists participated. In phase 1 of the study, dentists identified approximately 20 SOCLs, obtained patient consent, and recorded information about the lesion, treatment or treatments, and depth, if opened. Dentists were then randomly assigned into 1 of 3 groups: no device, DIAGNOdent (KaVo), and Spectra (Air Techniques). In phase 2, dentists enrolled approximately 20 additional patients and recorded the same phase 1 information while using the assigned device to help make their treatment decisions. A mixed-model logistic regression was used to determine any differences after randomizationin the proportion of lesions opened and, if opened, the proportion of lesions that penetrated into dentin. Results. A total of 1,500 SOCLs were enrolled in each phase. No statistically significant difference was found in the change in proportion of lesions receiving invasive treatment from phase 1 to phase 2 across the 3 groups ( P = .33) or in the change in proportion of percentage of opened lesions that extended into dentin ( P = .31). Conclusion. Caries-detecting devices in the study did not change substantially dentists' decisions to intervene or the accuracy of the intervention decision in predicting lesion penetration into dentin.

Background. A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically. Methods. Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted chi(2) test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster. Results. The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07). Conclusions. Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives.

OBJECTIVE:A systematic review was conducted to address this clinical question: Does consumption of (non-dairy) sugar-containing beverages (SCBs) among children under age 12 result in excess weight gain?METHODS:The authors searched four databases for controlled trials (randomized and non-randomized) and cohort studies published in English through March 29, 2016: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL. Initial and full-text screening, data abstraction, and risk of bias assessment were performed independently and in duplicate.RESULTS:Thirty-eight studies met inclusion criteria for this systematic review. One was a randomized controlled trial, and 37 were cohort studies. Though the results of these studies were mixed, the majority demonstrated a statistically significant positive association between SCB consumption in children under age 12 and total adiposity and central adiposity. In contrast, most studies that assessed 100 percent fruit juice consumption only with either total adiposity or central adiposity did not support an association. Among only children under age 5 at baseline, no studies examined central adiposity, but nearly all studies examining SCBs and total adiposity, and a majority examining only fruit juice consumption, demonstrated a statistically significant positive association.CONCLUSION:Our results support a statistically significant positive association between SCBs and total and central adiposity among children under age 12. This association is most consistent for total adiposity among children <5. Our results for 100 percent fruit juice only suggest differences by age, as most studies among those < 12 were negative but most among those <5 were positive.

Objective: Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs. Methods: 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk. Each vignette included a patient description and a photograph of a tooth presenting the 4 cues. Dentists were asked to decide the likelihood that a suspected lesion extended into dentin. A lens model analysis was used to examine how dentists use these cues in making their decisions. Results: 86% of dentists had a consistent pattern of cue use that defined their decision strategy. On average, 70% of the variance in their decisions was accounted for by their use of the 4 cues. However, there was considerable variability in the individual cues used by each dentist. The percentages of dentists who used the different cues consistently were: luster (58%), color (48%), roughness (36%), and risk (35%). 14% of dentists reliably used only color, 7% used only luster, 4% used only roughness, and 1% used only risk when making SOCL decisions. Conclusions: The online vignette system suggests that clinical SOCL decision strategies are highly individualized and dentists do not use all cues available to them to make these decisions. Clinical significance: Prior to this study, there has been little evidence about how dentists use these cues (either individually or in combination) when judging the extent of caries progression. Such knowledge would be valuable when designing interventions to help dentists maximize the likelihood of appropriate treatment decisions.

imal intervention dentistry concept. His latest line of research has resulted in the development of a novel carious lesion assessment and treatment instrument (CAST) for use in epidemiological studies. Dr. Frencken’s solid and highly dedicated research has contributed greatly to the prevention of dental diseases and to increasing the accessibility of oral health care for many individuals and population groups in different countries worldwide. Panos Papapanou is Professor of Dental Medicine, Director of the Division of Periodontics, and Chairman of The 2016 Yngve Ericsson Prize for Research in Preventive Odontology has been awarded jointly to Professor Jo Frencken of Radboud University, Nijmegen, the Netherlands, and Professor Panos Papapanou of Columbia University, New York, NY, USA. The Prize of SEK 400,000 (approx. EUR 43,000) is to be shared equally between the two recipients and will be awarded at the ORCA Congress in July in Athens, Greece. Jo Frencken, Associate Professor Emeritus in Minimal Intervention Dentistry at the College of Dental Sciences of the Radboud University Medical Centre in Nijmegen, is a public health specialist by training. His early experience, in Malawi, Africa, of the many facets of oral health in the absence of regular dental care significantly altered his perception on how dental caries might be managed, and this led him to reconsider how oral care can be made available for an increasing number of people and communities. Dr. Frencken’s research has thus mainly focused on caries prevention and on providing dental care by principles that were earlier deemed less justifiable but currently considered as valid, given the fact that low-income populations cannot afford the well-known standards of oral care. He pioneered the development of the ART (atraumatic restorative treatment) concept and was instrumental in researching the many aspects of this minPublished online: June 4, 2016

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance]. A sensitivity analysis added treatment to the models for both the control and treatment participants (n = 301) to predict RC for the control participants. Forty-nine percent of the control participants had incident RC. The model including the number of follow-up years at risk, the number of root surfaces at risk, RC index, gender, race, age, and smoking resulted in the best prediction performance, having the highest AUC and lowest Brier score. The sensitivity analysis supported the primary analysis and gave slightly better performance summary measures. The set of risk indicators best able to predict RC incidence included an increased number of root surfaces at risk and increased RC index at baseline, followed by white race and nonsmoking, which were strong nonsignificant predictors. Gender, age, and increased number of follow-up years at risk, while included in the model, were also not statistically significant. The inclusion of health, diet, RPD use, toothbrush use, income, education, and dental insurance variables did not improve the prediction performance.

OBJECTIVE:To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications.METHODS:The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth.RESULTS:Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X-ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined.CONCLUSIONS:This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed.

Community Dentistry and Oral EpidemiologyVolume 35, Issue 4 p. 318-319 Evidence-based dentistry: an introduction J.D. Bader DDS MPH, J.D. Bader DDS MPH Research Professor,UNC School of Dentistry,Chapel Hill, NC, USAe-mail: jim_bader@unc.eduSearch for more papers by this author J.D. Bader DDS MPH, J.D. Bader DDS MPH Research Professor,UNC School of Dentistry,Chapel Hill, NC, USAe-mail: jim_bader@unc.eduSearch for more papers by this author First published: 04 July 2007 https://doi.org/10.1111/j.1600-0528.2007.00390.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume35, Issue4August 2007Pages 318-319 RelatedInformation

ABSTRACT Background. A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions. Methods. Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. Results. At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio=3.4; 95 percent confidence interval, 1.7-6.8) and the lesion's being on a molar (odds ratio=1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinician's deciding at some point after follow-up to seal the lesion or treat it invasively. Conclusions. Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. Practical Implications. Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions.

BACKGROUNDDocumenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network").METHODSNetwork dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent ("1") or inconsistent ("0") with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.RESULTSThe authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).CONCLUSIONDentists reported a medium-range concordance between practice and published evidence.PRACTICAL IMPLICATIONSEfforts to bring research findings into routine practice are needed.

Background Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network (“the network”). Methods Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent (“1”) or inconsistent (“0”) with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence. Results The authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent). Conclusion Dentists reported a medium-range concordance between practice and published evidence. Practical Implications Efforts to bring research findings into routine practice are needed.

BACKGROUND:A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions.METHODS:Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months.RESULTS:At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion's being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinician's deciding at some point after follow-up to seal the lesion or treat it invasively.CONCLUSIONS:Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions.PRACTICAL IMPLICATIONS:Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions.

A critical summary of Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Lasers for the treatment of dentin hypersensitivity: a meta-analysis. J Dent Res 2013;92(6):492-499. A critical summary of Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Lasers for the treatment of dentin hypersensitivity: a meta-analysis. J Dent Res 2013;92(6):492-499. Systematic review conclusion. Erbium:yttrium-aluminum-garnet (Er:YAG), neodymium:yttrium-aluminum-garnet (Nd:YAG) and gallium-aluminum-arsenide (GaAlAs) lasers appear to be efficacious in reducing dentin hypersensitivity (DH). However, given the high degree of heterogeneity of the included studies, future adequately powered randomized controlled trials (RCTs) are needed to confirm these results.Critical summary assessment. The authors assessed 13 RCTs providing limited evidence that Er:YAG, Nd:YAG and GaAlAs lasers could be efficacious in reducing DH when compared with no treatment; however, they did not compare the results with those for studies of alternative treatments.Evidence quality rating. Limited. Systematic review conclusion. Erbium:yttrium-aluminum-garnet (Er:YAG), neodymium:yttrium-aluminum-garnet (Nd:YAG) and gallium-aluminum-arsenide (GaAlAs) lasers appear to be efficacious in reducing dentin hypersensitivity (DH). However, given the high degree of heterogeneity of the included studies, future adequately powered randomized controlled trials (RCTs) are needed to confirm these results. Critical summary assessment. The authors assessed 13 RCTs providing limited evidence that Er:YAG, Nd:YAG and GaAlAs lasers could be efficacious in reducing DH when compared with no treatment; however, they did not compare the results with those for studies of alternative treatments. Evidence quality rating. Limited. In adults with dentin hypersensitivity (DH), do certain lasers, compared with placebo or no treatment, effectively reduce DH? Two independent reviewers searched seven electronic databases through Feb. 10, 2013, with no language restrictions. The reviewers considered only randomized controlled trials (RCTs) involving adult participants in which investigators compared laser treatment for DH with placebo or no treatment. The reviewers combined the change in pain level from baseline to follow-up in a meta-analysis to determine efficacy. The reviewers assessed risk of bias. The reviewers included in the meta-analyses 13 RCTs that involved 373 adults and four types of lasers: erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) versus placebo, erbium:yttrium-aluminum-garnet (Er:YAG) versus placebo, neodymium:yttrium-aluminum-garnet (Nd:YAG) versus placebo, and gallium-aluminum-arsenide (GaAlAs) versus placebo. The reviewers reported no statistically significant differences for Er,Cr:YSSG versus placebo (standardized mean difference [SMD], 2.49; 95 percent confidence interval [CI], −0.25 to 5.22; P = .07) but did report statistically significant differences in favor of lasers for Er:YAG versus placebo (SMD, 2.65; 95 percent CI, 1.25 to 4.05; P = .0002), Nd:YAG versus placebo (SMD, 3.59; 95 percent CI, 0.49 to 6.69; P = .02) and GaAlAs versus placebo (SMD, 3.40; 95 percent CI, 1.93 to 4.87; P < .00001). The reviewers rated three trials as being at low risk of bias and the remaining 10 as being at high risk of bias. The reviewers found substantial clinical heterogeneity among each group of studies, including variation in how DH was stimulated (air blasts of varying duration and tactile stimulation) as well as in how pain was recorded (visual analog scale and verbal rating scale). All lasers (Er:YAG, Nd:YAG and GaAlAs) except Er,Cr:YSGG appear to be efficacious in reducing DH; however, considering the important limitations of the evidence, no clinical recommendation can be given.

OBJECTIVES To better understand the effectiveness of xylitol in caries prevention in adults and to attempt improved clinical trial efficiency. METHODS As part of the Xylitol for Adult Caries Trial (X-ACT), non cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 g/day of xylitol, consumed by dissolving in the mouth five 1 g lozenges spaced across each day, compared with a sucralose placebo. For this analysis, seeking trial efficiency, 538 subjects aged 21-80, with complete data for four dental examinations, were selected from the 691 randomized into the 3-year trial, conducted at three sites. Acceptable inter- and intra-examiner reliability before and during the trial was quantified using the kappa statistic. RESULTS The mean annualized noncavitated plus cavitated lesion transition scores in coronal and root surfaces, from sound to carious favoured xylitol over placebo, during the three cumulative periods of 12, 24, and 33 months, but these clinically and statistically nonsignificant differences declined in magnitude over time. Restricting the present assessment to those subjects with a higher baseline lifetime caries experience showed possible but inconsistent benefit. CONCLUSIONS There was no clear and clinically relevant preventive effect of xylitol on caries in adults with adequate fluoride exposure when non cavitated plus cavitated lesions were assessed. This conformed to the X-ACT trial result assessing cavitated lesions. Including non cavitated lesion assessment in this full-scale, placebo-controlled, multisite, randomized, double-blinded clinical trial in adults experiencing dental caries did not achieve added trial efficiency or demonstrate practical benefit of xylitol. TRIAL REGISTRATION ClinicalTrials.Gov NCT00393055.

OBJECTIVES:The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE.METHODS:Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE. Radiographs were assessed independently by two trained and calibrated examiners masked with respect to VTE results. The diagnostic threshold was surface-level disease/nondisease status. Kappa statistics provided an estimate of VTE-RE agreement on diseased surfaces. The additional diagnostic yield of the RE over VTE was calculated as the additional lesions detected radiographically as a percentage of the total number of lesions detected by VTE.RESULTS:Four-hundred ninety-four (51 occlusal, 433 proximal) lesions were detected; of these, 81 (2 occlusal, 79 proximal) lesions were detected by both VTE and RE. Kappa statistics were 0.18 (all surfaces), 0.04 (occlusal), and 0.18 (proximal). The additional diagnostic yield was 69 percent (all surfaces), 55 percent (occlusal), and 71 percent (proximal).CONCLUSIONS:There is poor agreement between VTE and RE to detect caries in posterior teeth of caries-active adults. However, an RE performed within 7 months of a VTE adds caries diagnostic yield in a clinical trial, especially on proximal surfaces.

OBJECTIVES This secondary analysis of data from the Prevention of Adult Caries Study (PACS) assesses risk factors for progression of coronal caries. METHODS Participants (n = 983) were adults at increased caries risk with at least one cavitated and one noncavitated lesions who were enrolled in a randomized clinical trial to test the effect of a 10% w/v chlorhexidine varnish coating on caries progression. Calibrated examiners scored tooth surfaces using a modified International Caries Detection and Assessment System (ICDAS) classification at baseline and at 7 and 13 months postrandomization. Potential baseline predictors of caries risk were used in adjusted negative binomial regression models to predict net D2FS increment and in linear regression models to predict the rank-normalized net D12FS increment. RESULTS Mean (SD) D2FS and D12FS increments were and 2.4 (3.1) and 2.1 (6.9), respectively. In multivariate analyses, two or more baseline D2 lesions, consumption of acidic drinks, and increasing age were all significantly associated with increased D2FS and D12FS risk. Daily flossing also was associated with increased D2FS risk. More frequent dental care at baseline was associated with significantly decreased caries risk for both increments. CONCLUSIONS The general concordance of risk factors in the D12FS and D2FS models lends support to the hypothesis that the D1 increment is an intermediate stage in the progression to fully cavitated lesions.