Examining the Validity of a Synthesized Summary Measure for Caries Detected Using the International Caries Detection and Assessment System

• Measuring Caries Using ICDAS

• Author / Creator

  Elsalhy, Mohamed

• Background: The International Caries Detection and Assessment System (ICDAS) was developed as a standardized system based on the best available evidence for detecting early and later stages of carious lesions. The aim of developing this system was to improve the quality of collected data on caries to be used for clinical research, clinical practice, and epidemiological studies. There is no synthesis about how studies that used the ICDAS summarized and reported caries and whether the system was used to its full potential. Objectives: This dissertation aimed to review how studies that employed the ICDAS system reported patient caries level and to identify a potential summative measure that could reflects patient’s caries level in children examined with the ICDAS. Values captured on specific surfaces from the ICDAS examination were examined as a short form of ICDAS to potentially be used to predict caries treatment need for children by classifying them into primary, secondary and tertiary prevention. In addition, the relationship between the proposed summative measures and oral health (OH) behaviors and oral health-related quality of life (OHRQoL) was evaluated. Methods: Participants were 1 to 15-year-old children cohorts from Kuwait, Brazil, and Spain. Children’s teeth were examined using the ICDAS. Multiple measures of central tendency and dentition specific indices (short ICDAS) were considered as potential summative measures. The relationship between the summative measures and number of caries lesions were evaluated. The agreement between the short and full ICDAS in classifying children into primary, secondary, and tertiary treatment need categories was examined. Sensitivity and specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (ROC) curve were used to measure the diagnostic accuracy of the short ICDAS compared to the full ICDAS. Initial analysis was conducted in the Kuwait sample, and the results were cross-validated using Brazil and Spain samples. In addition, 13-14 years-old children completed a previously validated OH behaviors and OHRQoL questionnaires. Linear regression analysis was used to examine the relationship between dental caries measured using the total score of the full and the short ICDAS and both OH behaviors and OHRQoL. Results: A total of 3,076 children participated in the present study. Total ICDAS score and mean ICDAS score showed a strong correlation with the number of caries lesions at different caries severity levels in both primary, mixed and permanent dentitions. The total ICDAS of 51 Buccal (B), 61B, 54 Occlusal (O), 55O, 64O, 65O, 74O, 75O, 84O, 85O surfaces in primary dentition and total ICDAS of 14O, 16L, 16O, 24O, 26L, 26O, 36B, 36O, 37O, 46O, 46B, 47O surfaces in permanent dentition or mixed dentition (if present) showed strong correlations (Spearman correlation coefficients >0.7) with the number of caries lesions at different caries severity levels. The total score of the full ICDAS and the short ICDAS were highly correlated (r=0.901, p<0.001). The proposed short ICDAS and the full ICDAS showed a very good agreement on treatment need determination with Kappa scores of more than 0.833 in all dentitions. The short ICDAS showed excellent operating characteristics in all types of dentitions. The area under the ROC curve was more than 0.90 in primary dentition, 0.89 in permanent dentition, and 0.86 in mixed dentition. Lowest area under the ROC curve and sensitivity values were seen in discriminating between secondary and tertiary prevention. The full and the short ICDAS showed similar relationships with oral health behaviors and OHRQoL. Children who brushed their teeth once a day or less had significantly higher levels of caries compared to children who brushed their teeth more than once a day. The frequency of sugar consumption was significantly associated with caries level. No significant association between flossing, use of mouthrinse, chewing gum and caries level was found. Both the total score of the full and the short ICDAS were significantly and moderately correlated with total CPQ11-14, oral symptoms, and functional limitations. Conclusions: There is a lack of consistency in the reporting of caries in studies using ICDAS. Total ICDAS and mean ICDAS scores were the best summary measures of overall caries level at different dentitions. A short version of ICDAS consisting of selectively examined 10 surfaces in primary dentition and 12 surfaces in permanent dentition can give an excellent summary measure for patient’s overall caries level with high diagnostic accuracy. The proposed short version of the ICDAS demonstrated a good diagnostic accuracy in classifying children into primary, secondary, and tertiary prevention groups according to their treatment need.

• Subjects / Keywords

  • Validity
  • Caries
  • Measure
  • Summary
  • ICDAS

• Graduation date

  Spring 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3S17T76Z

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.