Browsing by Author "Braga, Mariana M."

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    CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol
    (BMC, 2021-12) Martignon, Stefania; Cortes, Andrea; Douglas, Gail V. A.; Newton, J. Timothy; Pitts, Nigel B.; Avila, Viviana; Usuga-Vacca, Margarita; Gamboa, Luis F.; Deery, Christopher; Abreu-Placeres, Ninoska; Bonifacio, Clarisa; Braga, Mariana M.; Carletto-Körber, Fabiana; Castro, Patricia; Cerezo, María P.; Chavarría, Nathaly; Cifuentes, Olga L.; Echeverri, Beatriz; Jácome-Liévano, Sofía; Kuzmina, Irina; Lara, J. Sebastián; Manton, David; Martinez-Mier, E. Angeles; Melo, Paulo; Muller-Bolla, Michèle; Ochoa, Emilia; Osorio, Jesús R.; Ramos, Ketty; Sanabria, Angie F.; Sanjuán, Johanna; San-Martín, Magdalena; Squassi, Aldo; Velasco, A. Karina; Villena, Rita; Ferreira Zandona, Andrea; Beltrán, Edgar O.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Background Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.
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    Negligible therapeutic impact, false-positives, overdiagnosis and lead-time are the reasons why radiographs bring more harm than benefits in the caries diagnosis of preschool children
    (BMC, 2021-03-31) Pontes, Laura Regina A.; Lara, Juan Sebastian; Novaes, Tatiane Fernandes; Gomes Freitas, Julia; Gimenez, Thais; Moro, Bruna Lorena P.; Maia, Haline C. M.; Imparato, José Carlos P.; Braga, Mariana M.; Raggio, Daniela P.; Mendes, Fausto M.; Cariology, Operative Dentistry and Dental Public Health, School of Dentistry
    Background: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs. Methods: This is a secondary analysis of a two-arm randomized clinical trial with parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3-6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results: 4383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias. Conclusions: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice. Trial registration Clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014.