Showing papers by "Nigel Pitts published in 2019"

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

Abstract: Background: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. Aim: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. Design: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. Results: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. Conclusions: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

CariesCare practice guide: consensus on evidence into practice.

Abstract: This CariesCare practice guide is derived from the International Caries Classification and Management System (ICCMS) and provides a structured update for dentists to help them deliver optimal caries care and outcomes for their patients. This '4D cycle' is a practice-building format, which both prevents and controls caries and can engage patients as long-term health partners with their practice. CariesCare International (CCI™) promotes a patient-centred, risk-based approach to caries management designed for dental practice. This comprises a health outcomes-focused system that aims to maintain oral health and preserve tooth structure in the long-term. It guides the dental team through a four-step process (4D system), leading to personalised interventions: 1st D: Determine Caries Risk; 2nd D: Detect lesions, stage their severity and assess their activity status; 3rd D: Decide on the most appropriate care plan for the specific patient at that time; and then, finally, 4th D: Do the preventive and tooth-preserving care which is needed (including risk-appropriate preventive care; control of initial non-cavitated lesions; and conservative restorative treatment of deep dentinal and cavitated caries lesions). CariesCare International has designed this practice-friendly consensus guide to summarise best practice as informed by the best available evidence. Following the guide should also increase patient satisfaction, involvement, wellbeing and value, by being less invasive and more health-focused. For the dentist it should also provide benefits at the professional and practice levels including improved medico-legal protection.

Carious lesion activity assessment in clinical practice: a systematic review

Abstract: The objective of the manuscript is to systematically review the different techniques developed for activity assessment of coronal carious lesions (AACCL) in clinical settings. A search of PubMed identified original articles in English reporting on the different concepts/tools for AACCL in clinical settings and, when available, data related to their in vivo/in situ validation in terms of sensitivity, specificity, inter- and intra-examiner reproducibilities, area under the receiving operating curve, positive predictive value, negative predictive value, and relative risk of lesion progression. The present review included 25 articles. Four groups of techniques are available (1) systems based on combinations of visual and tactile criteria; devices based on (2) pH assessment, (3) fluorescence, or (4) bioluminescence. The most studied systems are those based on combinations of visual and tactile parameters when bioluminescence suffers from the lack of in vivo evaluation. Validation studies showed a wide disparity among protocols in terms of populations, dentitions, teeth surfaces, study design, the gold standard, and validation criteria. There is a need for definition and harmonization of standards for activity assessment-related concepts/tools, as well as further investigations for in vivo validation of newly developed tools. Carious lesion activity is an important component to be taken into account when making decisions as to appropriate clinical caries management. The development and use of validated techniques which are easy to use in everyday dental practice are important.

Monitoring erosive toothwear: BEWE, a simple tool to protect patients and the profession.

Abstract: Erosive tooth wear is the third most commonly observed oral condition after caries and periodontal disease, with a prevalence similar to that of dentine hypersensitivity. However, it is not a condition that is routinely screened, or monitored, as part of the standard dental examination. Following a meeting held in 2018, this paper considers the outlook for erosive tooth wear and the need for dental professionals to monitor for signs of the condition as part of an oral health assessment, to provide protection for patients and the profession. The use of the basic erosive wear examination (BEWE) is proposed as a simple screening tool designed to detect erosive tooth wear in clinical practice.

Caries classification and management in the context of the CariesCare International (CCI™) consensus: a clinical case study.

Abstract: The objective of this clinical case study is to illustrate the caries management four-step structured process, leading to personalised interventions specific for each individual patient's risks and needs, according to CariesCare International, derived from the International Caries Classification and Management System (ICCMS) for clinical practice. An 18-year-old female was diagnosed with higher caries risk at the individual level, and with several caries lesions at different severity stages, some likely active and others likely inactive. A care plan was co-created with the patient and delivered to obtain optimal health outcomes. Several issues pertinent to patient-centred care are discussed, including caries management at the individual and the tooth surface level, the preservation of tooth structure, patient's caries risk management, and prevention and control of caries lesions. The patient's perspective is taken into account and the health outcome focus of the system is highlighted.