Ensaio clínico randomizado para avaliação do risco de cárie individual em escolares: protocolo do estudo e o impacto do exame radiográfico

Abstract

Dental caries is a disease of high prevalence and severity in Brazilian children. Caries risk assessment is essential for the correct management and prevention of disease, and to set an adequate time for recall visits. Risk assessment should be practical, fast, efficient, easy, low cost and well accepted. There are basically two ways to assess caries risk through the assessment of isolated factors or through multivariate methods, which combine a series of variables through an analysis. Existing tools often use a large number of variables. In contrast, previous caries experience (a single variable) is the factor with the strongest association with an increased risk of dental caries. However, the evidence found is weak, and there are no studies comparing the superiority of one method over another. This would ideally be answered through a randomized clinical trial comparing the two strategies. Therefore, Article 1 of this thesis, a randomized, double-blind, controlled, parallel-treatment clinical trial protocol was developed. Two groups tested for two forms of caries risk assessment: an individualized and detailed multivariate method based on Caries Care International 4D guidelines and another simplified process, based only on caries experience in or permanent dentition, considering the presence of decayed teeth, lost and obturated using the DMFT/dmft index. Children from 8 to 11 years old will be following for 2 years. The primary outcome will be a composite outcome representing the number of tooth surfaces requiring operative intervention. In addition, the objective was to evaluate, through a cross-sectional study, the impact of radiographic examination in classifying the risk of childhood dental caries into low and high risk, comparing the two risk assessment methods (Article 2). A total of 107 children were selected and examined by trained and calibrated evaluators through clinical and radiographic examination. Initially, children were classified into low and high risk without considering the radiographic evaluation, later with the association of radiographic evaluation of the proximal surfaces of the posterior teeth. Descriptive statistical analysis was performed and both simplified and multivariate methods showed similar results. A low frequency of change to high risk was observed, less than 5%, when the radiographic analysis of the proximal surfaces of the posterior teeth was included. The impact of radiographic examination on risk classification for dental caries is low for this population for both risk assessment methods used. There is a need to carry out randomized clinical studies to evaluate the benefit of treatment directed by the assessment of caries risk, as well as in relation to the indication of the radiographic method as a routine in the improvement and maintenance of children's oral health. This study contributes to the literature as it idealizes a randomized clinical trial to assess the best method to carry out caries risk assessment.