*Katarzyna Jankowska, Dagmara Piesiak-Pańczyszyn, Elżbieta Sołtan, Urszula Kanaffa-Kilijańska, Mirosława Kasiak
A comparison of the usefulness of a caries indicator in the clinical practice of third-year and fifth-year dentistry students
Porównanie przydatności indykatora próchnicy w pracy klinicznej studentów III i V roku stomatologii
Chair and Department of Conservative Dentistry and Pedodontics, Wrocław Medical University of Silesian Piasts
Head of Chair and Department: prof. Urszula Kaczmarek, MD, PhD
Streszczenie
Wstęp. Wykrywanie próchnicy i prawidłowa ocena oczyszczenia ubytku może być problematyczna i powodować niepowodzenia podjętego leczenia szczególnie dla studentów i młodych lekarzy. Jedną z najmniej inwazyjnych metod diagnozowania próchnicy jest stosowanie tzw. identyfikatorów próchnicy.
Cel pracy. Ocena skuteczności usuwania zębiny próchnicowej przez studentów III oraz V roku stomatologii przy pomocy indykatora próchnicy.
Materiał i metody. W badaniu udział wzięli studenci III i V roku stomatologii Wydziału Lekarsko-Stomatologicznego Uniwersytetu Medycznego we Wrocławiu. Badanie składało się z badania klinicznego pacjenta, w trakcie którego był wybierany ząb do leczenia, mechanicznego usunięcia próchnicy, kontroli doszczętności usunięcia zmienionej tkanki i kwestionariusza wypełnianego przez studentów po zakończeniu leczenia. Prawidłowe usunięcie próchnicy potwierdzano najpierw za pomocą konwencjonalnych metod, tj. wzroku i dotyku, a w następnie przy użyciu indykatora próchnicy – Caries Marker firmy Voco.
Wyniki. W obu grupach studentów najlepszą ocenę (bardzo dobrą) uzyskał kolor indykatora, odpowiednio 76,79% na III roku i 79,31% na V roku. Z analizy wyników badania ankietowego wynika, że w porównaniu do studentów V roku (58,62%; 34/58) znacznie większa liczba studentów III roku (85,71%; 48/56) odpowiedziała twierdząco na wszystkie pytania dotyczące stosowania indykatora próchnicy.
Wnioski. Zastosowanie wskaźnika próchnicy jako metody wspomagającej usuwanie zębiny próchnicowej z ubytku, zwłaszcza w grupach studentów III roku, znacznie poprawia jakość leczenia i komfort pracy. Jest to metoda posiadająca pewne ograniczenia, a jej czułość i swoistość nie jest idealna, co może być przyczyną nadmiernej i niepotrzebnej preparacji zęba lub pozostawienia zainfekowanej zębiny próchnicowej w ubytku.
Summary
Introduction. Caries diagnosis and proper assessment of carious tissue removal from the cavity can be problematic and lead to treatment failures particularly for students and young doctors. One of the least invasive methods of caries diagnosis is a caries indicator.
Aim. To assess the effectiveness of removal of carious dentine from the cavity by third- and fifth-year dentistry students aided with a caries indicator.
Material and methods. The study involved students of the Faculty of Dentistry of the Medical University in Wrocław. It comprised a clinical examination and treatment of a previously selected tooth, verification whether the affected tissue has been fully removed, and a questionnaire the students filled in upon completing treatment. Adequate removal of carious tissue was confirmed using conventional methods (probe and mirror), followed by application of a caries indicator, specifically Voco Caries Marker.
Results. In both student groups, the indicator’s colour was the product’s quality rated the highest (as “very good”), with such rating provided by 76.79% of third-year respondents and 79.31% of the fifth-year ones. Analysis of the questionnaire results reveals a much larger number of third-year students (85.71%; 48/56) to have answered affirmatively all the questions concerning the usefulness of a caries indicator as compared to fifth-year students (58.62%; 34/58).
Conclusions. The use of a caries indicator as a supporting method for adequate removal of carious dentine from the cavity, especially in groups of third-year students, significantly improves the quality of care and the practitioners’ (students’) comfort of work. Nonetheless, it is a method with some limitations, with suboptimal sensitivity and specificity, potentially leading to excessive removal of sound tooth structure or leaving infected dentine within the cavity.
Introduction
Caries is a disease afflicting a wide spectrum of the society, hence the importance of adequate training of students for their future dental practice. Detection of caries and a proper assessment of removal of carious tissue may be problematic, and potentially lead to treatment failures and complications. One of the least invasive, simple, yet acknowledged methods of caries diagnostics is the use of caries indicators, i.e. chemical dyes that stain infected dentine a given colour, thus allowing evaluation of hard tissue and more accurate determination of the extent of the carious infection within the tooth (1-6).
Voco Caries Marker is one of the available caries indicators, containing rhodamine B (red dye agent), propylene glycol (carrier), and surface active agents. Owing to the formula’s mechanism of action, it is only demineralized dentine where the organic collagen matrix has been damaged that is turned red. Sound, non-demineralized tissue is not stained (2, 3, 5-7). The formula is applied to the cavity upon removing the softened and clearly discoloured dentine, for a period not exceeding 5-10 seconds, and is then rinsed with water. The stained areas require further excavation of carious tissue. This can be repeated several times, until a satisfactory result is obtained (the affected tissue is fully removed) (6, 8). In a clinical setting, application of a caries indicator helps to trace carious areas which are difficult to see, or by practitioners who have limited clinical experience. It allows to provide a clear boundary between carious and healthy dentine areas, particularly secondary dentine, verify if caries has been fully removed, find micro-cracks in fillings and margins, and micro-cracks in tooth structure (1, 3, 5, 8).
Aim
The study was aimed at assessing the completeness of removed carious dentine by third-year and fifth-year dentistry students aided with a caries indicator and of its usefulness for the training of future dentists.
Material and methods
The study covered 56 third-year students and 58 fifth-year students of the Faculty of Dentistry of the Medical University in Wrocław, who used Voco Caries Marker during their clinical practice classes to facilitate adequate evaluation of preparation of carious cavities. The patients participating in the study were 18-65 years old, and were enrolled among the patients checking into the Conservative and Paediatric Dentistry Department of the Medical University in Wrocław. The study comprised a clinical examination, whereupon a tooth was selected for treatment, mechanical removal of carious tissue from the tooth, an assessment of the completeness of removal of carious tissue, and, as its final part, a questionnaire filled in by the students upon completing treatment.
For each patient, a detailed medical history was collected, concerning their general health condition, received medication, and eating habits, along with a questionnaire related to personal dental hygiene practices (the frequency of tooth brushing, time taken to brush the teeth, and other methods of maintaining oral hygiene). Then, API and OHI were applied to assess the patient’s teeth and oral hygiene.
The inclusion criteria used to enrol patients for the study were as follows: primary caries w/o complications, not painful, Black’s class I, II, III and V cavities. The exclusion criteria comprised secondary caries, pulpitis, and teeth having undergone endodontic treatment. Carious cavities were initially drilled with a dental handpiece (to open the cavity), and micro-engine (to remove carious dentine). Whenever necessary, patients were treated under local or conduction anaesthesia. Each student treated one cavity. The initial assessment of the effectiveness of the preparation was conducted both by the student and the assisting teacher-supervisor, by visual examination with a mirror (the dentine’s colour), and by probing (the hardness of the cavity floor). The cavity’s preparation was repeatedly verified twice with Voco Caries Marker: upon cavity opening, and upon the removal of carious tissue. Caries Marker was applied for the third time only if the second application rendered any tissue red. The formula was applied with Pele-Tim pellets for 5-10 seconds, and then gently rinsed with a current of water (according to the producer’s recommendations). Tissues that were stained brighter indicated carious dentine within the cavity. Whenever profound caries was established in the patient, to account for the lack of experience on the students’ part the decision on the course of treatment was made by the assisting teacher-supervisor. Upon completing the treatment, the students filled in the questionnaire related to the product, addressing the following questions:
1. Does treatment aided by Caries Marker facilitate your diagnosis of carious dentine?
2. Do you feel more confident when removing carious dentine aided by a caries indicator?
3. Do you think you need a caries indicator for your daily treatment practice?
The scores used to address the questions were related to the usefulness of the product and ranged from 0 to 3, where 0 stood for “not necessarily”, 1 for “yes”, 2 for “no”, and 3 for “it’s hard to say”. Further questions were related to the indicator’s qualities: its consistency, colour, simplicity of application, simplicity of removing the dye from the cavity. The qualities were rated on a scale of 1 to 5, with 1 meaning “poor”, 2 – “average”, 3 – “quite good”, 4 – “good”, and 5 – “very good”.
Results
In our study, Caries Marker was applied to a total of 114 cavities. The third-year students treated 56 cavities, including 28 Black’s class I cavities, 18 class II cavities, 5 class III cavities, and 5 class V cavities. The fifth-year students treated a total of 58 cavities, including 11 class I cavities, 22 class II cavities, 12 class III cavities, and 13 class V cavities. The data has been shown in table 1. The treated cavities were primary carious lesions of various advancement stage. The third-year students treated 33 cavities with profound caries, and 23 cavities with intermediate caries, whereas the fifth-year students treated 39 profound caries cavities and 19 intermediate caries cavities.
Tab. 1. Carious lesions diagnosed with the help of Caries Marker, grouped according to Black’s classification
| Black’s class | Third-year students | Fifth-year students |
| N | % | N | % |
| I | 28 | 50.00 | 11 | 18.97 |
| II | 18 | 32.14 | 22 | 37.93 |
| III | 5 | 8.93 | 12 | 20.69 |
| IV | 0 | 0 | 0 | 0 |
| V | 5 | 8.93 | 13 | 22.41 |
| Total | 56 | 100 | 58 | 100 |
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Piśmiennictwo
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