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Table 5.1 continued Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries prevalence at start (dft/dfs) Obs time (yrs) Dropout (%) Explained Diagnostic criteria Examiner (n) Reliability Pienihäkkinen et al 2004 [18] Finland All 2-year-olds in a municipality in Finland born in 1987– 1988. Control group from prevention programme n: 226 Age: 2 Primary 3% had dmfs >0 Increment: 20% developed ≥1 new dmfs 3 19 dmfs, own criteria d1: Early enamel d2: Early dentine (no cavity) d3: Cavity 5 examiners Yes No BW (fibre optics) Karjalainen et al 2001 [19] Finland Every 5th child from larger intervention study, Turku n: 135 Age: 3 Primary 92% cariesfree Mean dmft: 0.19 Increment: Mean new dmft: 0.8 3 9 WHO No BW Yes 1 examiner Examiners at the end not stated 226 Karies – diagnostik, riskbedömning och icke-invasiv behandling
Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Visible plaque (≥1 surface in 4 sextants), gingival bleeding, incipient lesions, MS in plaque, fluoride use, candies ≥1 new d 3 mfs Proportion high risk: MS: 33% d 1–3 mfs: 9% candies: 54% Visible plaque: 15% Se, Sp, ROC, log regression, OR Model: area under ROC was highest for combined MS, d 1–3 mfs and candies (=0.81). Visible plaque NS in the model Single predictors MS Se: 69%; Sp: 78% d 1–3 mfs Se: 29%; Sp: 97% Candies >1/week Se: 84%; Sp: 55% Visible plaque Se: 26%; Sp: 88% Use of fluorides (NS) Se: 53%; Sp: 58% Modelling data. Same material as 2002 [17] Significant OR MS: 3.9 d 1–3 mfs: 7.3 Candies: 3.6 Visible plaque: 2.5 Mother’s education, sweet intake, tooth brushing frequency, visible plaque, general health Cariesfree vs not caries-free (including enamel lesions) Proportion high risk: 7–29% Relative risk Se, Sp calculated from numerical data Relative risk Sweet intake: 1.5 (NS) Visible plaque: 0.9 (NS) Combined: 1.7 (NS) Sweet intake Se: 61%; Sp: 54% Visible plaque Se: 19%; Sp: 79% Medium Insufficient data reporting. Only relative risk reported Combined Se: 72%; Sp: 47% The table continues on the next page KAPITEL 5 • Riskbedömning 227
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Karies - diagnostik, riskbedömning
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Karies - diagnostik, riskbedömning
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Primärt urval av studier 63 Bedöm
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Resultat 176 FOTI 176 DiFOTI 176 DI
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Metodik 356 Litteratursökning 356
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SBU:s sammanfattning och slutsatser
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Bakgrund Karies är en kronisk sjuk
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Gradering av slutsatsernas evidenss
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Visuell-taktil diagnostik Studier s
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Hur kan kariesskador predikteras me
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Barn (1-3 år) som borstar tändern
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Kostnadseffektivitet för diagnosti
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undersöks. Frekvensen röntgenunde
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sönderfall av tanden, då patiente
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av tandhälsan och har inga symtom.
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ning. Riskbedömning görs rutinmä
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Betydelsen av effektiv tidig behand
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Validitet och reliabilitet Validite
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negativa prediktionsvärdet (NPV) b
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ytterligare i Faktaruta 1.6. Exempe
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Samhällsnivå Sociodemografi och v
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Faktaruta 1.1 Olika aspekter på va
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Faktaruta 1.3 Fyrfältstabell med k
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Faktaruta 1.4 Diagram som illustrer
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Faktaruta 1.6 Beräkning av likelih
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Faktaruta 1.7 Nomogram som visar hu
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Referenser 1. Fiske J, Davis DM, Fr
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2. Metodik för sökning och utvär
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Primärt urval av studier För att
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laget för slutsatserna. En metod s
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• Förklarat/analyserat bortfall
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Otillräckligt vetenskapligt underl
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3. Praxisundersökning avseende bit
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svenska och norska tonåringar unde
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Totalt antal undersökta Stockholm
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Østfold Totalt antal undersökta %
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4. Diagnostik 4.1 Visuell-taktil di
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Bakgrund Den primära metoden för
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undersökare och bedömdes ha ett m
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diagnostik av emaljkaries på tuggy
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Aktiv (pågående) och inaktiv (kro
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Tabell 4.1.1 Inklusionskriterier f
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Dropout/ missing data Method or tec
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Table 4.1.7 continued Author, year,
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Referenser 1. Rocha RO, Ardenghi TM
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tion compared with conventional rad
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63. Banerjee A, Watson TF, Kidd EA.
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93. Rosén B, Birkhed D, Nilsson K,
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4.2 Röntgendiagnostik Slutsatser G
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antingen med kabel eller via trådl
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Risker med röntgenstrålning Rönt
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När observatörerna skulle bestäm
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Faktaruta 4.2.2 Nomogrammet som byg
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Metodik för litteraturgenomgång E
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procent och specificiteten mellan 9
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0,1 99 0,2 LR+ LR- 0,5 Visuell insp
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Intern och extern validitet Diagnos
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Kommentarer Vilka tänder eller tan
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för att en tvådimensionell bild a
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Method Number of teeth and surfaces
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52 molars and 11 premolars with occ
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Method Comparison method Outcome me
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Referenser 1. Akdeniz BG, Grondahl
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33. Espelid I, Tveit AB. A comparis
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66. Caliskan Yanikoglu F, Östurk F
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in proximal surfaces versus direct
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131. Wenzel A, Hintze H. The choice
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4.3 Tilläggsmetoder för kariesdia
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kariesskada [81,82]. En diagnostisk
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(a) (b) (c) (d) (e) Figur 4.3.1 Eff
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Page 177 and 178: Tabell 4.3.1 Inklusionskriterier f
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Page 185 and 186: Dropout/ missing data Method or tec
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Page 189 and 190: Referenser 1. Grossman ES, Cleaton-
Page 191 and 192: 30. Hall AF, DeSchepper E, Ando M,
Page 193 and 194: of occlusal caries in children. Car
Page 195: 4.4. Etiska aspekter Som det framg
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Page 216 and 217: Faktaruta 5.1 Inklusionskriterier f
Page 218 and 219: Table 5.1 Caries prediction in pre-
Page 220 and 221: Table 5.1 continued Author Year, re
Page 228 and 229: Table 5.2 Caries prediction in pre-
Page 236 and 237: Table 5.3 Caries prediction in scho
Page 250 and 251: Table 5.4 Caries prediction in scho
Page 268 and 269: Table 5.5 Caries prediction in adul
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Table 5.6 Caries prediction in adul
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Table 5.6 continued Author Year, re
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Table 5.7 Tillförlitligheten hos t
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Table 5.8 Post-eruptive age as risk
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Table 5.9 Post-eruptive age as risk
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Table 5.10 Excluded studies. Author
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Table 5.10 continued Author, year,
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19. Karjalainen S, Söderling E, Se
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social factors and diseases. Int De
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isk assessment program in an elderl
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121. Demers M, Brodeur JM, Simard P
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study. Community Dent Oral Epidemio
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private practice. Community Dent Or
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221. Schröder U, Granath L. Dietar
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groups. Oral Surg Oral Med Oral Pat
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287. Ravald N, Birkhed D, Hamp SE.
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En nyss frambruten tand är mer mot
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Övriga produkter Ozon De syraprodu
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En studie, som undersökte effekten
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för få för slutsatser om effekti
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Table 6.2 Treatment of early corona
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Table 6.3 Treatment of early corona
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Table 6.4 Treatment of early root s
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Table 6.5 Excluded studies. Author,
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Referenser 1. Abernathy JR, Graves
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composite resin restorations. Acta
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7. Ekonomiska aspekter Slutsatser A
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Kostnaden för visuell-taktil under
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Faktaruta 7.1 Hur beräknas kostnad
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7.1 7.1 1 800 Kronor Kronor 1 600 1
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8. Tänkbara praxisförändringar T
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Referenser 1. Ekstrand K. Faglig vi
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DFS DFT dft DiFOTI Dikotomisering D
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Likelihood-kvot Lingual Makroskopis
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Rotcement Sensitivitet Specificitet
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Svante Twetman Professor, odontolog
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Bilaga 1. Sökstrategier Kapitel 4.
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Kapitel 5 fortsättning NOT Cariost
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Bilaga 2. Granskningsmallar Diagnos
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Studier om riskbedömning Första f
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Studier om behandling av tidiga kar
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Bilaga 3. Sensitivitet, specificite
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9 8 8,0 8,0 LR+ emalj LR- emalj LR
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Sensitivitet och specificitet 2,0 1
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200 Procent 180 160 140 120 100 80
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180 160 140 120 100 80 60 40 20 0 8
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15. Lussi A. Comparison of differen
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49. Kordic A, Lussi A, Luder HU. Pe
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Ont i ryggen, ont i nacken (2000),
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Rapporter på engelska Obstructive
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