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Table 5.2 Caries prediction in pre-school children. Studies with low quality and relevance. Author Year, reference Country Sample, n Age (yrs) at start Teeth tested Caries prevalence at start Obs time (yrs) Dropout (%) Explained Diagnostic criteria Examiner (n) Reliability Alaluusua et al 1994 [20] Finland Convenience sample: mothers attending a public dental clinic in a small urban town, Orimattila n: 92 Age: 1.5 Primary 8% had ≥1 initial caries lesion 1.5 22 Own 1 examiner No Ekman 1990 [64] Sweden All Finnish children in Luleå born in 1974–1975 n: 70 Age: 5 Primary dmfs: 9.1 3 30 Koch 1967 BW 1 examiner Yes Holbrook et al 1993 [22] Iceland 10% of target population in Reykjavik n: 158 Age: 4 Primary and permanent dft: 2.4 dfs: 3.3 2 30 (between 4 and 6) Not analysed +55% intentionto-treat Möller & Poulsen 1973 No BW 2 examiners Yes 230 Karies – diagnostik, riskbedömning och icke-invasiv behandling
Predictor variables Validating criteria Statistical methods Results Sensitivity and specificity Study quality and relevance Comments Mothers’ DMFT, salivary MS, child’s use of nursing bottle, child’s visible plaque on all 4 labial surfaces of upper incisors Any dfs including initial lesions Proportion high risk: 18% (visible plaque), 36% (nursing bottle) Se, Sp, accuracy Visible plaque best predictor Se: 83%, Sp: 92% Mother’s DMFT (MS) Se: 46% (54%); Sp: 82% (75%) Use of nursing bottle Se: 85%; Sp: 72% Low Retrospective, population not specified Caries experience primary teeth, parents dental status dft value not stated Parent: full denture yes/no Proportion high risk: 25 or 30% Se, Sp, PPV, NPV >dmfs 25% Se: 47%; Sp: 80%; PPV: 0.39; NPV: 0.85 30% Se: 59%; Sp: 73% Parent full denture Se: 71%; Sp: 82%; PPV: 0.75; NPV: 0.88 Low Small sample validating criteria for caries not stated Misuse of sugar, fluoride use, MS, LB, baseline caries (dmfs >0), antibiotic use, combinations of these variables ≥1 DMFS in permanent teeth, ≥3 dmfs total score, ≥4 dmfs/DMFS Proportion high risk: 35% Se, Sp, PPV, NPV, log regression, OR Model all combined Se: 80%; Sp: 78%; PPV: 0.76; NPV: 0.82 Best single predictor Baseline caries Se: 91%; Sp: 61%; PPV: 0.48; NPV: 0.94 MS Se: 24%; Sp: 93%; PPV: 0.75; NPV: 0.58 LB Se: 10%; Sp: 100% (NS) Misuse of sugar Se: 45%; Sp: 93% Low Large dropout rate The table continues on the next page KAPITEL 5 • Riskbedömning 231
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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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scerar starkt, medan demineralisera
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förhållandet var tvärtom för pr
Page 177 and 178: Tabell 4.3.1 Inklusionskriterier f
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Page 181 and 182: Number of individuals Number of tee
Page 183 and 184: Number of individuals Number of tee
Page 185 and 186: Dropout/ missing data Method or tec
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Page 189 and 190: Referenser 1. Grossman ES, Cleaton-
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Page 193 and 194: of occlusal caries in children. Car
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Page 210 and 211: Övriga inkluderade studier har lå
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Page 214 and 215: studier visar att låg- och mellanr
Page 216 and 217: Faktaruta 5.1 Inklusionskriterier f
Page 218 and 219: Table 5.1 Caries prediction in pre-
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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
Page 274 and 275: 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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