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Table 5.4 continued Author Year, reference Country Sample, n Age (years) at start Teeth tested, Caries prevalence at start Obs time (yrs) Drop-out Explained Diagnostic criteria Examiner (n) Reliability Raadal et al 1992 [30] Norway All children born 1978– 1979 attending a public dental clinic in a town in Norway n: 192 Age: 6 Occlusal fissures 1st permanent molars Baseline: Mean dmft 3.4 2 Not stated Möller 1966 BW 3 examiners No Increment: Not stated Seppä et al 1988 [78] Finland Selected from a clinical trial on F-varnish n: 124 Age: 11–13 (mean 12) Permanent Mean DMFS 17.7 Increment: Mean new DMFS 14.1 5 34 Explained Möller & Poulsen 1973 BW 2 examiners Yes Seppä et al 1989 [79] Finland High risk individuals in Kuopio + random sample of low risk n: 512 Age: 6 Primary and permanent dmfs: 0.49 DMFS: 0.37 Increment: Mean 4.4 new DMFS 7, stepwise prediction 10 Möller & Poulsen 1973 BW at the end 3 examiners “trained research tem” No reliability test 264 Karies – diagnostik, riskbedömning och icke-invasiv behandling
Predictor variables Validating criteria Statistical methods Results* Sensitivity and specificity Study quality and relevance Comments Baseline dmft (from 0–11) ≥1 molar with initial or dentine caries or ≥1 molar with dentine caries Proportion high risk: 27–46% (all proportions reported) Se, Sp, PPV, NPV Best combined values for ≥3 dmft and ≥1 molar with dentine caries with proportion high risk: 46% Se: 72%; Sp: 67%; PPV: 0.52; NPV: 0.83 For proportion high risk: 27% ≥5 dmft and ≥1 molar with dentine caries) Se: 44%; Sp: 82%; PPV: 0.55; NPV: 0.74 Low Only 1 predictor. Incomplete data reporting. Possible bias from treatment Baseline DS, FS, initial lesions DFS: Not stated Proportion high risk: 30% Se, Sp, PPV, NPV, accuracy, OR DFS with (without) initial lesions Se: 49% (51%); Sp: 76% (78%); PPV: 0.45 (0.47); NPV: 0.79 (0.80) Initial caries added little to the predictive power Low Retrospective bias from treatment (F varnish). incomplete data reporting Caries experience each year from age 6 to 12 DMFS >14 Proportion high risk: 10–52% Se, Sp for diff Proportions believed to be high risk Se lowest at age 6: 28% (Sp: 92%); and highest at age 9: Se: 68% (Sp: 85%) For 30% high risk proportion, age 9 Se: 61%; Sp: 81%; PPV: 0.53; NPV: 0.85 Low Retrospective. Bias from treatment The table continues on the next page KAPITEL 5 • Riskbedömning 265
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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
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Tabell 4.3.1 Inklusionskriterier f
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Dropout/ missing data Comparison me
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Number of individuals Number of tee
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Number of individuals Number of tee
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Referenser 1. Grossman ES, Cleaton-
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30. Hall AF, DeSchepper E, Ando M,
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of occlusal caries in children. Car
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4.4. Etiska aspekter Som det framg
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• Salivens flöde och/eller buffr
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för riskfaktorn ifråga innan sjuk
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medel vid beslutsfattande. I slutä
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55 procent). Karjalainen och medarb
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Kariesskador i primära tänder som
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som hade högst sockerkonsumtion fa
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Övriga inkluderade studier har lå
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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
Page 274 and 275: Table 5.6 Caries prediction in adul
Page 290 and 291: Table 5.7 Tillförlitligheten hos t
Page 292 and 293: Table 5.8 Post-eruptive age as risk
Page 296 and 297: Table 5.9 Post-eruptive age as risk
Page 300 and 301: Table 5.10 Excluded studies. Author
Page 302 and 303: Table 5.10 continued Author, year,
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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 6.3 continued Author Year, re
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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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