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Table 4.1.4 continued Author Year, reference Country Type of study Blinding Number of observers Observer reliability Population Caries prevalence and type of lesions No of individuals Number of teeth Fyffe et al 2000 [7] United Kingdom Validity Not reported 10 experienced, 10 inexperienced Kappa Intra enamel: 0.62 Intra dentine: 0.65 Molars and premolars, occlusal-, buccal-, lingual surfaces 10% sound 8% 0.5 enamel 44% 0.5 dentine 20 mouth models with 160 teeth, 800 surfaces Kordic et al 2003 [4] Switzerland Validity Yes 4 Kappa Inter: 0.6–0.75 10– 38 yrs, premolars and molars 21% sound 61% enamel 18% dentine 61 teeth Lussi 1991 [6] Switzerland Validity, reliability, additive Not reported 34 12 of 34 observers tested. Kappa Inter: 0.47 Intra: 0.4–0.75 Molars and premolars from a pool 7 (11%) sound 17 (28%) subsurface lesion 3 (0.5%) enamel 34 (60.5%) dentine 61 teeth, 54 molars, 7 premolars Lussi 1993 [18] Switzerland Validity, reliability, additive Not reported 10–26 Kappa Inter: 0.14– 0.24 Intra: 0.49 Molars and premolars from a pool 21 (34%) sound 9 (14%) enamel 33 (52%) dentine 63 teeth, 52 molars, 11 premolars 94 Karies – diagnostik, riskbedömning och icke-invasiv behandling
Dropout/ missing data Method or technique Comparison method Outcome measure Results enamel caries Results dentine caries Study quality and relevance Comments Not reported VI DSTM Histology Se, Sp, PPV, NPV Se: 48% Sp: 76% PPV: 0.66 NPV: 0.59 Se: 10% Sp: 98% PPV: 0.69 NPV: 0.78 Medium Occlusal, buccal and lingual not separated Not reported VI SEM, quantitative image analysis Se, Sp, ROC, accuracy, PPV, PNV Se: 100% Sp: 38% PPV: 0.29 NPV: 1.00 Se: 82% Sp: 68% PPV: 0.31 NPV: 0.96 High Not reported VI VIP Hemisection Se, Sp, kappa, % correct diagnoses – Se: 62% Sp: 84% Kappa: 0.23 Correct diagnoses: 41.8% High Not reported VI VIM VIP Histology and dying Se, Sp, LR – Se VI: 12% VIM: 20% VIP: 14% Sp VI: 93% VIM: 89% VIP: 93% LR VI: 1.84 VIM: 1.86 VIP: 2.05 High The table continues on the next page KAPITEL 4 • Diagnostik 95
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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
Page 42 and 43: ytterligare i Faktaruta 1.6. Exempe
Page 44 and 45: Samhällsnivå Sociodemografi och v
Page 46 and 47: Faktaruta 1.1 Olika aspekter på va
Page 48 and 49: Faktaruta 1.3 Fyrfältstabell med k
Page 50 and 51: Faktaruta 1.4 Diagram som illustrer
Page 52 and 53: Faktaruta 1.6 Beräkning av likelih
Page 54 and 55: Faktaruta 1.7 Nomogram som visar hu
Page 56 and 57: Referenser 1. Fiske J, Davis DM, Fr
Page 59 and 60: 2. Metodik för sökning och utvär
Page 61 and 62: Primärt urval av studier För att
Page 63 and 64: laget för slutsatserna. En metod s
Page 65 and 66: • Förklarat/analyserat bortfall
Page 67 and 68: Otillräckligt vetenskapligt underl
Page 69 and 70: 3. Praxisundersökning avseende bit
Page 71 and 72: svenska och norska tonåringar unde
Page 73 and 74: Totalt antal undersökta Stockholm
Page 75 and 76: Østfold Totalt antal undersökta %
Page 77 and 78: 4. Diagnostik 4.1 Visuell-taktil di
Page 79 and 80: Bakgrund Den primära metoden för
Page 81 and 82: undersökare och bedömdes ha ett m
Page 83 and 84: diagnostik av emaljkaries på tuggy
Page 85 and 86: Aktiv (pågående) och inaktiv (kro
Page 87 and 88: Tabell 4.1.1 Inklusionskriterier f
Page 89 and 90: Dropout/ missing data Method or tec
Page 91: Dropout/ missing data Method or tec
Page 105 and 106: Table 4.1.7 continued Author, year,
Page 107 and 108: Table 4.1.7 continued Author, year,
Page 109 and 110: Referenser 1. Rocha RO, Ardenghi TM
Page 111 and 112: tion compared with conventional rad
Page 113 and 114: 63. Banerjee A, Watson TF, Kidd EA.
Page 115 and 116: 93. Rosén B, Birkhed D, Nilsson K,
Page 117 and 118: 4.2 Röntgendiagnostik Slutsatser G
Page 119 and 120: antingen med kabel eller via trådl
Page 121 and 122: Risker med röntgenstrålning Rönt
Page 123 and 124: När observatörerna skulle bestäm
Page 125 and 126: Faktaruta 4.2.2 Nomogrammet som byg
Page 127 and 128: Metodik för litteraturgenomgång E
Page 129 and 130: procent och specificiteten mellan 9
Page 131 and 132: 0,1 99 0,2 LR+ LR- 0,5 Visuell insp
Page 133 and 134: Intern och extern validitet Diagnos
Page 135 and 136: Kommentarer Vilka tänder eller tan
Page 137 and 138: för att en tvådimensionell bild a
Page 139 and 140: Method Number of teeth and surfaces
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Method Comparison method Outcome me
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Table 4.2.4 continued Author, year,
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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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Dropout/ missing data Method or tec
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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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områdena Aiken och Portland i Nort
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studier visar att låg- och mellanr
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Faktaruta 5.1 Inklusionskriterier f
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Table 5.1 Caries prediction in pre-
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Table 5.1 continued Author Year, re
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Table 5.2 Caries prediction in pre-
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Table 5.3 Caries prediction in scho
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Table 5.4 Caries prediction in scho
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Table 5.5 Caries prediction in adul
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Table 5.6 Caries prediction in adul
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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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