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  • 1.
    Senneby, Anna
    Malmö högskola, Odontologiska fakulteten (OD).
    Re-evaluation of methods to identify individuals with increased risk of caries2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis was to evaluate methods used to identify individuals with increased risk of coronal caries lesion development. The specific aims were to:•evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries lesions (study I)•design and pilot a novel classification system for the assessment of caries lesion progression in bitewing radiography and to report rater agreement of the system (study II)•assess intra-individual differences in biofilm acid-tolerance between different tooth surfaces and inter-individual variation as well as stability of acid tolerance over time (study III)•assess diagnostic accuracy of two established methods and a candidate method to identify adolescents with increased risk of dental coronal caries lesion development (study IV).Study I comprised a systematic review of caries risk assessment methods, following methods were included for final analysis: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, dental plaque, dietary habits and sociodemographic variables. Assessment of risk of bias with the aid of Quadas-2 resulted in identification of methodological limitations concerning study design, test technology and reporting. Evidence for methods using previous caries experience and salivary mutans streptococci was low and evidence regarding other methods was lacking. The overall evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design. In study II a classification system with drawings and text was designed to assess caries lesion progression in bitewing radiographs. Guidelines for Reporting Reliability and Agreement Studies, GRRAS were used to design and report the study. Pairs of posterior bitewing radiographs (baseline and 1-year follow-up) with different status concerning caries lesion progression were selected and 10 raters assessed the radiographs with the aid of the classification system. Seven raters repeated their assessments. Kappa for the interrater agreement of 10 raters assessing progression was 0.61, indicating substantial agreement. Corresponding intrarater agreement was substantial (kappa 0.66–0.82). This system can provide a common framework for clinical decision-making on caries interventional methods and patient visiting intervals. Scientifically, the system allows for a comparative analysis of different methods of prevention and treatment of caries as well as of different caries risk assessment methods.In study III dental biofilms were collected from supragingival approximal surfaces of canines and first premolars, second premolar and first molars, and between the central incisors of both jaws in adolescents at baseline, day 3, after 1 month as well as after 6- and 12 months for the approximal surfaces of second molars and first molars. After exposure to pH 3.5 for 2 hours, biofilm cells were visualized using LiveDead® BacLightTM staining and each sample was examined using an inverted confocal scanning laser microscope. Live bacteria (acid-tolerant) appeared green while dead (non acid-tolerant) bacteria appeared red. Images of the biofilm were compared with a scale (score 1-5) to assess the proportion acid-tolerant bacteria in each sample. A majority of the adolescents were assessed with low scores of biofilm acid tolerance. In 14 of 20 individuals, no differences were seen between the three dental sites. At 51 of total 60 sites, assessed score of acid tolerance at baseline was unchanged after one month. However, scores for acid tolerance changed over a 1-year period in 50% of the individuals. Results should be interpreted with caution because of the limitation in sample size. Acid tolerance of dental biofilm is a candidate method that may be implement in caries risk assessment methods. It needs to be scientifically evaluated in clinical prospective studies as a biomarker for caries development. For the purpose of study IV, the STARD-statement “Standards for Reporting of Diagnostic Accuracy” was implemented for design and reporting of the study. Adolescents, aged 12, visiting two public dental clinics were examined by visual/tactile examination and bitewing radiography of posterior teeth at baseline and after 1 year. Two established methods (previous caries experience and dentists’ risk assessment) and one candidate method (acid tolerance in dental biofilm) were applied with pre-specified thresholds. The reference standard comprised coronal caries lesion development after 1 year. Caries lesion progression occurred in 29% of the adolescents, mainly approximal lesions within enamel. Diagnostic test accuracy varies with thresholds of the index tests, reference standard and with different caries status and caries lesion progression. Most positive likelihood ratios for the methods were

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  • 2.
    Senneby, Anna
    et al.
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Davies, Julia
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Svensäter, Gunnel
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Neilands, Jessica
    Malmö högskola, Odontologiska fakulteten (OD). Malmö högskola, Biofilms Research Center for Biointerfaces.
    Acid tolerance properties of dental biofilms in vivo2017Ingår i: BMC Microbiology, E-ISSN 1471-2180, Vol. 17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The ecological plaque hypothesis explains caries development as the result of the enrichment of acid tolerant bacteria in dental biofilms in response to prolonged periods of low pH. Acid production by an acid tolerant microflora causes demineralisation of tooth enamel and thus, individuals with a greater proportion of acid tolerant bacteria would be expected to be more prone to caries development. Biofilm acid tolerance could therefore be a possible biomarker for caries prediction. However, little is known about the stability of biofilm acid tolerance over time in vivo or the distribution throughout the oral cavity. Therefore the aim of this study was to assess intra-individual differences in biofilm acid-tolerance between different tooth surfaces and inter-individual variation as well as stability of acid tolerance over time. Results: The majority of the adolescents showed low scores for biofilm acid tolerance. In 14 of 20 individuals no differences were seen between the three tooth sites examined. In the remaining six, acid-tolerance at the premolar site differed from one of the other sites. At 51 of 60 tooth sites, acid-tolerance at baseline was unchanged after 1 month. However, acid tolerance values changed over a 1-year period in 50% of the individuals. Conclusions: Biofilm acid tolerance showed short-term stability and low variation between different sites in the same individual suggesting that the acid tolerance could be a promising biological biomarker candidate for caries prediction. Further evaluation is however needed and prospective clinical trials are called for to evaluate the diagnostic accuracy.

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  • 3.
    Senneby, Anna
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Elfvin, Margareta
    Färjestaden General Dental Clinic, Public Dental Health Service, Sweden.
    Stebring-Franzon, Christina
    Alvesta General Dental Clinic, Public Dental Health Service, Sweden.
    Rohlin, Madeleine
    Malmö högskola, Odontologiska fakulteten (OD).
    A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs2016Ingår i: Dento-Maxillo-Facial Radiology, ISSN 0250-832X, E-ISSN 1476-542X, Vol. 45, nr 5, artikel-id 20160039Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To design and pilot a novel classification system for the assessment of caries lesion progression in bitewing radiography and to report rater agreement of the system.

    METHODS: A classification system with drawings and text was designed to assess caries lesion progression. Guidelines for Reporting Reliability and Agreement Studies were used to study and report rater agreement. Pairs of posterior bitewing radiographs (baseline and 1-year follow-up) with different status concerning caries lesion progression were selected from files from public dental health clinics. 10 raters, 5 general dental practitioners and 5 specialists in oral and maxillofacial radiology were asked to assess the radiographs with the aid of the classification system. Seven raters repeated their assessments. Rater agreement was expressed as percentage of agreement and kappa.

    RESULTS: Kappa for the interrater agreement of 10 raters assessing progression was 0.61, indicating substantial agreement. Agreement was moderate for progression in the outer half of the dentine (kappa 0.55) and within enamel (kappa 0.44). Pairwise interrater agreement varied (range 69-92%; kappa 0.42-0.84). For about half of the pairs of raters, kappa was substantial (≥0.61). Intrarater agreement assessing progression was substantial (kappa 0.66-0.82).

    CONCLUSIONS: We demonstrated the applicability of the proposed classification system on caries lesion progression with respect to rater agreement. This system can provide a common framework for clinical decision-making on caries interventional methods and patient visiting intervals. Scientifically, this system allows for a comparative analysis of different methods of prevention and treatment of caries as well as of different caries risk assessment methods.

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  • 4.
    Senneby, Anna
    et al.
    Malmö universitet, Foresight. Malmö universitet, Odontologiska fakulteten (OD). Malmö universitet, Biofilms Research Center for Biointerfaces. Department of Oral Radiology, Skåne University Hospital, Malmö, Sweden.
    Fransson, Helena
    Malmö universitet, Foresight. Malmö universitet, Odontologiska fakulteten (OD). Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
    Vareman, Niklas
    Department of Medical Ethics, Lund University, Lund, Sweden.
    What is risk? The challenge of defining ‘risk’ in caries risk assessment2024Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, s. 42-46Artikel i tidskrift (Övrigt vetenskapligt)
  • 5.
    Senneby, Anna
    et al.
    Malmö högskola, Odontologiska fakulteten (OD).
    Mejàre, Ingegerd
    Sahlin, Nils-Eric
    Svensäter, Gunnel
    Malmö högskola, Odontologiska fakulteten (OD).
    Rohlin, Madeleine
    Malmö högskola, Odontologiska fakulteten (OD).
    Diagnostic accuracy of different caries risk assessment methods: A systematic review2015Ingår i: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 43, nr 12, s. 1385-1393Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the accuracy of different methods used to identify individuals with increased risk of developing dental coronal caries. Data: Studies on following methods were included: previous caries experience, tests using microbiota, buffering capacity, salivary flow rate, oral hygiene, dietary habits and sociodemographic variables. QUADAS-2 was used to assess risk of bias. Sensitivity, specificity, predictive values, and likelihood ratios (LR) were calculated. Quality of evidence based on >= 3 studies of a method was rated according to GRADE. Sources: PubMed, Cochrane Library, Web of Science and reference lists of included publications were searched up to January 2015. Study selection: From 5776 identified articles, 18 were included. Assessment of study quality identified methodological limitations concerning study design, test technology and reporting. No study presented low risk of bias in all domains. Three or more studies were found only for previous caries experience and salivary mutans streptococci and quality of evidence for these methods was low. Evidence regarding other methods was lacking. For previous caries experience, sensitivity ranged between 0.21 and 0.94 and specificity between 0.20 and 1. Tests using salivary mutans streptococci resulted in low sensitivity and high specificity. For children with primary teeth at baseline, pooled LR for a positive test was 3 for previous caries experience and 4 for salivary mutans streptococci, given a threshold >= 10(5) CFU/ml. Conclusions: Evidence on the validity of analysed methods used for caries risk assessment is limited. As methodological quality was low, there is a need to improve study design. Clinical significance: Low validity for the analysed methods may lead to patients with increased risk not being identified, whereas some are falsely identified as being at risk. As caries risk assessment guides individualized decisions on interventions and intervals for patient recall, improved performance based on best evidence is greatly needed. (C) 2015 Elsevier Ltd. All rights reserved.

  • 6.
    Senneby, Anna
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Neilands, Jessica
    Malmö universitet, Odontologiska fakulteten (OD).
    Svensäter, Gunnel
    Malmö universitet, Odontologiska fakulteten (OD).
    Axtelius, Björn
    Malmö universitet, Odontologiska fakulteten (OD).
    Rohlin, Madeleine
    Malmö universitet, Odontologiska fakulteten (OD).
    Threshold values affect predictive accuracy of caries risk assessment2019Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 315-327Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment. Material and methods: Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists’ risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds. Results: Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk. Conclusions: As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

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