Overdiagnosis estimation for the detection of proximal caries in primary teeth

• Grant number: 23/06640-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): November 01, 2023
• Effective date (End): October 31, 2024
• Field of knowledge: Health Sciences - Dentistry - Pediatric Dentistry
• Principal Investigator: José Carlos Pettorossi Imparato
• Grantee: Ana Beatriz Tournoul de Moraes Simão
• Host Institution: Faculdade de Odontologia (FO). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Overdiagnosis is the detection of a condition or disease that would not lead to death, sequelae, or even symptoms in the patient. Therefore, this diagnosis does not bring any benefits but can potentially provoke harm. Although the issue has been extensively studied in medicine, studies that evaluate the potential overdiagnosis for dental health problems are scarce. Different study designs could be used to assess the overdiagnosis occurrence, being the randomized clinical trials of diagnostic strategies is the most robust design. The potential occurrence of overdiagnosis has also been studied in autopsy studies, where identifying some diseases that were not the cause of patient death evidences this potential. A similar analysis would evaluate naturally exfoliated primary teeth to determine the risk of overdiagnosis related to dental caries. Therefore, this study will aim to assess the potential for overdiagnosis related to proximal caries lesions in primary teeth using a sample of a Human Teeth Biobank. A total of 220 primary molars will be selected that present evidence of physiological exfoliation and intact marginal ride, stored in the Human Teeth Biobank of the School of Dentistry, University of São Paulo. One examiner will assess the proximal surfaces by direct visual inspection, classifying them in sound, with initial caries lesions and cavitated caries lesions. Then, radiographs will be taken, and the images will be classified according to radiolucency related to dental caries. The estimation for potential overdiagnosis will be evaluated considering three features: any caries lesions visually detected, cavitated lesions, and radiographic opacities suggesting dental caries lesions. The frequency of these occurrences and 95% confidence intervals will be calculated. Multilevel regression analyses will be conducted to evaluate the association of independent variables (molar type, dental arch, and dental surface) in the overdiagnosis occurrence (p<0.05). With this study, it is expected to estimate overdiagnosis occurrence related to caries detection in proximal surfaces of primary teeth.