Desempenho de estudantes de graduação em odontologia na detecção e avaliação da atividade de lesões de cárie: revisão sistemática e meta-análise

Abstract

The caries detection is an essential topic in the curriculum of graduation courses in Dentistry, since establishing the diagnosis is essential for the correct clinical decision making. However, many factors can influence the performance of the visual examination, such as the examiners’ training. This could be crucial considering the undergraduate students have not yet developed the diagnostic skills. Thus, this systematic review and meta-analysis aimed to evaluate the performance of dental undergraduate students in detecting and assessing the activity status of caries using visual inspection. A comprehensive search was undertaken through PubMed/MEDLINE, Scopus, Lilacs databases and OpenSINGLE up to June 2018 to identify literature related to research question. No publication year or language restriction was considered. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias with Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). Meta-analyses summarized the results concerning reproducibility and accuracy (Summary Receiver Operating Characteristics analysis [SROC], diagnostic odds ratio [DOR], considering D1 (all lesions) and D3 (only lesions into dentin, when lesion depth was assessed, or cavitated lesions, when surface integrity was evaluated) thresholds. For activity, we considered sound surfaces + inactive caries lesions vs. active caries lesions. Meta-regression was also performed to assess the effect of methodological variables on the outcome. Heterogeneity was explored using random-models and meta-regression analysis. The heterogeneity of the studies was also assessed. From 233 potentially eligible studies, 31 were selected for full-text analysis and 14 were included in the systematic review. Most of the included studies used the ICDAS (92.9%) for severity assessment and Nyvad (28.6%) for caries activity. Studies showed moderate values of pooled interexaminer agreement (0.52; 95% CI 0.39-0.66) and substantial pooled values of intra-examiner agreement (0.70; 95% CI 0.55-0.86) when severity was considered. Substantial pooled values of intra-examiner agreement (0.62; 95% CI 0.38-0.86), but poor pooled values of interexaminer agreement (0.39; 95% CI 0.10-0.67) were found for activity assessment. Studies showed moderate values of pooled sensibility at D1 (0.640; 95% CI 0.620-0.660) and D3 (0.625 95% CI 0.585-0.664) thresholds. Excellent values of pooled specificity were found at D1 (0.97 95% CI 0.967-0.973) and D3 (0.984 95% CI 0.982-0.986) thresholds. The pooled sensitivity was also lower than pooled specificity for caries activity. Overall, the heterogeneity was high. All included studies presented a high risk of bias in sample selection. Students’ education level in the course and previous clinical experience did not influence on the accuracy and reproducibility of the visual inspection. In conclusion, the undergraduate students’ performance in detecting caries lesions using visual inspection was good, although activity status assessment should be improved.