title: Comparison of three salivary flow rate assessment methods in an elderly population. The development of an index of orthodontic treatment priority. In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars. Electronic thermography for the assessment of mild and moderate temporomandibular joint dysfunction. Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status. A re-evaluation of electrical resistance measurements for the diagnosis of occlusal caries Sialolithiasis: MR sialography of the submandibular duct--an alternative to conventional sialography and US? An Abbreviated Caries Clinical Trial Design Validated over 24 Months Reliability of the craniomandibular index. Improving detection of precancerous and cancerous oral lesions. Computer-assisted analysis of the oral brush biopsy. U.S. Collaborative OralCDx Study Group. Using the modified Schirmer test to measure mouth dryness: a preliminary study. Inter-examiner reliability of salivary diagnostic tests in a practice-based research network. The Dutch periodontal screening index validation and its application in The Netherlands.
abstract: Measuring salivary flow rates among the frail elderly is a challenge . The currently used spit collection method requires levels of time and cooperation that often may exclude the frail elderly who are at high risk for salivary compromise . A measurement method that is not only valid and reliable , but also feasible and acceptable is needed for use in population studies of compromised adults . This study compared two salivary flow rate assessment methods using a suction machine against the currently accepted spit collection method in an elderly population aged 75 and older . Three methods of flow rate ( g/min ) assessment were compared at three time periods among 16 elders ( mean age 86.6 years ) .  Flow rates using the 2-min open suction method compared well with the 10-min spit method ( r=0.778 ) but the 2-min closed suction method did not ( r=0.158 ) . Reliability evaluation of the open suction method and the spit method was assessed using a test/retest with a 1-week interval . Both methods demonstrated good comparable reliability  ( spit method r=0.566 , P=0.01 ) ; open suction method , ( r= 0.861 , P<0.01 ) . Based on a short survey question naire about the three methods , 11 of the 16 elderly subjects preferred the use of the suction machine to the spit method . These results indicate that the 2-min open suction method technique is a valid and reliable means of measuring salivary flow . The lower level of patient cooperation needed , the shorter time period required , and this preliminary report of its acceptability support the use of this method in future population studies of frail elders The aim of this study was to develop a valid and reproducible index of orthodontic treatment priority . After review ing the available literature , it was felt that this could be best achieved by using two separate components to record firstly the dental health and functional indications for treatment , and secondly the aesthetic impairment caused by the malocclusion . A modification of the index used by the Swedish Dental Health Board was used to record the need for  orthodontic treatment on dental health and functional grounds . This index was modified by defining five grade s , with precise dividing lines between each grade . An illustrated 10-point scale was used to assess independently the aesthetic treatment need of the patients . This scale was constructed using dental photographs of 12-year-olds collected during a large multi-disciplinary survey . Six non-dental judges rated these photographs on a visual analogue scale , and at equal intervals along the judged range , representative photographs were chosen . To test the index in use , two sample population s were defined ; a group of patients referred for treatment , and a r and om sample of 11 - 12-year-old schoolchildren . Both sample s were examined using the index and satisfactory levels of intra- and inter-examiner agreement were obtained OBJECTIVES The aim of this r and omised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions , as well as to find appropriate cut-off values . METHODS One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined , then either opened or not , after which their laser fluorescence was measured . Forty-three lesions were opened , the caries removed and the clinical ly identified caries depths were registered in addition to the radiographical scoring . Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened . Here , the radiographical scorings were registered . RESULTS Taking the radiographic  scoring as gold st and ard for all investigated approximal sites , sound sites ( D(0 ) , n=40 ) showed significantly lower laser fluorescence measurements than carious sites ( D(1 - 4 ) , n=77 ) ( Mann-Whitney test , P<0.025 ) suggesting a cut-off at 7 ( sensitivity=0.68 , specificity=0.7 ) . Comparing measurements of D(0 - 2 ) ( n=74 ) and D(3,4 ) ( n=43 ) , the results were also different by a statistically significant amount ( P<0.025 ) and the cut-off calculated to be 16 ( sensitivity=0.6 , specificity=0.84 ) . A fair positive correlation between laser fluorescence values and radiographical scoring was found ( rho=+0.47 , P<0.01 ) . Analysing the 43 opened lesions with their clinical ly found lesion depths as gold st and ard , there was a fair positive correlation to the laser fluorescence values ( rho=+0.34 , P=0.03 ) and a moderately strong correlation to the radiographic scoring ( rho=+0.67 , P<0.01 ) . CONCLUSION The device may be an adjunct tool in the approximal detection of caries along with established procedures Today facial heat emission patterns may be rapidly obtained and quantified with the use of advanced electronic thermography units that have the promise of being a nonionizing , noninvasive , low-cost diagnostic alternative for the evaluation of temporom and ibular joint disorders . This study design measured the use of electronic thermography as a tool to select between asymptomatic ( control ) subjects and a patient group with mild to moderate temporom and ibular joint disorders . Study population s consisted of 24 asymptomatic ( control ) subjects and 20 patients with ( 1 ) either locked or unlocked temporom and ibular joints , ( 2 ) varying degrees of limitation of mouth opening , ( 3 ) mild to moderate muscle pain , and ( 4 ) mild to moderate temporom and ibular joint arthralgia . The results indicated that the control group demonstrated a high level of thermal symmetry over the temporom and ibular joint region . The patient group demonstrated a low level of thermal symmetry with a delta T value of 0.4 degrees C. The control group was selected from the patient group with 85 % sensitivity ( 17 of 20 ) , and 92 % specificity ( 22 of 24 ) , and 89 % overall accuracy ( 39 of 44 ) , when selecting among the 44 subjects used in this study . The conclusion therefore is that electronic thermography shows promise as a method of diagnosing mild to moderate temporom and ibular joint disorders OBJECTIVE The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporom and ibular joint disk status . STUDY DESIGN Sixty magnetic resonance images of adolescent temporom and ibular joints were r and omly drawn for analysis . Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images . Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique .  Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures . RESULTS The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement . In addition , the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement . CONCLUSIONS Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images Clinical and radiographic diagnosis of occlusal caries is difficult . Resistance measurements in pits and fissures have shown better sensitivity compared with the more conventional methods of diagnosis . Two machines have been manufactured for this purpose : the Vanguard and the Caries Meter L. The aims of this study were to calibrate the readouts of these machines against a variable st and ard resistance box and use the Vanguard to compare readings taken in vivo and in vitro after extraction of the teeth . The diagnostic accuracy of clinical , radiographic , Vanguard and Caries Meter L diagnoses were also assessed . One hundred occlusal sites in 40 teeth of 20 patients were investigated in vivo with the Vanguard , noting clinical and radiographic appearances . The teeth were then extracted and the Vanguard readings repeated in vitro , together with Caries Meter L readings . The in vivo/in vitro comparison between Vanguard readings showed excellent reproducibility ( Cohen 's Kappa = 0.80 ) . The sensitivity and specificity for the different examination techniques at the enamel level of diagnosis were 27 % and 89 % for visual , 6 % and 100 % for radiographic , 81 % and 78 % for the Vanguard and 74 % and 74 % for the Caries Meter L. In conclusion , this study supports the renewed interest in resistance measurements as a diagnostic technique and indicates that the in vitro model used gives results comparable to those in PURPOSE To determine the value of magnetic resonance ( MR ) sialography for the diagnosis of sialolithiasis by comparing results prospect ively with those of ultrasonography ( US ) and digital sialography . MATERIAL S AND METHODS MR sialography was prospect ively performed with T2-weighted three-dimensional ( 3D ) constructive interference in steady-state ( CISS ) and rapid acquisition with relaxation-enhancement ( RARE ) sequences in 24 patients suspected of having sialolithiasis . Evoked salivation was used as contrast material . T1-weighted spin-echo and T2-weighted turbo spin-echo MR imaging also were performed . The results were then compared with those of US and digital sialography , with the latter as st and ard of reference . RESULTS The 3D CISS images were significantly ( P : < .05 ) superior to RARE images for demonstrating the subm and ibular ductal system , followed by T2-weighted turbo spin-echo images ( P : < .01 ) and T1-weighted spin-echo images ( P : < .001 ) . The sensitivity and specificity were 100 % and 80 % , respectively , for CISS MR sialography and 80 % and 100 % , respectively , for RARE MR imaging . The sensitivity and specificity of US were both 80 % . CONCLUSION MR sialography with evoked salivation is noninvasive and allows delineation of the subm and ibular ductal system and detection of sialoliths with accuracy that is similar to that of digital sialography and superior to that of US Conventional caries trials last from 24 to 36 months . This study evaluated whether the previously established difference in efficacy between 1000- and 2500-ppm-fluoride dentifrices could be detected after 12 months . Caries was assessed by clinical visual assessment ( CVA-simplified version of Dundee Selectable Threshold Method - DSTM ) ,  bitewing radiography , and Fiber Optic Transillumination ( FOTI ) . Changes in status for individual surfaces were classified by means of pre-prepared matrices as 0 ( unchanged ) , + 1 ( initiation or progression ) , or -1 ( regression ) and summed for each subject to yield an event score . Mean group event scores were calculated for each product . DSTM at the D1 [ enamel and dentin ] threshold showed significant inter-group differences in mean event scores ( p < 0.003 ) and D1MFS increment ( < 0.007 ) at 12 months ; these were confirmed at 24 months by traditional increment analysis ( CVA & FOTI at the D3 ( dentin only ) threshold + radiography , p < 0.03 ) . This study confirms the validity of an abbreviated trial protocol AIMS To examine various dimensions of reliability of the  Craniom and ibular Index , a commonly used instrument for quantifying the severity of signs and symptoms of temporom and ibular disorders . METHODS Classical psychometric theory and generalizability theory were used to assess the reliability of data obtained from a calibration study of examiners participating in a multi-site clinical trial and from a r and om community sample . RESULTS The reliability of aggregate scores formed by summing individual binary scored items was high , with intraclass correlations ranging from 0.81 to 0.88 . When it was required that examiners recognize and agree upon a specific pattern of signs and symptoms exhibited by a patient , however , reliability dropped dramatically ( multivariate kappas ranged from 0.26 to 0.32 ) . A group of practicing examiners also showed limited ability to agree with the pattern of signs and symptoms identified by a " gold st and ard " examiner ( multivariate kappas ranging from 0.25 to 0.32 ) . Generalizability analysis failed to identify the specific sources of measurement error that played a major role in limiting reliability but demonstrated that generalizability of aggregate scores was very high . CONCLUSION Methods of classical psychometric theory and generalizability theory support the conclusion that the reliability of aggregate scores is acceptably high . Individual items assessing certain aspects of jaw mobility and joint sounds are measured with poor reliability . Reliability declines when it is defined as the ability of examiners to agree among themselves upon a specific constellation of signs and symptoms or their ability to identify correctly a " correct " constellation identified by an expert examiner BACKGROUND A study group composed of research ers from across the United States undertook a study to evaluate the sensitivity and specificity of OralCDx ( OralScan Laboratories Inc. ) , a computer-assisted method of analysis of the oral brush biopsy , in the detection of precancerous and cancerous lesions of the oral mucosa . METHODS The study group conducted a multicenter double-blind study comparing results of OralCDx analysis with those of scalpel biopsy of suspicious oral lesions , as well as using OralCDx on oral lesions that appeared benign clinical ly . RESULTS In 945 patients , OralCDx independently detected every case of histologically confirmed oral dysplasia and carcinoma ( sensitivity = 100 percent , false-negative rate = 0 percent ) . Every OralCDx " positive " result was subsequently confirmed by histology as dysplasia or carcinoma . The specificity for the OralCDx " positive " result was 100 percent , while the specificity for the OralCDx " atypical " results was 92.9 percent . In 4.5 percent of clinical ly benign-appearing lesions that would not have received additional testing or attention other than clinical follow-up , OralCDx uncovered dysplasia or carcinoma ( statistical sensitivity > 96 percent , P < .05 , n = 131 ; statistical specificity for the OralCDx " positive " result > 97 percent and for the " atypical " result > 90 percent , P < .05 , n = 196 ) . CONCLUSIONS The authors propose that this multicenter trial demonstrates that OralCDx is a highly accurate method of detecting  oral precancerous and cancerous lesions .  OralCDx can aid in confirming the nature of apparently benign oral lesions and , more significantly , revealing those that are precancerous and cancerous when they are not clinical ly suspected of being so . All OralCDx " atypical " and " positive " results should be referred for scalpel biopsy and histology to completely characterize the lesion . CLINICAL IMPLICATION S Given the difficulty in clinical ly differentiating premalignant and malignant lesions from benign lesions with a similar appearance , OralCDx appears to determine the significance of an oral lesion definitively and detect innocuous-appearing oral cancers at early , curable stages BACKGROUND Current methods of measuring saliva volume often are difficult to perform in a general dental or medical office setting . This study seeks to determine whether the Schirmer test for measuring eye dryness can be modified to measure mouth dryness . METHODS The authors performed a modified Schirmer test ( MST ) on a control group composed of 41 healthy adult volunteers and a study group composed of 10 patients who had received head and neck radiation and 10 patients who had oral chronic graft-versus-host disease ( CGVHD ) . The authors placed the strip on the floor of each subject 's mouth and took readings at one minute , two minutes and three minutes . Fourteen control subjects  also spat into a container over a five-minute interval , and the authors weighed the collected saliva . RESULTS The mean reading for the control subjects at three minutes was 29.5 millimeters , while the mean reading for the test subjects was 6.9 mm ( P < .00005 ) . CONCLUSIONS The results of the MST were able to distinguish between healthy adult volunteers and subjects who experienced profound xerostomia and hyposalivation . CLINICAL IMPLICATION S The MST as used in this preliminary study is an objective , inexpensive , easy-to-perform and well-tolerated test for measuring mouth dryness . It readily distinguishes between patients who are healthy and asymptomatic and those who experienced profound xerostomia and hyposalivation PURPOSE Patient salivary characteristics are being measured as part of the Northwest PRECEDENT ( Practice -based REsearch Collaborative in Evidence -based DENTistry ) study on caries risk assessment . Prior to the implementation of these salivary diagnostic tests in a practice -based cohort study , inter-examiner reliability was assessed for resting salivary pH , stimulated salivary flow rate , pH and buffering capacity . METHODS An initial evaluation of inter-examiner reliability of the 4 salivary tests was conducted among 6 dental auxiliary examiners using a convenience sample of 40 dental students . An in complete block design was used to assign sample s to examiners ( 3 examiners per sample and 20 sample s per examiner ) . Inter-examiner reliability testing was conducted on a patient population representative of the practice -based network in 4 member practice s. Two dental assistants per practice independently conducted the salivary tests on sample s provided by a r and om selection of 20 to 25 patients . A separate analysis was performed for each study . For each test , an inter-examiner reliability index was computed . RESULTS Results from two studies are reported . In the first , stimulated salivary flow rate demonstrated excellent inter-examiner reliability , and resting salivary pH showed high inter-examiner reliability , while buffering capacity and stimulated salivary pH had moderate and very low inter-examiner reliability , respectively . In the second , inter-examiner reliability was excellent for the stimulated salivary flow rate and the resting salivary pH. The inter-examiner reliability for the stimulated salivary pH was also high and the stimulated salivary buffering capacity test had moderate reliability . CONCLUSION The small variance in stimulated salivary pH and buffering capacity in dental students may have artificially made the reliability appear low in the first attempt at inter-examiner reliability testing . In the second study , all 4 tests had an accept able performance OBJECTIVE To provide evidence that the Dutch periodontal screening index ( DPSI ) is a valuable tool for the screening of the periodontal status and to evaluate the application of the DPSI by general practitioners in the Netherl and s. MATERIAL AND METHODS To assess the validity of the DPSI , an available data set was used consisting of 131 subjects with various degrees of periodontal breakdown in whom plaque , calculus , pocket depth , bleeding on probing and attachment loss was evaluated at all inter-proximal sites . The application of the DPSI in general practice was studied in a r and om sample of 300 practising dentists in the Netherl and s by means of a question naire . RESULTS Full-mouth inter-proximal measurements showed that 19.1 % of the subjects had > or=6 mm attachment loss at > or=2 sites . The DPSI identified 100 % of the subjects with this condition . The results of the survey question naire showed that about 75 % of the general dental practitioners were applying the DPSI  , although only 15.1 % were performing this consistently when a regular check-up was performed . The mean time required for the assessment of the DPSI  was 3 min . CONCLUSION The DPSI is valuable tool for the screening of the periodontal condition during general dental check-ups
target: Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice , they do not allow assessing all components of physical oral health .
background: OBJECTIVE This study aim ed at exploring available clinical instruments and methods for assessing physical oral health , and at identifying those with sufficient diagnostic performance .