3529 DOI: 10.1590/1413-81232018249.21682017 CAST instrument in epidemiological surveys: Results TEMAS LIVRES FREE THEMES presentation in comparison to the WHO criteria Uso do instrumento CAST em levantamentos epidemiológicos: apresentação dos resultados em comparação ao critério da OMS Isadora Passos Maciel (http://orcid.org/0000-0002-0424-9335) 1 Ana Paula Dias Ribeiro (http://orcid.org/0000-0003-0840-4205) 2 Gilberto Alfredo Pucca Júnior (http://orcid.org/0000-0002-8781-9857) 1 Aline Bié (https://orcid.org/0000-0003-2816-275X) 1 Soraya Coelho Leal (http://orcid.org/0000-0002-4834-0210) 1 Resumo O CAST (Caries Assessment Spectrum Abstract Caries Assessment Spectrum and Tre- atment (CAST) is an instrument developed for and Treatment) é um instrumento desenvolvido caries detection to be used in epidemiological sur- para a detecção de cárie a ser utilizado em le- veys; it has been validated and is believed to pro- vantamentos epidemiológicos. Foi validado e tem vide a clearer picture of the oral health status than se mostrado efetivo, fornecendo um diagnóstico the criteria provided by the World Health Orga- mais preciso do estado de saúde bucal do que o nization (WHO). This article aims to compare critério OMS, recomendado pela Organização the epidemiological survey results using the CAST Mundial da Saúde. O objetivo deste artigo é com- instrument and the WHO criteria in the same po- parar a apresentação dos resultados de cárie den- pulation. 680 schoolchildren aged 6-8 years from tária utilizando o instrumento CAST e o critério Federal District, Brazil, were evaluated by two OMS, numa mesma população. Foram avaliados examiners trained to use the CAST. The visible por dois examinadores treinados na utilização do plaque index (VPI) and gingival bleeding index instrumento CAST 680 escolares de 6 a 8 anos do (GBI) were also evaluated. The maximum CAST Distrito Federal, Brasil. A avaliação constou do codes per tooth were converted into the dmf/DMF, índice de placa visível (IPV) e do índice de san- the mean scores for primary and permanent den- gramento gengival (ISG). Os escores CAST dente tition were calculated. The mean age was 7.45(± foram convertidos em componentes ceo/CPO e 0.91) years. The prevalence of caries differed when calculados os ceod/CPOD. Os pais responderam a CAST and the WHO criteria were applied. In the um questionário sociodemográfico. A idade média primary dentition, it was 65.44% and 61.61%, foi 7,45 anos (± 0,91). A prevalência de cárie na and for the permanent dentition, 38.19% and dentição decídua foi de 65,44% e 61,61%, consi- 10.2%, respectively. It was possible to calculate the derando o CAST e o critério da OMS, respectiva- mean dmft [2.4(± 2.7)] and the DMFT [0.16(± mente; na dentição permanente: 38,19% e 10,2%, 0.53)] using CAST. VPI was associated with hi- respectivamente. A média do ceod foi de 2.4 (± gher maximum CAST scores p < 0,005. The way 2.7) e a média do CPOD 0.16 (± 0.53). o IPV foi 1 Departamento de Odontologia, Universidade CAST results are presented showed a higher sen- associado a maiores CAST máximos p < 0,005. de Brasília. Campus sibility to identify the presence and severity of ca- O instrumento CAST demonstrou maior sensibi- Universitário Darcy Ribeiro, rious lesions in comparison to the WHO criteria . lidade em identificar a presença e gravidade de le- Asa Norte. 70000-000 Key words Dental caries, CAST, Caries epide- sões cariosas quando comparado ao critério OMS . Brasília DF Brasil. isadora.odt@gmail.com Palavras-chave Cárie dentária, CAST, Epide- miology 2 University of Florida. miologia da cárie Gainesville Florida EUA.
3530 Maciel IP et al. components is possible (an essential characteris- Introduction tic for the implementation of a new dental caries For years, researchers have been seeking an im- detection instrument), as shown by de Souza et al. 13 . Whereas that for decades the DMF index proved and easy-to-use instrument for conduct- was the most commonly used criteria worldwide, ing standardized epidemiological surveys, which this conversion will be necessary and extreme- is also designed to support subsequent action planning and implementation 1 . Given the impact ly important. In Brazil, for example, oral health of dental caries in people’s life, it is essential that surveys at the national level are conducted using the WHO criteria. Thus, this study aims to com- these surveys generate useful information for pare the presentation of results of an epidemio- public health action planning and comply to na- logical survey in which CAST was used to those tional policies 2 . However, the instruments avail- able for carrying out epidemiological surveys on converted to the WHO criteria and to determine dental caries do not adequately address the en- whether there is an association of visible plaque and gingival bleeding index with the occurrence tire spectrum of the disease (either they do not of carious lesions. include initial states of dental caries or their not able to provide information about caries severi- ty). This deficit might potentially contributes to the failure of existing health programs involved Materials and methods in early stage prevention or intervention of den- tal caries, as observed by the results of SBBrasil, Clinical design and sample selection in wich 80% of the children at the age of 5 years with at least one cavitated lesion were not treated A cross-sectional study was conducted to in 2003 and remained untreated in 2010 3,4 . obtain the prevalence of dental caries in school- children aged 6 to 8 years from Estrutural, an ur- To standardize the international studies of ban area of Brazil’s Federal District; the region dental caries in various populations, the World has 39,015 inhabitants and a monthly per capita Health Organization (WHO) 5 recommends us- ing the criteria proposed by Klein et al. 6 , which is income of 153 U$ 14 . The study was approved by the most frequently used criteria worldwide. The the Research Ethics Committee of the School of Health Sciences of the University of Brasilia and criteria are simple, presenting high reproducibil- authorized by the Secretary of Education from ity by detecting only the presence or absence of the Federal District. decayed, filled, and missing teeth. Nevertheless, the criteria do not detect the complexity of the All children whose parents signed the in- disease or related treatment, which requires the formed consent form were included in this study. The sample of 680 children was obtained from use of additional instruments such as the pufa/ two public schools. For those in need of dental PUFA (pulp involvement, ulceration, fistula, and treatment, simple procedures, such as resto- abscess) 7 and the Treatment Need Index 8 . An instrument that has proven to be effective rations and sealants, were performed at schools; in assessing the prevalence and the different se- pulpectomies and tooth extractions were per- formed at the Pediatric Dentistry Clinic of the verity stages of dental caries is the Caries Assess- University Hospital of Brasilia (HUB). ment Spectrum and Treatment (CAST) 9 . It was proposed in 2011, validated in 2013 and has been proven to be easy-to-use, with its results easily Training and calibration communicated to health policy makers 10 . The full The clinical examination was performed by spectrum of disease is captured in this single in- two examiners who were trained and calibrated strument, with codes listed in hierarchical order in the use of the CAST instrument according to that reveal additional complexities and suggest the need for treatment of the individual or the the instructions of the CAST manual 12 . Training population as a whole. Through the instrument included a theoretical 2-hour lecture taught by an experienced examiner and a practice session it is possible to calculate caries prevalence and to demonstrating the use of the CAST instrument group individuals according to the disease severi- in children at the Pediatric Dentistry Clinic of ty 11 . Another distinguishing feature of the instru- ment is the grouping of codes according to dental HUB. Then, the calibration was performed by health status as follows: healthy, pre-morbidity, examining children from the same age of those who would be included in the main study, but morbidity, and severe morbidity and mortality 12 . who did not take part of it. The calibration ex- Additionally, the conversion of CAST codes ercise was considerate concluded when adequate into the D (decayed), M (missing) and F (filling)
Recommend
More recommend
