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Query: UMLS:C0220723 (PCA)
 4,687 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis of primary coronal caries should be seen as a complex process, comprising both detection and measurement phases, which enables clinicians, researchers and epidemiologists to make informed decisions about the management and prognosis of the disease process. The different diagnostic thresholds employed for measurements of caries experience can be viewed as an iceberg, a metaphor which demonstrates the ambiguity of the term "caries free" and which can also represent the differing management options appropriate for the care of different types of active and inactive lesions: NAC (No Active Care). PCA (Preventive Care Advised) and OCA (Operative Care Advised). There are considerable methodological difficulties in drawing valid comparisons between studies using incompatible criteria and simulations. However, it is apparent that no caries diagnostic tool in current clinical use fulfils all of the ideal criteria for measurements needed to plan and monitor appropriate care. Systems providing reliable serial measurements with which to assess future caries risk and present caries activity are urgently required as diagnostic tasks are becoming both more difficult and more important from the standpoint of long-term oral health. Existing diagnostic tools frequently rely on subjective judgements and provide only semi-quantitative measures insensitive to smaller lesions. In the future tools are needed which are objective, quantitative and which can provide acceptable compromises between sensitivity and specificity for a wide range of applications for individual patient care as well as for research and survey use. Key problem areas with existing tools include confusion in terminology and between caries assessments made by clinicians and epidemiologists as well as the lack of valid measurements relating to the activity of primary root caries and secondary caries. Deficiencies with current tools impact on the care of individuals by allowing false negative diagnoses of hidden occlusal dentine lesions and approximal cavities on the one hand, whilst generating some false positive diagnoses on sound surfaces leading to inappropriate decisions to restore on the other. At the population level, current conventional tools significantly underestimate overall caries experience. In future the adoption of more accurate and reliable methods would facilitate more effective preventive care and promote more appropriate restorative treatment decisions. Research in this area should focus for the next five years on diagnostic technologies which: 1) inform valid prospective caries risk assessments for different age groups, 2) can help to determine present caries activity and monitor lesion behaviour over time and 3) help identify methods which can implement existing and new research knowledge about diagnostic tools into clinical and research practice.
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PMID:Diagnostic tools and measurements--impact on appropriate care. 908 89

This consideration of the determination of patient caries status in the context of practical, evidence-based management of the initial caries lesion relates to assessments of caries in individuals. It provides the diagnostic basis for the related topics of radiographic monitoring, caries activity testing, and lesion management strategies that follow in subsequent papers. The "totality" of caries experience must be recognized in making individual assessments; this ranges from sub-clinical, to initial, and then dentinal (including hidden) lesions. The detection of initial and dentine lesions using existing diagnostic tools is imperfect and to an extent unreliable, but, notwithstanding the limitations of existing technology, this step is of pivotal importance. Similarly, the measurement of lesion extent and depth by existing methods is problematic but possible. Having identified different types of caries, categorization of lesions by the appropriate management "option" permits clear statements of intent to be made to both patients and dental funding agencies. The NAC/PCA/PCA + OCA system is suggested as a simple and explicit method of describing caries status for individual lesions and for communicating their current caries status to patients.
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PMID:Patient caries status in the context of practical, evidence-based management of the initial caries lesion. 942 May 62