Efficacy of American Academy of Pediatric Dentistry Best Practice Recommendations for Diagnosis and Management of Deep Caries in Primary Teeth.

Purpose: To evaluate the efficacy of the American Academy of Pediatric Dentistry (AAPD) best practice recommendations for the diagnosis and management of deep carious lesions in primary teeth.

Methods

Primary molars from four to eight-year-old children were selected for diagnosis and treatment planning independently by a pediatric dental resident using the AAPD recommendations and a pediatric dentist using his clinical expertise and experience. The analysis of the two evaluators was performed for sensitivity, specificity, positive predictive value, negative predictive values, and agreement scores.

Results

A total of 365 primary molars from 185 children were used. Diagnosis and treatment planning by the resident demonstrated a higher sensitivity score of 92.7 percent (95 percent confidence interval [95% CI]=80.1 to 98.5) and specificity score of 96.6 percent (95% CI=94 to 98.3) for treatment planning compared to a diagnosis having sensitivity and specificity scores of 74 percent (95% CI=59.7 to 85.4) and 89.8 percent (95% CI=86 to 92.9), respectively. Lower agreement scores between the resident and the pediatric dentist were found for the diagnosis of asymptomatic irreversible pulpitis and the use of lesion sterilization and tissue repair as a treatment modality.

Conclusions

The AAPD best practice recommendations showed a better consistency for treatment planning than the diagnosis of carious primary molars.