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.