APLICAÇÃO DO INTERNATIONAL CARIES DETECTION AND ASSESSMENT SYSTEM (ICDAS) E INTERNATIONAL CARIES CLASSIFICATION AND MANAGEMENT SYSTEM (ICCMS): EFEITOS SOBRE A PRÁTICA PROFISSIONAL EM AUDITORIA E ASSISTÊNCIA ODONTOLÓGICA

• DOI: 10.22533/at.ed.6102321091

• Palavras-chave: Auditoria odontológica. Administração dos serviços de saúde. Cárie dentária. Diagnóstico. Controle.

• Keywords: Dental audit. Health services administration. Dental caries. Diagnosis. Control.

• Abstract: Lack of clinical protocol into dental health services management systems facilitates divergence happening. This study investigated the applicability of the protocol ICCMSTM - International Caries Classification and Management System and its effectiveness in reducing the chances of occurrence of divergence events between audit and accredited network of dentists. Initially we conducted a systematic review to identify the potential benefits and the current state of the art of its use in management systems in oral health. Search was carried out on the databases: Cochrane Central Register of Controlled Trials; Database of Abstracts of Reviews of Effects; Cochrane Database of Systematic Reviews; Health Technology Assessment Database; NHS Economic Evaluation Database; MEDLINE, LILACS, PubMed, Scielo, Bireme, Scopus and Web of Science, from 13 July to 11 August 2015. Twelve studies were selected by agreement to eligibility criteria. The results revealed that the ICCMSTM has high potential of contribution due it has easiness and quickness of use, good reproducibility and accuracy, and its training can be done through photographs. It was found no study about its effectiveness in dental health management systems. After then, a randomized clinical trial was conducted to analyze its effectiveness in reducing the chance of divergence occurrence in a dental health management system, which was carried out in 3 phases: Phase 1 (baseline) - corresponding data collection previous 4 months; Phase 2 - training and calibration of auditors and data collection in the next 4 months; Phase 3 - random selection of 20 dentists among those who performed restorative treatment due to dental caries in the 4 months prior to the study, which has drawn up 10 to receive training and calibration (intervention group) and 10 did not received training (control group), followed by data collection concerning the following four months. We conducted bivariate association analysis with Chi-square test between the dichotomous dependent variable "Divergence" (1 = yes, 0 = no) and the independent variables: phase (baseline=phase 1, phase 2 and phase 3); group (auditor, intervention and control), tooth face (buccal, lingual/palatal, occlusal and proximal); specialist (1 = yes, 0 = no). The variables with p value <0.2 were enabled to be inserted in the initial model of multiple logistic regression, remaining in the model only variables with p value <0.05 (CI: 95%). The chance of the divergence occurrence decreased similarly after training and calibration of auditors and dentists, 47% and 52%, respectively. Dentists who have been trained presented chance of divergence occurrence of 33% less than the control group. The application of ICCMSTM protocol into the oral health management systems was effective in reducing the occurrence of divergence. Combined with Computerized Clinical Decision Support Systems can maximize its benefits, but this has not been done currently.