D3G SPECIALISTS GUIDE FOR GRADING MOLAR HYPOMIN

Specialist Stuff

Again building on the Basic Guidelines, here we aim to define the key "shades-of-grey" questions, as may be asked by experienced GPs and paediatric dental specialists, and as could be used in experimental design by researchers. As a starting point, please consider existing guidelines (summaries below) before proceeding to rethink the issues through in a research-friendly way.

Existing Grading Guidelines from around the world

D3G Australia

USA

Europe

FAQS

A. Grading at case level

Q A1: What defines a severe case?

Subquestions:

  • is at least one severely-affected molar the best criterion for a severe case?
  • is there a better single measure?
  • would additional criteria be helpful, or better to keep it simple?

Additional key literature:

  • ??

Research needs:

  • what is the tipping point for Molar Hypomin becoming a severe problem?
  • on what primary basis should this be measured – caries risk, tooth loss, cost...?

Q A2: What distinguishes a moderate from a mild case?

Subquestions:

  • is at least one moderately-affected first molar the best criterion for a moderate case?
  • is significant pain a valid reason to upgrade from mild to moderate?
  • would additional criteria be helpful or best to keep it simple?

Additional key literature:

  • ??

Research needs:

  • is painfulness a key prognostic indicator? – does it amplify caries risk (mild cases particularly)?
  • how well does the extent of pain correlate with other prognostic factors?

B. Grading at tooth level

Q B1: What defines a severely-affected tooth?

Subquestions:

  • is loss of surface integrity the best criterion for a severely-affected tooth?
  • how subjective is current assessment of this criterion?
  • is there are better single criterion?
  • are additional criteria (e.g. lesion colour, topography) helpful, or better to keep simple?

Additional key literature:

Research needs:

  • is surface breakdown a decisive "point of no return" for treatment planning?
  • how well does lesion colour correlate with clinical prognosis?
  • does lesion topography (size, position on tooth) correlate well with clinical prognosis?
  • can we develop more-objective measures for "visible pitting"?

Q B2: What distinguishes moderately from mildly affected teeth?

Subquestions:

  • is loss of shiny surface the best discriminator from a mildly-affected tooth?
  • are additional criteria such as lesion colour helpful, or better to keep simple?

Additional key literature:

  • ??

Research needs:

  • can moderate lesions be maintained for the long term without restoration?
  • better still, can moderate lesions be "reversed" back to mild grade or disappearance?

C. Advanced reporting

Q C1: What additional information should specialists report about typical cases?

  • involvement of both the primary and secondary dentitions?
  • obvious aetiological associations and dissociations? – cf. contender causal factors

Q C2: How should specialists report atypical Hypomin cases?

 

Current D3G Research

Clinical research

Pressing needs exist to understand the clinical parameters of Molar Hypomin more fully. An ongoing study, supported by the EviDent dental practice based research network, involves testing of Louise Messer's Hypomin Severity Index by multiple D3G practitioners at various clinical settings in Melbourne. Read more about their trial of the Molar Hypomin Severity Index.

Basic and applied science

Just as with diagnosis, strong potential exists to supplement clinical grading parameters with better diagnostic tests based on distinctive biophysical or biomolecular properties. Ultimately, improved grading may help provide better treatment solutions on the lifelong term.

Current projects at D3G

Grading-related areas being researched by D3G teams include:

  • severity index for grading Molar Hypomin (article) – Messer/Manton/D3G team
  • biophysical parameters vs lesion colour (article) – Drummond/Swain team
  • protein profiles vs lesion colour (article) – Drummond group
  • protein profiles vs surface integrity, molecular diagnostics (article) – Hubbard/D3G team