Can we trust visual methods alone for detecting caries in teeth?

Area of Science:

• Dentistry
• Diagnostic Accuracy
• Caries Detection

Background:

• Accurate detection of coronal caries lesions is crucial for timely dental treatment.
• Visual inspection is a common method for caries detection, but its diagnostic performance varies.
• Systematic reviews are needed to synthesize evidence on the accuracy of visual caries detection.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of visual inspection for detecting primary coronal caries lesions.
• To assess factors influencing the accuracy of visual caries detection, including setting, tooth type, and lesion location.
• To identify the impact of using validated visual scoring systems on detection accuracy.

Main Methods:

• A systematic review and meta-analysis of studies using visual inspection for caries detection was conducted.
• Databases searched included PubMed, Embase, and Scopus, with a focus on studies published between 2003-2014.
• Studies were included if they reported true positives, false positives, true negatives, and false negatives, with histologic evaluation, operative intervention, or radiography as reference standards.

Main Results:

• The meta-analysis included 102 manuscripts, demonstrating good overall accuracy for visual caries detection.
• Pooled specificity was generally high (>0.90), particularly in clinical settings, while pooled sensitivity varied (0.274–0.77).
• Studies using well-established visual scoring systems showed significantly higher accuracy than those using self-developed criteria.

Conclusions:

• Visual inspection is a reliable method for detecting coronal caries lesions, with good overall performance.
• High heterogeneity and risk of bias were noted across the included studies.
• The use of detailed, validated visual indices appears to enhance the accuracy of caries detection.