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

Eileen R Hoskin1, Analia Veitz Keenan2

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Visual inspection effectively detects dental caries, especially in clinical settings. Using validated scoring systems improves accuracy, despite study heterogeneity and potential bias in caries detection research.

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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.