Validation of different diagnostic aids in detection of occlusal caries in primary molars: An in vitro study

To estimate the accuracy and assess the sensitivity and specificity of direct visual examination (DVE), computerized radiograph (VISTA SCAN mini), and DIAGNOdent (DD) for caries diagnosis in primary molars as compared to histological examination of the teeth.

An in vitro comparative study was carried out on 40 freshly extracted primary molars with questionable pit and fissures that yielded 89 examination sites. These samples were mounted on plaster and were subjected to examination methods for caries detection on the occlusal surface by two trained and calibrated examiners. The examination methods used in this study were DVE, computerized radiographic (CR) examination, laser fluorescence examination using DD followed by histological examination which is a gold standard; later, these samples were examined under microscope for caries extent. The scoring criteria given by Nytun et al. were used in this study for scoring the extent of caries.

The sensitivity for caries in enamel were 66.10%, 52.86%, and 54.17% for DVE, CR, and DD, respectively, while the specificity for DVE, CR, and DD were found to be 86.67%, 68.42%, and 76.47%, respectively. For dentinal caries, sensitivity for DVE, CR, and DD were 86.67%, 92.86%, and 81.25%, respectively, while the specificity were 66.10%, 56%, and 54.79%, respectively. The accuracy were 73.03%, 61.80%, and 59.55%, respectively, suggesting that the DVE showed highest sensitivity, specificity, and accuracy for enamel caries, whereas for dentinal caries, CR showed highest sensitivity and DVE showed highest specificity and accuracy.

The DD exhibited better specificity than sensitivity for enamel lesions and better sensitivity than specificity for lesions into dentin. DD may prove useful as a predictive clinical tool and should only be used in addition to other diagnostic methods such as visual inspection and dental radiographs to avoid false-positive diagnoses.