Accuracy of smartphone photographs for detecting active carious lesions in orthodontic patients

Advancements in digital media have driven the study and use of photographic records as a diagnostic method for carious lesions, with smartphone images being widely utilized across various health fields. This study aimed to evaluate the diagnostic accuracy of smartphone photography for detecting active caries in orthodontic patients. The sample comprised 100 individuals of both sexes, aged 11 to 46 years, who were undergoing fixed orthodontic treatment. Following professional tooth cleaning and drying, patients underwent a visual-tactile clinical examination for caries detection, which served as the gold standard. Digital photographs were then taken using a smartphone camera in five views: frontal, right and left lateral, and upper and lower occlusal. The diagnostic parameters-sensitivity, specificity, accuracy, positive predictive value (PV+), and negative predictive value (PV-)-were calculated for the photographic method relative to the clinical examination. The prevalence of active caries in the sample was 74%. The smartphone photographs correctly identified 66 of the 74 individuals with active caries according to the gold standard. However, only 4 of the 26 sound patients were correctly identified. These findings correspond to the following diagnostic parameters: sensitivity, 89%; specificity, 15%; accuracy, 70%; PV+, 75%; and PV-, 33%. In conclusion, the photographic method demonstrated high sensitivity and satisfactory accuracy in detecting caries in patients undergoing fixed orthodontic therapy. However, the low specificity observed suggests a tendency to overdiagnose sound teeth.