Automated Classification of Enamel Caries from Intraoral Images Using Deep Learning Models: A Diagnostic Study

Background: Dental caries is a prevalent global oral health issue. The early detection of enamel caries, the initial stage of decay, is critical to preventive dentistry but is often limited by the subjectivity and variability of conventional diagnostic methods. Objective: This study aims to develop and evaluate two explainable deep learning models for the automated classification of enamel caries from intraoral images. Dataset and Methodology: A publicly available dataset of 2000 intraoral images showing early-stage enamel caries, advanced enamel caries, no-caries was used. The dataset was split into training, validation, and test sets in a 70:15:15 ratio, and data preprocessing and augmentation were applied to the training set to balance the dataset and prevent model overfitting. Two models were developed, ExplainableDentalNet, a custom lightweight CNN, and Interpretable ResNet50-SE, a fine-tuned ResNet50 model with Squeeze-and-Excitation blocks, and both were integrated with Gradient-Weighted Class Activation Mapping (Grad-CAM) for visual interpretability. Results: As evaluated on the test set, ExplainableDentalNet achieved an overall accuracy of 96.66% and a Matthews Correlation Coefficient [MCC] = 0.95, while Interpretable ResNet50-SE achieved 98.30% accuracy (MCC = 0.975). McNemar's test indicated no significant prediction bias, with p > 0.05, and internal bootstrap and cross-validation analyses indicated stable performance. Conclusions: The proposed explainable models demonstrated high diagnostic accuracy in enamel caries classification on the studied dataset. While the present findings are promising, future clinical applications will require external validation on multi-center datasets.