Lightweight Deep Learning for Automated Dental Caries Screening from Pediatric Oral Photographs

Background: Early childhood caries (ECC) affects a substantial proportion of young children worldwide, and timely screening is essential for early intervention and referral. While deep learning has shown promise for automated dental diagnostics, many existing approaches rely on computationally heavy models that limit deployment in community and mobile settings. This study investigates whether compact convolutional neural networks can achieve clinically meaningful performance for screening dental caries from oral photographs. Methods: We curated a dataset of 435 intraoral images from children aged 3-14 years, annotated by licensed dentists, and performed patient-level stratified splitting to prevent data leakage. Three convolutional neural networks (ResNet-18, MobileNetV3-Small, and EfficientNet-B0) were fine-tuned using ImageNet-pretrained weights and comparatively evaluated for the detection of dental caries from oral photographs. Models were trained with class-weighted cross-entropy loss and evaluated on a held-out test set using sensitivity, specificity, balanced accuracy, ROC-AUC, and PR-AUC with bootstrap 95% confidence intervals. Results: ResNet-18 achieved the highest balanced accuracy (0.929), weighted F1-score (0.954), and perfect sensitivity (1.00), while EfficientNet-B0 achieved the strongest threshold-independent discrimination with the highest ROC-AUC (0.978) and PR-AUC (0.990). MobileNetV3-Small maintained competitive performance (ROC-AUC 0.952; PR-AUC 0.976) with substantially lower computational complexity. Conclusions: In addition to performance evaluation, we incorporated an interpretability analysis using Grad-CAM to examine model decision behavior. The resulting attribution maps predominantly highlighted clinically relevant tooth regions associated with caries, providing evidence that the models rely on meaningful dental features rather than background artifacts. These results demonstrate that compact, deployment-friendly architectures can achieve clinically meaningful performance for ECC detection, supporting their suitability for scalable, real-world screening applications.