A critical review of the validity and reliability of caries detection methods for non-cavitated lesions

Dental caries is the most prevalent chronic disease that affects people of all ages. Early detection of dental caries is crucial to prevent irreversible dental tissue damage, infection, and tooth loss, yet traditional detection methods face challenges in reliably identifying non-cavitated lesions. The review aims to determine the validity and reliability of epidemiological and clinical diagnostic methods used to detect non-cavitated caries.

Twenty in-vivo studies from 1997 to 2025 were analyzed, focusing on clinical visual examination, radiographs, tactile examination, and fiber-optic transillumination (FOTI), along with new adjunctive technologies, such as LumiCare, CALCIVIS, and BlueCheck. Diagnostic validity among the studies was assessed using reference standards, including histological validation, operative intervention involving fissure opening, and, in some studies, clinical visual examination.

Of the 20 included studies, 18 evaluated conventional diagnostic methods, with only two assessing tactile examination, and one evaluating FOTI. Only one study evaluated newer adjunctive technologies, including LumiCare and CALCIVIS. Visual examination with International Caries Detection and Assessment System (ICDAS) showed high sensitivity for enamel caries (up to 98%), while radiographs demonstrated greater specificity, particularly for dentinal lesions. Approximal detection with either visual or radiograph examinations showed variable sensitivity but consistently high specificity. Visual methods demonstrated moderate-to-high reliability (≥ 0.85), whereas radiographic reliability varied widely (0.08-1.00). Evidence for FOTI and tactile examination was limited, and the validity of FOTI remains underexplored. Despite limited available evidence, LumiCare and CALCIVIS reported high sensitivity (91%-92%) and specificity (98%-100%) for early caries detection.

Overall, detailed visual examination demonstrated higher sensitivity, while radiographs offer greater specificity, highlighting the need for combined diagnostic approaches based on lesion type and location. Evidence for LumiCare and CALCIVIS is limited, with a need for further clinical validation.