Clinically undetected dental caries assessed by bitewing screening in children with little caries experience

Following the decline in caries prevalence, it has been questioned whether it is still justifiable to continue the practice of radiographic bitewing screening. This study was undertaken to compare the value of a clinical examination with screening bitewing radiograph in children who had little previous caries experience. One hundred and sixty-eight 14-year-old children participated in the investigation. The children were examined clinically by one of three pedodontists for the presence of 'sound', 'suspect caries', and 'carious' occlusal and approximal tooth surfaces. Bitewing screening radiographs were obtained of all the children prior to the clinical examination. The radiographs were assessed for the presence and extent of occlusal and approximal caries. Radiography detected more than 94% of the total number of reported (clinically and radiographically) caries lesions. 1.2% of the occlusal and 10.2% of the approximal surfaces clinically designated sound were scored as carious by radiography. Of these clinically undetected lesions, 15% were assessed to have penetrated into dentine on the radiographs. Although the number of false-positive radiographic scores could not be ascertained in this study, it is likely that, as the caries prevalence was low, the probability of a false-positive diagnosis would be high. It was therefore concluded that there was no convincing evidence that 14-year-old children with little previous caries experience benefit from a screening bitewing examination.