Impact of including or excluding cavitated lesions when evaluating methods for the diagnosis of occlusal caries

The aim of this study was to assess different methods for the diagnosis of fissure caries when employed on 37 extracted teeth with cavitated occlusal surfaces. A further aim was to compare these results with a previous assessment of the same diagnostic methods on 63 non-cavitated teeth [Lussi, 1993]. The examinations were performed under standard conditions in a professional dental unit. The methods employed were: visual inspection (VI, 26 dentists), VI with magnification (VIM, x2, 26 dentists), bite-wing radiography (BW, 24 dentists), VI combined with BW (VI + BW, 10 dentists) and VI combined with light-pressure probing (VI + P, 23 dentists). For information about the reproducibility, the VI and the VI + BW were repeated. After the last inspection, the teeth were histologically prepared, serially sectioned perpendicular to the occlusal surface and diagnosed for the presence of caries. The agreement between histological and clinical diagnosis was assessed. Sensitivities were VI = 62%, VIM = 75%, BW = 79%, VI + BW = 90%, and VI + P = 82%. The sensitivities found by the same dentists diagnosing non-cavitated teeth were VI = 12%, VIM = 20%, BW = 45%, VI + BW = 49%, VI + P = 14%. The differences between these sensitivities have a direct impact on the DMFS reported for fissure caries. It was concluded that the significant influence of the surface status (cavitated/non-cavitated) should be taken into account when comparing different methods for the diagnosis of occlusal caries.