title: The sensitivity and specificity of clinical assessment compared with bitewing radiography for detection of occlusal dentin caries.
abstract: OBJECTIVE
  This prospective, cross-sectional study examined the sensitivity and specificity of clinical assessment compared to bitewing radiographs in the detection of occlusal dentin caries in permanent molars.
  
  
  METHODS
  Subjects were 481 children aged 5-12 years from a school-based dental clinic. Occlusal surfaces of 1929, sealed and unsealed first and second permanent molars were examined clinically and scored using specific criteria. Teeth with any type of restorations or proximal caries, including preventive resin restorations, were excluded from the study. Bitewing radiographs were exposed within 4 weeks of clinical examination and were assessed for dentin radiolucencies beneath the occlusal surface. The results of the clinical examinations were correlated with those of bitewing radiographs. Information provided by the parents on history forms, including systemic fluoride exposure, was also noted.
  
  
  RESULTS
  Of the 1833 teeth scored as clinically sound in the study, only 72 (4%) demonstrated a dentin radiolucency on bitewings, and 1761 (96%) were scored as sound. The sensitivity of the clinical examination was determined to be 0.96. In the teeth clinically scored as showing dentin caries, only 56/96 (58%) were found to have dentin radiolucencies on the radiographs. The specificity of the technique was determined to be 0.58. A positive history of a medical condition, or fluoride exposure, in the forms of toothpaste use, or water fluoridation did not affect the examination results.
  
  
  CONCLUSIONS
  Clinical examination of cleaned and dried, sealed, and unsealed teeth has a sensitivity of 0.96 and a specificity of 0.58 in the detection of dentin radiolucencies in bitewing radiographs. Dentin radiolucencies beneath clinically sound occlusal surfaces are not significantly associated with gender, medical conditions or fluoride.
authors.affiliation: University of Queensland School of Dentistry, Australia.
authors.forename: M S
authors.initials: MS
authors.lastname: Fracaro
authors.forename: W K
authors.initials: WK
authors.lastname: Seow
authors.forename: L H
authors.initials: LH
authors.lastname: McAllan
authors.forename: D M
authors.initials: DM
authors.lastname: Purdie
mesh_terms: D002327:Cariostatic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005457:Fluoridation; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D010808:Physical Examination; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D011446:Prospective Studies; D016300:Radiography, Bitewing / Q000592:standards; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013223:Statistics as Topic; D014100:Toothpastes / Q000627:therapeutic use
chemical_list: D002327:Cariostatic Agents; D010895:Pit and Fissure Sealants; D014100:Toothpastes; D005459:Fluorides