title: Implications of caries diagnostic strategies for clinical management decisions.
abstract: OBJECTIVE
  In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions in a low-caries population.
  
  
  METHODS
  Each of four examiners independently examined preselected contacting interproximal surfaces in 53 dental students aged 20-37 years using a visual-tactile examination and bitewing radiography. The visual-tactile examination distinguished between noncavitated and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1-specificity) were calculated for each diagnostic strategy.
  
  
  RESULTS
  Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold for assuming cavitation had a true-positive rate of 76.3% and a false-positive rate of 8.2%. When diagnostic observations were translated into clinical management decisions using the rule that a noncavitated lesion should be treated nonoperatively and a cavitated lesion operatively, our results showed that the visual-tactile method alone was the superior strategy, resulting in most correct clinical management decisions and most correct decisions regarding the choice of treatment.
authors: School of Dentistry and Institute of Public Health, Aarhus University Faculty of Health Sciences, Aarhus, Denmark. baelum@soci.au.dk
authors: Vibeke
authors: V
authors: Baelum
authors: Hanne
authors: H
authors: Hintze
authors: Ann
authors: A
authors: Wenzel
authors: Bo
authors: B
authors: Danielsen
authors: Bente
authors: B
authors: Nyvad
mesh_terms: D000328:Adult; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D003804:Dentin / Q000473:pathology; D006801:Humans; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014070:Tooth / Q000473:pathology; D055815:Young Adult