title: The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation.
abstract: BACKGROUND
  The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample.
  
  
  METHODS
  One trained examiner assessed 105 occlusal surfaces by using the LF device, LF pen, FC, International Caries Detection and Assessment System (ICDAS) criteria and bitewing (BW) radiographic methods. After tooth extraction, the authors assessed the teeth histologically. They determined the optimal clinical cutoffs by means of receiver operating characteristic curve analysis.
  
  
  RESULTS
  The specificities and sensitivities for enamel and dentin caries detection versus only dentin caries detection thresholds were 0.60 and 0.93 and 0.77 and 0.52 (ICDAS), 1.00 and 0.29 and 0.97 and 0.44 (BW radiography), 1.00 and 0.85 and 0.77 and 0.81 (LF device), 0.80 and 0.89 and 0.71 and 0.85 (LF pen) and 0.80 and 0.74 and 0.49 and 0.85 (FC), respectively. The accuracy values were higher for ICDAS, the LF device and the LF pen than they were for BW radiography and the FC.
  
  
  CONCLUSIONS
  The clinical cutoffs for sound teeth, enamel carious lesions and dentin carious lesions were, respectively, 0 through 4, 5 through 27 and 28 through 99 (LF device); 0 through 4, 5 through 32 and 33 through 99 (LF pen); and 0 through 1.2, 1.3 and 1.4 through 5.0 (FC). The ICDAS, the LF device and the LF pen demonstrated good performance in helping detect occlusal caries in vivo. The ICDAS did not seem to perform as well at the D(3) threshold (histologic scores 3 and 4) as at the D(1) threshold (histologic scores 1-4). BW radiography and the FC had the lowest performances in helping detect lesions at the D(1) and D(3) thresholds, respectively.
  
  
  CONCLUSIONS
  Occlusal caries detection should be based primarily on visual inspection. Fluorescence-based methods may be used to provide a second opinion in clinical practice.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, UNICSUL-Cruzeiro do Sul University, São Paulo, Brazil. mibdiniz@hotmail.com
authors.forename: Michele B
authors.initials: MB
authors.lastname: Diniz
authors.forename: Thalita
authors.initials: T
authors.lastname: Boldieri
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Rodrigues
authors.forename: Lourdes
authors.initials: L
authors.lastname: Santos-Pinto
authors.forename: Adrian
authors.initials: A
authors.lastname: Lussi
authors.forename: Rita C L
authors.initials: RC
authors.lastname: Cordeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D001641:Bicuspid / Q000000981:diagnostic imaging / Q000473:pathology; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000473:pathology; D003750:Dental Fissures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology; D005453:Fluorescence; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007834:Lasers; D016013:Likelihood Functions; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology; D055100:Optical Fibers; D023861:Photography, Dental / Q000295:instrumentation; D010808:Physical Examination; D012372:ROC Curve; D016300:Radiography, Bitewing / Q000379:methods; D012680:Sensitivity and Specificity; D012984:Software; D019228:Tooth Crown / Q000000981:diagnostic imaging / Q000473:pathology; D014075:Tooth Discoloration / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult