Radiographic and laser fluorescence methods have no benefits for detecting caries in primary teeth.
Clinical guidelines advise that dentists take radiographs in children to detect caries lesions missed by visual inspection; however, due to the current low caries prevalence in most countries, we hypothesized that the adjunct methods of caries detection would not significantly improve the detection of primary molar lesions in comparison to visual inspection alone. We evaluated the performance of visual inspection, alone or in combination with radiographic and laser fluorescence pen (LFpen) methods, in detecting occlusal and approximal caries lesions in primary molars. Two examiners evaluated children who had sought dental treatment with these diagnostic strategies. The reference standard involved the temporary separation of approximal and operative interventions for occlusal surfaces. The sensitivity, specificity, accuracy and utility of diagnostic strategies were calculated. Simultaneous combined strategies increased sensitivities but decreased specificities. Furthermore, no differences were observed in accuracy and utility, parameters more influenced by caries prevalence. In conclusion, adjunct radiographic and laser fluorescence methods offer no benefits to the detection of caries in primary teeth in comparison to visual inspection alone; hence, present clinical guidelines should be re-evaluated.
Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil. fmmendes@usp.br
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Mendes
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Matos
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Bittar
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Piovesan
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Gimenez
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Braga
D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003743:Dental Enamel / Q000473:pathology; D003804:Dentin / Q000473:pathology; D005260:Female; D005453:Fluorescence; D006801:Humans; D007834:Lasers; D008297:Male; D008963:Molar / Q000473:pathology; D055361:Multilevel Analysis; D017410:Practice Guidelines as Topic; D016300:Radiography, Bitewing / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D014094:Tooth, Deciduous / Q000473:pathology*