title: Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity.
abstract: BACKGROUND
  Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits.
  
  
  OBJECTIVE
  We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions.
  
  
  METHODS
  Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND DIAGNOSTIC METHODS: The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods.
  
  
  METHODS
  A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated.
  
  
  RESULTS
  Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias.
  
  
  CONCLUSIONS
  Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo-USP, São Paulo, Brazil.
authors.forename: Thais
authors.initials: T
authors.lastname: Gimenez
authors.forename: Mariana Minatel
authors.initials: MM
authors.lastname: Braga
authors.forename: Daniela Procida
authors.initials: DP
authors.lastname: Raggio
authors.forename: Chris
authors.initials: C
authors.lastname: Deery
authors.forename: David N
authors.initials: DN
authors.lastname: Ricketts
authors.forename: Fausto Medeiros
authors.initials: FM
authors.lastname: Mendes
mesh_terms: D003731:Dental Caries / Q000175:diagnosis*; D005453:Fluorescence; D006801:Humans; D008163:Luminescent Measurements / Q000379:methods; D017594:Publication Bias; D012372:ROC Curve; D015203:Reproducibility of Results