A Comparison of Clinical and Radiographic Caries Diagnoses in Posterior Teeth of 12–Year–Old Lithuanian Children

Abstract

Bite–wing radiography has been recommended for use in adolescents as clinical examinations alone may lead to underestimation of carious lesions in approximal and occlusal surfaces. The aim of this study was to describe the relationship between clinical and radiographic caries diagnoses among 12–year–old Lithuanians using a new clinical scoring system which differentiates between cavitated and non–cavitated caries lesions. Eight hundred and seventy–two children were examined clinically and two standardized posterior bite–wing radiographs were taken of each participant. Bite–wing radiography contributed significantly to the total number of lesions diagnosed only at the dentin level in approximal surfaces. Clinical examination performed better than radiographic examination at the non–cavitated/enamel level, particularly on occlusal surfaces. Less than 2% of the clinically sound surfaces were diagnosed with dentin lesions/fillings radiographically. When using the cavitated level of clinical diagnosis, the frequency of ‘hidden’ caries lesions increased from 1.9 to 2.9% in approximal surfaces, and from 1.7 to 5.2% in occlusal surfaces. The intra–examiner reliability data for the clinical and radiographic recordings supported the conclusion of an additional diagnostic value of bite–wings only for approximal surfaces. The findings demonstrate that the diagnostic yield of bite–wing radiography is higher for approximal than for occlusal surfaces. The efficacy of bite–wings depends on the refinement of the clinical caries diagnostic criteria. ‘Hidden’ caries does not seem to be a major problem when the clinical caries diagnostic criteria include non–cavitated diagnoses.

Diagnostic Outcome of Methods Frequently Used for Caries Validation

“…This finding is in accordance, not only with the present results for approximal surfaces, but also with results from a recent in vivo study where many surfaces showing clinical signs of caries were not detected by radiography [Machiulskiene et al, 1999]. At threshold 2 significantly fewer lesions were detected with CL than with RA.…”

“…Furthermore, it may also be difficult from visual inspection to decide how deep a lesion is. If the presence of a cavitation is set to be the diagnostic threshold for disease, many lesions (which will be defined as caries by other validation methods) may go undetected [Svenson and Petersson, 1989;Møystad et al, 1995;Hintze et al, 1998;Machiulskiene et al, 1999].…”

Digital transillumination in caries detection versus radiographic and clinical methods: an in-vivo study

“…However, radiographs are unable to identify the initial demineralization of the tooth, resulting in low sensitivity, with decalcification ranging from 40% to 60%, necessary to produce a radiographic image of caries, and this might result in false-negative tests. [21][22][23] Conversely, the use of digital transillumination might lead to overdetection, as the device has a lower specificity compared with radiographs; besides, this method has been shown to be more sensitive than radiographs in detecting early changes in the enamel. 12,13,20,24 These findings were confirmed in the present study; more approximal lesions in the enamel were detected using the birpublications.org/dmfrtransillumination device compared with those identified by the radiographic evaluation.…”

Clinical detection of caries in the primary dentition with and without bitewing radiography

“…On the other hand, other authors have reported that the use of bitewing radiography did not result in a significant increase in permanent dentition caries experience rates in subjects under the age 12 years. [19][20][21] As the majority of permanent teeth in children under 12 years have been erupted for relatively short periods of time and their proximal caries experience was low, inclusion of bitewing radiography for epidemiological purposes for this age group of children would yield only a minimal increase in caries rates over the visual examination. 9,10,22 Previous studies suggest that bitewing radiography has the greatest value in detecting caries in subjects with the highest susceptibility to caries.…”