Diagnostic caries dentis

Diagnostic Methods
The EPC team evaluated the strength of the evidence describing the performance of diagnostic methods separately for cavitated lesions, lesions involving dentin, enamel lesions, and any lesions. They also separated the evaluations by the surface and tooth type involved. The team found 39 studies reporting 126 histologically validated assessments of diagnostic methods.

* There are few assessments of the performance of any diagnostic methods for primary or anterior teeth, and no assessments of performance on root surfaces. The strength of the evidence describing the performance of any diagnostic method for these teeth and surfaces is poor.
* Among studies assessing diagnostic performance for proximal and occlusal surfaces in posterior teeth, the team rated the strength of the evidence describing the performance of visual/tactile, fiberoptic transillumination (FOTI), and laser fluorescence methods as poor due to the small numbers of studies available.
* They also rated the strength of the evidence for radiographic, visual, and electrical conductance (EC) methods as poor for all types of lesions on posterior proximal and occlusal surfaces. However, these ratings were due less to inadequate numbers of assessments than to variation among reported results. In one instance, the quality of the available studies was the principal reason for the rating.
* For all but EC assessments, specificity of a diagnostic method was generally higher than sensitivity. Thus, false negative diagnoses are proportionally more apt to occur in the presence of disease than are false positive diagnoses in the absence of disease.
* The evidence did not support the superiority of either visual or visual/tactile methods. The number of available assessments was small and there was substantial variation among reports for each method.
* The evidence suggests, but is not conclusive, that some digital radiographic methods offer small gains in sensitivity compared to conventional film radiography on both proximal and occlusal surfaces.
* The evidence also suggests, but is not conclusive, that EC methods may offer heightened sensitivity on occlusal surfaces, but at the expense of specificity.
* The diagnostic performance literature is limited in terms of numbers of available assessments for most diagnostic techniques overall, and especially for primary teeth, anterior teeth and root surfaces, and for visual/tactile and FOTI methods. The literature is further limited by threats to both internal and external validity represented by incomplete descriptions of selection and diagnostic criteria and examiner reliability, the use of small numbers of examiners, nonrepresentative teeth, samples with high lesion prevalence, and a variety of reference standards of unknown reliability.

Management of Noncavitated Carious Lesions