Assessment of the accuracy of visual examination, bite-wing radiographs and DIAGNOdent r on the diagnosis of occlusal caries

Aim: This was to evaluate the accuracy of the different methods for diagnosing occlusal caries in vivo, and to compare their performance in primary and permanent teeth. Study Design: Permanent teeth (199) and primary molars (65) with macroscopically intact occlusal surface, with caries lesions without cavitation (white spot) or with a darkened sulcus were selected. The teeth were examined by the following methods: visual inspection, bite-wing radiographs and DIAGNOdent((R)). The validation method employed for asserting the existence of carious lesion was cavity preparation. Results: When the total sample was taken into consideration, laser (DIAGNOdent((R))) provided the highest accuracy (74.8%) Even when the total sample was stratified, the laser accuracy was still high for both primary (88.4%) and permanent molars (70.4%). Visual inspection also provided a high accuracy for primary teeth (83.9%). The chi-square test showed a statistically significant difference between permanent and primary teeth considering occlusal caries diagnosis (p=0.0001). The Kappa coefficient showed good inter-examiner reproducibility for all methods. McNemar test revealed that the degree of intra-examiner agreement for visual inspection was lower than for the other methods. Conclusions: As visual inspection also showed a high degree of accuracy, the laser method should be used as a complementary method in doubtful cases. Diagnostic methods of occlusal caries, in general, are more efficient in primary than in permanent teeth.