Precision of clinical diagnosis of fissure caries by different methods

Abstract

AIM: To describe the precision of diagnosis of fissure caries into dentine by clinical examination, taking bitewing radiograph, and using a qualitative laser-induced fluorescence detection device. MATERIALS AND METHODS: Subjects were recruited from university students who had signs of early caries in the fissures of their molars found in an oral health screening programme. Two calibrated dentists performed a visual and then tactile examination by using portable fiber-optic light, dental mirrors and sharp explorers. Bitewing radiographs were taken and scanned into a computer. The images were viewed for signs of dental caries. Status of the fissures in the molars were assessed using a laser-induced fluorescence detection device (DIAGNOdent, KaVo). Biopsy was performed during the restorative treatment of the clinically diagnosed carious fissures and this was used as the reference standard. The sensitivity and specificity of different diagnostic methods, as well as the optimal cut-off point for DIAGNOdent reading were calculated. RESULTS: This study involved 145 first and second permanent molars in 41 subjects. The sensitivity & specificity of using visual examination, tactile probing, DIAGNOdent reading (>35) and bitewing radiograph to diagnose fissure caries into dentine were 16 & 100, 89 & 44, 75 & 75 and 2 & 100, respectively. The diagnosis by a combination of tactile probing and DIAGNOdent reading had a sensitivity & specificity of 71 &90. CONCLUSION: Tactile probing had a high sensitivity but a low specificity for detecting fissure caries into dentine while visual examination and bitewing radiograph had the reverse. Caries diagnosis based on the combined findings from tactile probing and qualitative laser-induced fluorescence detection had a good level for both sensitivity and specificity.