Lasers in Medical Science

, Volume 28, Issue 1, pp 287–295 | Cite as

Traditional and novel methods for occlusal caries detection: performance on primary teeth

  • J. F. SouzaEmail author
  • T. Boldieri
  • M. B. Diniz
  • J. A. Rodrigues
  • A. Lussi
  • R. C. L. Cordeiro
Original Article


This study aimed to assess the performance of International Caries Detection and Assessment System (ICDAS), radiographic examination, and fluorescence-based methods for detecting occlusal caries in primary teeth. One occlusal site on each of 79 primary molars was assessed twice by two examiners using ICDAS, bitewing radiography (BW), DIAGNOdent 2095 (LF), DIAGNOdent 2190 (LFpen), and VistaProof fluorescence camera (FC). The teeth were histologically prepared and assessed for caries extent. Optimal cutoff limits were calculated for LF, LFpen, and FC. At the D 1 threshold (enamel and dentin lesions), ICDAS and FC presented higher sensitivity values (0.75 and 0.73, respectively), while BW showed higher specificity (1.00). At the D 2 threshold (inner enamel and dentin lesions), ICDAS presented higher sensitivity (0.83) and statistically significantly lower specificity (0.70). At the D3 threshold (dentin lesions), LFpen and FC showed higher sensitivity (1.00 and 0.91, respectively), while higher specificity was presented by FC (0.95), ICDAS (0.94), BW (0.94), and LF (0.92). The area under the receiver operating characteristic (ROC) curve (Az) varied from 0.780 (BW) to 0.941 (LF). Spearman correlation coefficients with histology were 0.72 (ICDAS), 0.64 (BW), 0.71 (LF), 0.65 (LFpen), and 0.74 (FC). Inter- and intraexaminer intraclass correlation values varied from 0.772 to 0.963 and unweighted kappa values ranged from 0.462 to 0.750. In conclusion, ICDAS and FC exhibited better accuracy in detecting enamel and dentin caries lesions, whereas ICDAS, LF, LFpen, and FC were more appropriate for detecting dentin lesions on occlusal surfaces in primary teeth, with no statistically significant difference among them. All methods presented good to excellent reproducibility.


Occlusal caries Caries detection Visual examination Radiography Fluorescence Primary teeth 



The authors wish to thank Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), process number 2009/00218-0 for their financial support. This study was submitted to the School of Dentistry of Araraquara (Univ. Estadual Paulista—UNESP, Brazil) as a requirement for a master’s degree in pediatric dentistry for Souza JF.

Declaration of interests

The undersigned authors declare that they have no proprietary, financial, professional or other personal interest of kind in any product, service and/or company that might introduce bias or affect their judgment or that could be construed as influencing the position presented herein or the review of the manuscript entitled “Traditional and novel methods for occlusal caries detection: performance on primary teeth.”


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Copyright information

© Springer-Verlag London Ltd 2012

Authors and Affiliations

  • J. F. Souza
    • 1
    • 5
    Email author
  • T. Boldieri
    • 1
  • M. B. Diniz
    • 2
  • J. A. Rodrigues
    • 3
  • A. Lussi
    • 4
  • R. C. L. Cordeiro
    • 1
  1. 1.Department of Pediatric Dentistry, Araraquara School of DentistryUniv. Estadual Paulista (UNESP)AraraquaraBrazil
  2. 2.Department of Pediatric Dentistry, School of DentistryCruzeiro do Sul University (UNICSUL)São PauloBrazil
  3. 3.Department of Pediatric Dentistry, School of DentistryFederal University of Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  4. 4.Department of Preventive, Restorative and Pediatric Dentistry, School of Dental MedicineUniversity of BernBernSwitzerland
  5. 5.Faculdade de Odontologia de Araraquara, Departamento de Clínica InfantilAraraquaraBrazil

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