Oral Radiology

, Volume 32, Issue 3, pp 154–159 | Cite as

Effects of education and experience on detection of proximal caries on digital radiographs

  • Nasim Shams
  • Narges Panahandeh
  • Hilda Aghababa
  • Bahar Shams
  • Ershad Hemati
Original Article



Early detection of proximal caries can result in less-invasive treatments. This study aimed to assess the effects of education and experience on accurate detection of proximal caries on digital radiographs.


Third-year and sixth-year dental students, maxillofacial radiology postgraduate students, and general dentists comprised the study population (total, 28). Standard digital bitewing radiographs were obtained for 50 extracted teeth, and evaluated for proximal caries on a monitor. All assessments were performed under ambient light (<50 lux). The teeth were subsequently sectioned into 1-mm-thick slices. After reaching the lesion, it was visually inspected, and then determined for its depth in each slice using a caries detector solution. A four-scale grading system for assessment of lesion depth. These results were considered to be the gold standard, and compared with the opinions of the observers. Data were analyzed using SPSS16 software for kappa, sensitivity, specificity, false-negative, false-positive, negative predictive value, and positive predictive value statistics. The kappa coefficients were used to compare the accuracy of diagnoses of the observers and the extents of involvement of tooth structures.


The diagnostic accuracy for grade I caries was 21.9 % among third-year dental students, 17.4 % among sixth-year dental students, 34.5 % among maxillofacial radiology postgraduate students, and 14.3 % among general dentists. The respective diagnostic accuracies were 16.2, 15.2, 5.7, and 7.6 % for grade II caries and 3.5, 32.1, 25, and 14.2 % for grade III caries.


Although education played a great role in improving caries detection skill, it failed to raise it to an acceptable range.


Caries Radiography Education Academic training 



This study was part of a thesis (#364) for a DDS degree at Jundishapur University School of Dentistry, and the authors would like to thank the vice chancellor for Research and Technology Development of the university for financial support in the form of a grant (No. U-91218).

Compliance with ethical standards

Conflict of interest

Nasim Shams, Narges Panahandeh, Hilda Aghababa, Bahar Shams, and Ershad Hemati declare that they have no conflict of interest.

Ethical statement

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Ferreira MA, Latorre Mdo R, Rodrigues CS, Lima KC. Effect of regular fluoride gel application on incipient carious lesions. Oral Health Prev Dent. 2005;3:141–9.PubMedGoogle Scholar
  2. 2.
    Bonow ML, Azevedo MS, Goettems ML, Rodrigues CR. Efficacy of 1.23 % APF gel applications on incipient carious lesions: a double-blind randomized clinical trial. Br Oral Res. 2013;27:279–85. doi: 10.1590/S1806-83242013000300007.CrossRefGoogle Scholar
  3. 3.
    White SC, Pharoah MJ. Oral radiology principles and interpretation. 6th ed. Philadelphia: Elsevier; 2008. p. 78–99, 270–81.Google Scholar
  4. 4.
    Mileman PA, van den Hout WB. Comparing the accuracy of Dutch dentists and dental students in the radiographic diagnosis of dentinal caries. Dentomaxillofac Radiol. 2002;31:7–14.CrossRefPubMedGoogle Scholar
  5. 5.
    Gordan VV, Riley JL 3rd, De Carvalho RM, Snyder J, Sanderson JL Jr, Anderson M, et al. Methods used by dental practice-based research network dentists to diagnose dental caries. Tex Dent J. 2013;130:321–32.PubMedGoogle Scholar
  6. 6.
    Bengtson AL, Gomes AC, Mendes FM, Cichello LR, Bengtson NG, Pinheiro SL. Influence of examiner’s clinical experience in detecting occlusal caries lesions in primary teeth. Pediatr Dent. 2005;27:238–43.PubMedGoogle Scholar
  7. 7.
    Newman B, Seow WK, Kazoullis S, Ford D, Holcombe T. Clinical detection of caries in the primary dentition with and without bitewing radiography. Aust Dent J. 2009;54:23–30. doi: 10.1111/j.1834-7819.2008.01084.x.CrossRefPubMedGoogle Scholar
  8. 8.
    Heymann HO, Swift EJ Jr, Ritter AV. Sturdevant’s art and science of operative dentistry. 6th ed. Chapel Hill: Mosby; 2013. p. 63–139.Google Scholar
  9. 9.
    Ko AC, Hewko M, Sowa MG, Dong CC, Cleghorn B, Choo-Smith LP. Early dental caries detection using a fibre-optic coupled polarization-resolved Raman spectroscopic system. Opt Express. 2008;16:6274–84.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Karlsson L. Caries detection methods based on changes in optical properties between healthy and carious tissue. Int J Dent. 2010;2010:270729. doi: 10.1155/2010/270729.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Braga MM, Mendes FM, Ekstrand KR. Detection activity assessment and diagnosis of dental caries lesions. Dent Clin N Am. 2010;54:479–93. doi: 10.1016/j.cden.2010.03.006.CrossRefPubMedGoogle Scholar
  12. 12.
    Rando-Meirelles MP, de Sousa Mda L. Using laser fluorescence (DIAGNOdent) in surveys for the detection of noncavitated occlusal dentine caries. Community Dent Health. 2011;28:17–21.PubMedGoogle Scholar
  13. 13.
    Abesi F, Mirshekar A, Moudi E, Seyedmajidi M, Haghanifar S, Haghighat N, et al. Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries. Iran J Radiol. 2012;9:17–21. doi: 10.5812/iranjradiol.6747.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Hellén-Halme K, Petersson GH. Influence of education level and experience on detection of approximal caries in digital dental radiographs. An in vitro study. Swed Dent J. 2010;34:63–9.PubMedGoogle Scholar
  15. 15.
    Hala LA, Mello JBD, Carvalho PLD. Evaluation of the effectiveness of clinical and radiographic analysis for the diagnosis of proximal caries for different clinical experience levels: comparing lesion depth through histological analysis. Br J Oral Sci. 2006;5:1012–7.Google Scholar
  16. 16.
    Minston W, Li G, Wennberg R, Näsström K, Shi XQ. Comparison of diagnostic performance on approximal caries detection among Swedish and Chinese senior dental students using analogue and digital radiographs. Swed Dent J. 2013;37:79–85.PubMedGoogle Scholar
  17. 17.
    Hellén-Halme K, Petersson A, Warfvinge G, Nilsson M. Effect of ambient light and monitor brightness and contrast settings on the detection of approximal caries in digital radiographs: an in vitro study. Dentomaxillofac Radiol. 2008;37:380–4. doi: 10.1259/dmfr/26038913.CrossRefPubMedGoogle Scholar
  18. 18.
    Wojtowicz PA, Brooks SL, Hasson H, Kerschbaum WE, Eklund SA. Radiographic detection of approximal caries: a comparison between senior dental students and senior dental hygiene students. J Dent Hyg. 2003;77:246–51.PubMedGoogle Scholar
  19. 19.
    Lazarchik DA, Firestone AR, Heaven TJ, Filler SJ, Lussi A. Radiographic evaluation of occlusal caries: effect of training and experience. Caries Res. 1995;29:355–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Wrbas KT, Kielbassa AM, Schulte-Mönting J, Hellwig E. Effects of additional teaching of final-year dental students on their radiographic diagnosis of caries. Eur J Dent Educ. 2000;4:138–42.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan 2015

Authors and Affiliations

  • Nasim Shams
    • 1
  • Narges Panahandeh
    • 2
  • Hilda Aghababa
    • 3
  • Bahar Shams
    • 4
  • Ershad Hemati
    • 5
  1. 1.Department of Oral and Maxillofacial Radiology, Dental SchoolJundishapur University of Medical SciencesAhwazIran
  2. 2.Department of Restorative Dentistry, Dental SchoolShahid Beheshti University of Medical SciencesTehranIran
  3. 3.Department of Pediatric DentistryJundishapur University of Medical SciencesAhwazIran
  4. 4.Department of Periodontology, Dental SchoolShahid Beheshti University of Medical SciencesTehranIran
  5. 5.Department of Oral and Maxillofacial SurgeryJundishapur University of Medical SciencesAhwazIran

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