Lasers in Medical Science

, Volume 34, Issue 6, pp 1235–1241 | Cite as

Performance of light-emitting diode device in detecting occlusal caries in the primary molars

  • Michele B. DinizEmail author
  • Priscila H. Campos
  • Sabrina Wilde
  • Rita de Cássia L. Cordeiro
  • Andréa G. F. Zandona
Original Article


This in vitro study aimed to compare the performance of a light-emitting diode (LED) device (Midwest Caries I.D.: MID), International Caries Detection and Assessment System (ICDAS) visual criteria, and fluorescence-based devices (DIAGNOdent: LF; DIAGNOdent pen: LFpen; and Quantitative Light-induced Fluorescence: QLF) in detecting occlusal caries in the primary molars. Eighty-eight primary molars with sound occlusal surfaces or carious lesions at different stages were assessed twice, with a 1-week interval in between, by one examiner using all three methods. Subsequently, the teeth were sectioned and lesion depth was verified using stereomicroscopy as a gold standard. Sensitivity, specificity, and accuracy were calculated at D1 (all carious lesions—enamel and dentin) and D3 (dentin lesions) thresholds. Correlation with histological analysis was evaluated using Spearman’s rank correlation coefficients (rho). Weighted Kappa and intraclass-correlation (ICC) coefficients were calculated to assess intra-examiner reproducibility. At D1 threshold, ICDAS and LFpen showed higher sensitivity than the other methods, whereas ICDAS, LF, and QLF showed higher specificity (p < 0.05), and MID showed lower accuracy. At D3 threshold, ICDAS, LFpen, and QLF showed higher sensitivity than MID, whereas ICDAS, LF, and MID showed higher specificity (p < 0.05). All methods, except MID, showed statistically similar accuracy values (p < 0.05). Correlations with histopathological analysis varied from 0.15 (MID) to 0.57 (ICDAS). Intra-examiner reproducibility varied from 0.30 (MID) to 0.92 (ICDAS, LF, and QLF). The MID device exhibited a poor performance in detecting occlusal carious lesions in the primary molars, and ICDAS visual criteria exhibited greater accuracy than LF, LFpen, and QLF devices.


Caries detection Primary teeth Occlusal surfaces Fluorescence 



The study is financially supported by the Coordination of Improvement of Higher Education Personnel (CAPES) PDEE.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Rodrigues JA, Hug I, Diniz MB, Lussi A (2008) Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 42:297–304CrossRefGoogle Scholar
  2. 2.
    Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel- Gutenbrunner M, Pieper K (2008) Reproducibility and accuracy of the ICDAS-II detection of occlusal caries in vitro. Caries Res 42:79–87CrossRefGoogle Scholar
  3. 3.
    Diniz MB, Rodrigues JA, Hug I, Cordeiro Rde C, Lussi A (2009) Reproducibility and accuracy of the ICDAS-II for occlusal caries detection. Community Dent Oral Epidemiol 37:399–404CrossRefGoogle Scholar
  4. 4.
    Diniz MB, Boldieri T, Rodrigues JA, Santos-Pinto L, Lussi A, Cordeiro RC (2012) The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation. J Am Dent Assoc 143:339–350CrossRefGoogle Scholar
  5. 5.
    Shoaib L, Deery C, Ricketts DN, Nugent ZJ (2009) Validity and reproducibility of ICDAS II in primary teeth. Caries Res 43:442–448CrossRefGoogle Scholar
  6. 6.
    Souza JF, Boldieri T, Diniz MB, Rodrigues JA, Lussi A, Cordeiro RCL (2013) Traditional and novel methods for occlusal caries detection: performance on primary teeth. Lasers Med Sci 28:287–295CrossRefGoogle Scholar
  7. 7.
    Freitas LA, Santos MT, Guaré RO, Lussi A, Diniz MB (2016) Association between visual inspection, caries activity status, and radiography with treatment decisions on approximal caries in primary molars. Pediatr Dent 38:140–147Google Scholar
  8. 8.
    Gomez J (2015) Detection and diagnosis of the early caries lesion. BMC Oral Health 15(Suppl 1):S3CrossRefGoogle Scholar
  9. 9.
    Neuhaus KW, Rodrigues JA, Hug I, Stich H, Lussi A (2011) Performance of laser fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars. Clin Oral Investig 15:635–641CrossRefGoogle Scholar
  10. 10.
    Matos R, Novaes TF, Braga MM, Siqueira WL, Duarte DA, Mendes FM (2011) Clinical performance of two fluorescence-based methods in detecting occlusal caries lesions in primary teeth. Caries Res 45:294–302CrossRefGoogle Scholar
  11. 11.
    Novaes TF, Matos R, Gimenez T, Braga MM, De Benedetto MS, Mendes FM (2012) Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study. Int J Paediatr Dent 22:459–466CrossRefGoogle Scholar
  12. 12.
    Mendes FM, Novaes TF, Matos R, Bittar DG, Piovesan C, Gimenez T, Imparato JC, Raggio DP, Braga MM (2012) Radiographic and laser fluorescence methods have no benefits for detecting caries in primary teeth. Caries Res 46:536–543CrossRefGoogle Scholar
  13. 13.
    Twetman S, Axelsson S, Dahlén G, Espelid I, Mejàre I, Norlund A, Tranæus S (2013) Adjunct methods for caries detection: a systematic review of literature. Acta Odontol Scand 71:388–397CrossRefGoogle Scholar
  14. 14.
    Gimenez T, Braga MM, Raggio DP, Deery C, Ricketts DN, Mendes FM (2013) Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity. PLoS One 8:e60421CrossRefGoogle Scholar
  15. 15.
    Pretty IA, Ellwood RP (2013) The caries continuum: opportunities to detect, treat and monitor the re-mineralization of early caries lesions. J Dent 41(Suppl 2):S12–S21CrossRefGoogle Scholar
  16. 16.
    Jallad M, Zero D, Eckert G, Ferreira Zandona A (2015) In vitro detection of occlusal caries on permanent teeth by a visual, light-induced fluorescence and photothermal radiometry and modulated luminescence methods. Caries Res 49:523–530CrossRefGoogle Scholar
  17. 17.
    Gomez J, Zakian C, Salsone S, Pinto SC, Taylor A, Pretty IA, Ellwood R (2013) In vitro performance of different methods in detecting occlusal caries lesions. J Dent 41:180–186CrossRefGoogle Scholar
  18. 18.
    Kühnisch J, Heinrich-Weltzien R (2004) Quantitative light-induced fluorescence (QLF)--a literature review. Int J Comput Dent 7:325–338Google Scholar
  19. 19.
    Pontes LRA, Novaes TF, Moro BLP, Braga MM, Mendes FM (2017) Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth. Braz Oral Res 31:e91CrossRefGoogle Scholar
  20. 20.
    Novaes TF, Reyes A, Matos R, Antunes-Pontes LR, Marques RP, Braga MM, Diniz MB, Mendes FM (2017) Association between quantitative measures obtained using fluorescence-based methods and activity status of occlusal caries lesions in primary molars. Int J Paediatr Dent 27:154–162CrossRefGoogle Scholar
  21. 21.
    Strassler HE, Sensi LG (2008) Technology-enhanced caries detection and diagnosis. Compend Contin Educ Dent 29:464–465 468, 470 passimGoogle Scholar
  22. 22.
    Rodrigues JA, Hug I, Neuhaus KW, Lussi A (2011) Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries. J Biomed Opt 16:107003CrossRefGoogle Scholar
  23. 23.
    Aktan AM, Cebe MA, Ciftçi ME, Sirin Karaarslan E (2012) A novel LED-based device for occlusal caries detection. Lasers Med Sci 27:1157–1163CrossRefGoogle Scholar
  24. 24.
    Bozdemir E, Karaarslan ES, Ozsevik AS, Ata Cebe M, Aktan AM (2013) In vivo performance of two devices for occlusal caries detection. Photomed Laser Surg 31:322–327CrossRefGoogle Scholar
  25. 25.
    Van Hilsen Z, Jones RS (2013) Comparing potential early caries assessment methods for teledentistry. BMC Oral Health 13:16CrossRefGoogle Scholar
  26. 26.
    Patel SA, Shepard WD, Barros JA, Streckfus CF, Quock RL (2014) In vitro evaluation of Midwest Caries ID: a novel light-emitting diode for caries detection. Oper Dent 39:644–651CrossRefGoogle Scholar
  27. 27.
    Neuhaus KW, Ciucchi P, Rodrigues JA, Hug I, Emerich M, Lussi A (2015) Diagnostic performance of a new red light LED device for approximal caries detection. Lasers Med Sci 30:1443–1447CrossRefGoogle Scholar
  28. 28.
    Francescut P, Zimmerli B, Lussi A (2006) Influence of different storage methods on laser fluorescence values: a two-year study. Caries Res 40:181–185CrossRefGoogle Scholar
  29. 29.
    Diniz MB, Sciasci P, Rodrigues JA, Lussi A, Cordeiro RCL (2011) Influence of different professional prophylactic methods on fluorescence measurements for detection of occlusal caries. Caries Res 45:264–268CrossRefGoogle Scholar
  30. 30.
    Ekstrand KR, Martignon S, Ricketts DJ, Qvist V (2007) Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 32:225–235CrossRefGoogle Scholar
  31. 31.
    Ekstrand KR, Ricketts DNJ, Kidd EAM, Qvist V, Schou S (1998) Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res 32:247–254CrossRefGoogle Scholar
  32. 32.
    Teo TK, Ashley PF, Louca C (2014) An in vivo and in vitro investigation of the use of ICDAS, DIAGNOdent pen and CarieScan PRO for the detection and assessment of occlusal caries in primary molar teeth. Clin Oral Investig 18:737–744CrossRefGoogle Scholar
  33. 33.
    Singh R, Tandon S, Rathore M, Tewari N, Singh N, Shitoot AP (2016) Clinical performance of ICDAS II, radiovisiography, and alternating current impedance spectroscopy device for the detection and assessment of occlusal caries in primary molars. J Indian Soc Pedod Prev Dent 34:152–158CrossRefGoogle Scholar
  34. 34.
    Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, Ekstrand KR, Mendes FM (2015) Visual inspection for caries detection: a systematic review and meta-analysis. J Dent Res 94:895–904CrossRefGoogle Scholar
  35. 35.
    Cınar C, Atabek D, Odabaş ME, Olmez A (2013) Comparison of laser fluorescence devices for detection of caries in primary teeth. Int Dent J 63:97–102CrossRefGoogle Scholar
  36. 36.
    Braga MM, Nicolau J, Rodrigues CR, Imparato JC, Mendes FM (2008) Laser fluorescence device does not perform well in detection of early caries lesions in primary teeth: an in vitro study. Oral Health Prev Dent 6:165–169Google Scholar
  37. 37.
    Kavvadia K, Lagouvardos P, Apostolopoulou D (2012) Combined validity of DIAGNOdent™ and visual examination for in vitro detection of occlusal caries in primary molars. Lasers Med Sci 27:313–319CrossRefGoogle Scholar
  38. 38.
    Rosa MI, Schambeck VS, Dondossola ER, Alexandre MC, Tuon L, Grande AJ, Hugo F (2016) Laser fluorescence of caries detection in permanent teeth in vitro: a systematic review and meta-analysis. J Evid Based Med 9:213–224CrossRefGoogle Scholar
  39. 39.
    Ferreira Zandona A, Santiago E, Eckert G, Fontana M, Ando M, Zero DT (2010) Use of ICDAS combined with quantitative light-induced fluorescence as a caries detection method. Caries Res 44:317–322CrossRefGoogle Scholar
  40. 40.
    Feng Y, Yin W, Hu D, Zhang YP, Ellwood RP, Pretty IA (2007) Assessment of autofluorescence to detect the remineralization capabilities of sodium fluoride, monofluorophosphate and non-fluoride dentifrices. A single-blind cluster randomized trial. Caries Res 41:358–364CrossRefGoogle Scholar
  41. 41.
    Ferreira Zandoná AG, Analoui M, Beiswanger BB, Isaacs RL, Kafrawy AH, Eckert GJ, Stookey GK (1998a) An in vitro comparison between laser fluorescence and visual examination for detection of demineralization in occlusal pits and fissures. Caries Res 32:210–218CrossRefGoogle Scholar
  42. 42.
    Ferreira Zandoná AG, Analoui M, Schemehorn BR, Eckert GJ, Stookey GK (1998b) Laser fluorescence detection of demineralization in artificial occlusal fissures. Caries Res 32:31–40CrossRefGoogle Scholar
  43. 43.
    Kühnisch J, Ifland S, Tranaeus S, Hickel R, Stösser L, Heinrich-Weltzien R (2007) In vivo detection of non-cavitated caries lesions on occlusal surfaces by visual inspection and quantitative light-induced fluorescence. Acta Odontol Scand 65:183–188CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Post-graduate Program in DentistryCruzeiro do Sul UniversitySão PauloBrazil
  2. 2.Department of Pediatric DentistryRio Grande do Sul Federal UniversityPorto AlegreBrazil
  3. 3.Department of Pediatric Dentistry, Araraquara School of DentistrySão Paulo State UniversityAraraquaraBrazil
  4. 4.Department of Comprehensive CareTufts University School of Dental MedicineBostonUSA

Personalised recommendations