A Systematic Review of the Performance of Methods for Identifying Carious Lesions


Send correspondence to Dr. Bader, Sheps Center, CW#7590, University of North Carolina, Chapel Hill, NC 27599. E-mail: jim_bader@unc.edu. Web site: http://www.unc.edu. Dr. Shugars is affiliated with the School of Dentistry and the Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. Dr. Bonito is affiliated with the Research Triangle Institute. Reprints will not be available. This study was developed by the RTI/LJNC Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract #290-97-0011), Rockville, MD. This paper was presented at the NIH Consensus Develop Conference on Diagnosis and Management of Dental Caries Throughout Life, March 26, 2001, Bethesda, MD. The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.


This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessments of visual, visuaVtactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to supporf generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.