In-vivo validity of proximal caries detection in primary teeth, with histological validation.

BACKGROUND: Detection and diagnosis of proximal caries in primary molars is challenging. AIM: The aim of this in-vivo study was to assess the validity and reproducibility of four methods of proximal caries detection in primary molar teeth. DESIGN: Eighty-two children (5-10 yrs) were recruited. Initially 1030 proximal surfaces were examined using meticulous visual examination (ICDAS) (VE1), bitewing radiographs (RE), and a laser fluorescence pen device (LF1). Temporary tooth separation (TTS) was achieved for 447 surfaces and these were re-examined visually (VE2) and using the LF-pen (LF2). Three hundred and fifty-six teeth (542 surfaces) were subsequently extracted and provided histological validation. RESULTS: At D1 (enamel and dentine caries) diagnostic threshold, the sensitivity of VE1, RE, VE2, LF1 and LF2 examination were 0.52, 0.14, 0.75, 0.58, 0.60 and the specificity values were 0.89, 0.97, 0.88, 0.85, 0.77 respectively. At D3 (dentine caries) threshold, the sensitivity values were 0.42, 0.71, 0.49, 0.63, 0.65 respectively, while specificity was 0.93 for VE1 and VE2, and 0.98, 0.87 and 0.88 for RE, LF1 and LF2 examinations respectively. ROC analysis showed radiographic examination to be superior at D3 . CONCLUSION: Meticulous caries diagnosis (ICDAS) should be supported by radiographs for detection of dentinal proximal caries in primary molars.