Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
Caries Res. 2012;46(6):536-43. doi: 10.1159/000341189. Epub 2012 Aug 16.
Clinical guidelines advise that dentists take radiographs in children to detect caries lesions missed by visual inspection; however, due to the current low caries prevalence in most countries, we hypothesized that the adjunct methods of caries detection would not significantly improve the detection of primary molar lesions in comparison to visual inspection alone. We evaluated the performance of visual inspection, alone or in combination with radiographic and laser fluorescence pen (LFpen) methods, in detecting occlusal and approximal caries lesions in primary molars. Two examiners evaluated children who had sought dental treatment with these diagnostic strategies. The reference standard involved the temporary separation of approximal and operative interventions for occlusal surfaces. The sensitivity, specificity, accuracy and utility of diagnostic strategies were calculated. Simultaneous combined strategies increased sensitivities but decreased specificities. Furthermore, no differences were observed in accuracy and utility, parameters more influenced by caries prevalence. In conclusion, adjunct radiographic and laser fluorescence methods offer no benefits to the detection of caries in primary teeth in comparison to visual inspection alone; hence, present clinical guidelines should be re-evaluated.
临床指南建议牙医拍摄儿童的放射线照片，以检测肉眼检查遗漏的龋齿病变；然而，由于目前大多数国家的龋齿患病率较低，我们假设与单独肉眼检查相比，辅助龋病检测方法不会显著提高对乳磨牙病变的检测效果。我们评估了单独使用或结合放射线照相和激光荧光笔 (LFpen) 方法检测乳磨牙的窝沟和邻面龋病的性能。两名检查者使用这些诊断策略评估寻求牙科治疗的儿童。参考标准涉及临时分离邻面和窝沟面的手术干预。计算了诊断策略的敏感性、特异性、准确性和实用性。联合使用策略虽然提高了敏感性，但降低了特异性。此外，在准确性和实用性方面没有观察到差异，这些参数受龋齿患病率的影响更大。总之，与单独肉眼检查相比，辅助放射线照相和激光荧光方法在检测乳牙龋齿方面没有任何益处；因此，应该重新评估当前的临床指南。
