Chu Chun Hung, Chau Alex M, Lo Edward C
University of Hong Kong, Hong Kong.
Oral Health Prev Dent. 2013;11(2):181-9. doi: 10.3290/j.ohpd.a29365.
The biochemical definition of dental caries is reasonably understood and generally agreed upon, but there is no consensus on a clinical definition among dentists. There are many proposed diagnostic criteria of dental caries in the dental literature. The recently developed International Caries Detection and Assessment System (ICDAS II) has been constructed to allow data comparison between studies. It can be used in epidemiological studies, public health research, clinical research, clinical practice and dental education. A good study evaluating a caries detection method should contain information on caries prevalence of the study sample and other measures, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). It is noteworthy that measuring sensitivity and specificity provides no quantitative information on how likely a tested tooth is to be carious because the true caries status of the tooth is not known in a clinical situation. Moreover, the study design for caries detection should address the interpretation of predictive values because PPV and NPV are affected by the caries prevalence. The study design should also measure patient-oriented outcomes, address allocation concealment and avoid lead-time bias to generate valid and clinically relevant studies. Prudent evaluation of caries detection methods is the standard of care. This paper reviews current diagnostic criteria for caries detection and discusses proper ways to evaluate new diagnostic methods.
龋齿的生化定义已得到合理理解且普遍达成共识，但牙医之间对于临床定义尚未形成统一意见。牙科文献中有许多关于龋齿的诊断标准。最近开发的国际龋病检测与评估系统（ICDAS II）旨在实现不同研究之间的数据比较。它可用于流行病学研究、公共卫生研究、临床研究、临床实践及牙科教育。一项评估龋病检测方法的良好研究应包含研究样本的龋病患病率及其他指标的信息，包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。值得注意的是，测量敏感性和特异性并不能提供关于被测牙齿患龋可能性的定量信息，因为在临床情况下牙齿的真实龋病状态是未知的。此外，龋病检测的研究设计应考虑预测值的解读，因为PPV和NPV受龋病患病率的影响。研究设计还应测量以患者为导向的结果，解决分配隐藏问题并避免提前期偏倚，以产生有效且与临床相关的研究。谨慎评估龋病检测方法是医疗标准。本文回顾了当前龋病检测的诊断标准，并讨论了评估新诊断方法的恰当方式。
