Dundee Dental School, University of Dundee, Dundee, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
Cochrane Database Syst Rev. 2020 Dec 7;12(12):CD013806. doi: 10.1002/14651858.CD013806.
Root caries is a well-recognised disease, with increasing prevalence as populations age and retain more of their natural teeth into later life. Like coronal caries, root caries can be associated with pain, discomfort, tooth loss, and contribute significantly to poorer oral health-related quality of life in the elderly. Supplementing the visual-tactile examination could prove beneficial in improving the accuracy of early detection and diagnosis. The detection of root caries lesions at an early stage in the disease continuum can inform diagnosis and lead to targeted preventive therapies and lesion arrest.
To assess the diagnostic test accuracy of index tests for the detection and diagnosis of root caries in adults, used alone or in combination with other tests.
Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles.
We included diagnostic accuracy study designs that compared one or more index tests (laser fluorescence, radiographs, visual examination, electronic caries monitor (ECM), transillumination), either independently or in combination, with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. In vitro and in vivo studies were eligible for inclusion but studies that artificially created carious lesions were excluded.
Two review authors extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) specific to the review context. Estimates of diagnostic test accuracy were expressed as sensitivity and specificity with 95% confidence intervals (CI) for each dataset. We planned to use hierarchical models for data synthesis and explore potential sources of heterogeneity through meta-regression.
Four cross-sectional diagnostic test accuracy studies providing eight datasets with data from 4997 root surfaces were analysed. Two in vitro studies evaluated secondary root caries lesions on extracted teeth and two in vivo studies evaluated primary root caries lesions within the oral cavity. Four studies evaluated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. Two studies evaluated radiographs and reported estimates of sensitivity ranging from 0.40 to 0.63 and specificity ranging from 0.31 to 0.80. One study evaluated visual examination and reported sensitivity of 0.75 (95% CI 0.48 to 0.93) and specificity of 0.38 (95% CI 0.14 to 0.68). One study evaluated the accuracy of radiograph and visual examination in combination and reported sensitivity of 0.81 (95% CI 0.54 to 0.96) and specificity of 0.54 (95% CI 0.25 to 0.81). Given the small number of studies and important differences in the clinical and methodological characteristics of the studies we were unable to pool the results. Consequently, we were unable to formally evaluate the comparative accuracy of the different tests considered in this review. Using QUADAS-2 we judged all four studies to be at overall high risk of bias, but only two to have applicability concerns (patient selection domain). Reasons included bias in the selection process, use of post hoc (data driven) positivity thresholds, use of an imperfect reference standard, and use of extracted teeth. We downgraded the certainty of the evidence due to study limitations and serious imprecision of the results (downgraded two levels), and judged the certainty of the evidence to be very low.
AUTHORS' CONCLUSIONS: Visual-tactile examination is the mainstay of root caries detection and diagnosis; however, due to the paucity of the evidence base and the very low certainty of the evidence we were unable to determine the additional benefit of adjunctive diagnostic tests for the detection and diagnosis of root caries.
根面龋是一种公认的疾病，随着人口老龄化以及人们保留更多天然牙齿进入老年期，其发病率呈上升趋势。与冠面龋一样，根面龋可引起疼痛、不适和牙齿丧失，并极大地影响老年人的口腔健康相关生活质量。补充视觉触觉检查可能有助于提高早期发现和诊断的准确性。在疾病连续体的早期阶段检测到根面龋病变可以为诊断提供信息，并导致针对预防性治疗和病变抑制。
评估单独或联合其他测试用于检测和诊断成人根面龋的指标测试的诊断测试准确性。
Cochrane Oral Health 的信息专家对以下数据库进行了搜索：MEDLINE Ovid（1946 年至 2018 年 12 月 31 日）；Embase Ovid（1980 年至 2018 年 12 月 31 日）；美国国立卫生研究院正在进行的临床试验登记处（ClinicalTrials.gov，至 2018 年 12 月 31 日）；以及世界卫生组织国际临床试验注册平台（至 2018 年 12 月 31 日）。我们还研究了参考文献列表和已发表的系统评价文章。
我们纳入了比较一种或多种指标测试（激光荧光、射线照相、视觉检查、电子龋病监测仪、透照）的诊断准确性研究设计，这些测试单独或联合使用，以参考标准为基准。这包括评估单一指标测试诊断准确性的前瞻性研究，以及直接比较两种或多种指标测试的研究。体外和体内研究符合纳入条件，但人工制造龋损的研究除外。
两名综述作者使用基于特定于综述背景的质量评估工具（QUADAS-2），基于标准的数据提取和质量评估表格，独立且重复地提取数据。使用每个数据集的敏感性和特异性及其 95%置信区间（CI）来表示诊断测试准确性。我们计划使用分层模型进行数据综合，并通过元回归探索潜在的异质性来源。
四项横断面诊断准确性研究提供了 4997 个根面的 8 个数据集进行分析。两项体外研究评估了从牙齿中提取的继发根面龋病变，两项体内研究评估了口腔内的原发性根面龋病变。四项研究评估了激光荧光，报告的敏感性范围为 0.50 至 0.81，特异性范围为 0.40 至 0.80。两项研究评估了射线照相，报告的敏感性范围为 0.40 至 0.63，特异性范围为 0.31 至 0.80。一项研究评估了视觉检查，报告的敏感性为 0.75（95%CI 0.48 至 0.93），特异性为 0.38（95%CI 0.14 至 0.68）。一项研究评估了射线照相和视觉检查联合的准确性，报告的敏感性为 0.81（95%CI 0.54 至 0.96），特异性为 0.54（95%CI 0.25 至 0.81）。由于研究数量较少，且研究在临床和方法学特征方面存在重要差异，我们无法对结果进行汇总。因此，我们无法正式评估本综述中考虑的不同测试的比较准确性。使用 QUADAS-2，我们判断所有四项研究的总体偏倚风险都很高，但只有两项研究存在应用问题（患者选择领域）。原因包括选择过程中的偏倚、后分析（数据驱动）阳性阈值的使用、不完美的参考标准的使用以及提取牙齿的使用。由于研究局限性和结果的严重不准确性，我们降低了证据的确定性等级（降低了两个等级），并认为证据的确定性非常低。
视觉触觉检查是根面龋检测和诊断的主要手段；然而，由于证据基础薄弱，证据确定性非常低，我们无法确定辅助诊断测试对根面龋的检测和诊断的额外益处。
