New visual caries detection criteria in clinical studies

Objectives: The purpose of these studies was to test the repeatability of new visual diagnostic criteria in three different clinical studies. Methods: Clinical visual examination was performed on clean, dry teeth in three different clinical studies. The studies were on caries validation (V, 119 subjects), secondary caries (SC, 90 subjects), and a small clinical caries trial (DR, 60 subjects). All subjects were 8-13 years old. The criteria used were slightly different, due to progressive steps in international collaboration in the development of new visual criteria. The first study (V) used a 5-step criteria (Ekstrand), the second one (SC) was slightly adapted for secondary caries, and the third one (DR) used collaborative international criteria with 7 steps for lesion severity (ICDAS). Additionally, in two of the studies (V, DR) separate activity score was given for the lesions found, using a 5-step confidence scale. Results: In these on-going studies all available data was analyzed. Repeatability was substantial to almost perfect using weighted Kappa (V = 0.81, SC = 0.76, and DR = 0.69). Percentage agreement was also high (V = 92%, SC = 92%, DR = 95%) For the studies looking at primary caries, repeatability was greater for pit-and fissure caries than for smooth surfaces (PF: V = 0.87, DR = 0.75; SS: V = 0.70 DR = 0.37) but a low number of smooth surface lesions and high prevalence of fluorosis marks may have affected the outcome. Repeatability for the activity scores was also substantial to almost perfect (WK: V = 0.76, DR = 0.67) Conclusions: The new caries detection criteria showed promising results, with consistent high repeatability across all three studies. This indicates that these criteria can be effectively applied in clinical caries studies. These studies were supported by NIH/NIDCR P01 DE013540, and Indiana 21st Century Research and Technology grant.