Title	Use of Ultrasound Testing for Interproximal Caries Causes Increased False Positive Results Compared With Bite Wing Radiography
Clinical Question	In detecting if caries is present on contacting proximal surfaces, are ultrasound caries detectors statistically better than bite wing radiography?
Clinical Bottom Line	Ultrasound caries detection cannot replace bite wing radiography but can be a beneficial diagnostic tool.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18656396 Tagtekin/2008 42 white/brown lesions on extracted teeth Laboratory blind comparison to gold standard Key results Reported sensitivity and specificity of 86% and 84% for ultrasound. 17178503 Matalon/2007 197 Approximal surfaces on 47 adult patients Clinical trial Key results Reported sensitivity and specificity of 82% and 75% for ultrasound versus 75% and 90% for bite wing. 12738956 Matalon/2003 36 extracted teeth Laboratory blind comparison to gold standard Key results Reported sensitivity and specificity of 100% and 100% for ultrasound. Bite wing sensitivity and specificity was reported as 92% and 90% respectively.
Evidence Search	(("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields]) AND detection[All Fields]) AND ("ultrasonography"[MeSH Terms] OR "ultrasonography"[All Fields] OR "ultrasonic"[All Fields] OR "ultrasonics"[MeSH Terms] OR "ultrasonics"[All Fields])
Comments on The Evidence	Validity: Tagtekin 2008 did not directly compare to bite wing radiography. The extracted teeth were mounted individually which made it unclear as to where the ultrasound probe was placed. Placement of the probe directly on the proximal surface would not be relevant to this clinical question. Histology was used as gold standard. The 2007 Matalon study was not able to use the true gold standard of histology to diagnose caries since it was an in vivo study. Instead, they relied on direct visualization during the restorative procedure to determine the true diagnosis. The patients had been previously diagnosed as needing at least two proximal surface restorations. The study design used three examiners for the conventional bite wing exam and the ultrasound detector on each patient. Matalon 2003 was an in vitro study that did mount teeth so that they had proximal contacts. Histology was used as a gold standard and conventional x-rays were used as the comparison. Seven investigators looked at the bite wings and used the ultrasound device. In both Matalon’s 2003 and 2007 studies, it was not clear if the researcher had any conflicting interest in regards to the particular ultrasonic caries detector being tested. Perspective: The low specificity of the ultrasound test for interproximal caries produces an increased number of false positive results that lead to the treatment of normal teeth. Therefore, dentists should not depend on ultrasound as the primary diagnostic test for caries.
Applicability	Because the ultrasound detectors do not use radiation, they would be a good option for patients who prefer to avoid the small dose obtained from bite wings. However, the patients should be informed of the significant specificity discrepancy between the two diagnostic tests. If further research and development could increase the specificity of ultrasound, it could replace bite wing radiography as the practical gold standard in the diagnosing of proximal caries.
Specialty	(Oral Medicine/Pathology/Radiology) (General Dentistry) (Restorative Dentistry)
Keywords	Caries detection, ultrasound, bitewing
ID#	2546
Date of submission	08/05/2013
E-mail	RussellP@uthscsa.edu
Author	Paul Russell
Co-author(s)	Aimee Villamayor
Co-author(s) e-mail	Villamayor@livemail.uthscsa.edu
Faculty mentor
Faculty mentor e-mail
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available