Title	DIAGNOdent Provides A More Sensitive, But Less Specific Diagnostic Method Than Visual Detection
Clinical Question	Does the use of the DIAGNOdent device provide a better detection capability than visual detection in patients with occlusal caries in a clinical setting?
Clinical Bottom Line	The DIAGNOdent clearly is more sensitive than traditional diagnostic methods (i.e. visual alone, visual and/or radiographic, or visual and radiographic). However, the increased likelihood of false-positive diagnoses compared with that with visual methods limits its usefulness as a principal diagnostic tool. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 15551982 Bader/2004 Of 115 articles identified in the search, 25 studies were included in the review according to criteria requiring histologic validation and outcomes expressed as sensitivity and specificity values. Systematic Review Key results For detection of dentinal caries, sensitivity values ranged widely (0.19 to 1.0), although most tended to be high. Specificity values exhibited a similar pattern, ranging from 0.52 to 1.0. In comparison with visual assessment methods, DIAGNODent tended to show higher sensitivity but lower specificity than visual assessment methods.
Evidence Search	PubMED: "Diagnodent" OR "Laser fluorescence" OR "Fluorescence” [Mesh] AND "Dental caries" [Mesh]
Comments on The Evidence	The highest level of evidence found was the systematic review. In this article, although 25 studies were included in the review according to the criteria requiring histologic validation, only four studies considered DIAGNODent’s in vivo performance. The demonstrated in vivo sensitivity ranged from 0.73 to 0.96 and specificity from 0.63 to 0.95. Owing to small sample sizes and the heterogeneity of the included studies, the results should be read with caution.
Applicability	This article would be very applicable to all dentists who are considering using the DIAGNOdent device as a method for occlusal caries detection.
Specialty	(Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords	Diagnodent, Laser fluorescence, caries, caries detection, evidence-based dentistry
ID#	276
Date of submission	01/28/2010
E-mail	loke@uthscsa,edu
Author	Weiqiang Loke, DDS
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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) by Reyhaneh Alimohammadi, Lea Matni (San Antonio, TX) on 11/17/2015 A Pubmed search was conducted on this topic in November 2015. A more recent publication was found: Nokhbatolfoghahaei, 2013. PMID: 25606325. This systematic review supports the conclusion of this CAT and, in addition suggests the usage of DIAGNOdent as a complementary method of caries detection. Recent guidelines found on TRIP database categorized DIAGNOdent as emerging diagnostic technique in detection of early dental caries. by James Bartee (San Antonio, TX) on 04/10/2012 I conducted a PubMed search on this topic April 2012 and found two more recent publications: PubMed #’s: 21913840 and 18930575. These two RCTs suggest that the DIAGNOdent should not be used as a primary diagnostic tool. It can be used as an adjunct to visual/radiographic examination and it provides accurate discrimination of caries depth.