Title Visual Inspection for Caries Remains The Clinical Diagnostic Standard
Clinical Question For an average adult patient, is visual inspection alone sufficient to accurately diagnose non-proximal caries?
Clinical Bottom Line Visualization inspection alone is a reliable method to diagnose caries. A meta-analysis and systematic review reached that same basic conclusion. However, the evidence demonstrates moderate heterogeneity and publication bias.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25994176Gimenez/ 2015102 articlesMeta-Analysis
Key resultsVisual inspection of lesions demonstrates a good level of accuracy and high specificity in the diagnosis of caries. Validated visual scoring systems have proven to increase the accuracy of visual inspection, however.
25180412Gomez/ 201342 articlesSystematic review of randomized trials
Key resultsThere was high variability in sensitivity and specificity with visual detection of caries (limitations shared by all alternative diagnostic methods). Visual detection is recommended as the standard for clinical practice.
Evidence Search ("Dental Caries/diagnosis"[Majr] AND (Meta-Analysis[ptyp] OR systematic[sb])) AND (visual[All Fields] AND detection[All Fields]) AND (Meta-Analysis[ptyp] OR systematic[sb])
Comments on
The Evidence
Giminez: Specificity was deemed more important than sensitivity for caries diagnosis by the authors. This decision impacted their conclusions, as specificity was uniformly higher than sensitivity. Most reviewed studies displayed moderate to high heterogeneity and had evidence of publication bias. Gomez: Quality of evidence for visual detection of caries was deemed as poor.
Applicability Due to the nature of studies assessing caries diagnosis, unbiased and clear results are hard to achieve. However, visual detection of caries remains the clinical standard as it is a simple, low cost method for caries detection that demonstrates few false positives. Utilization of a validated visual scoring system is recommended.
Specialty (General Dentistry)
Keywords Dental caries, diagnosis, visual detection, caries, cavities, interproximal decay, pit (fissure) cavity(ies), decay, tooth decay, smooth surface cavity(ies)
ID# 2955
Date of submission 10/20/2015
E-mail forresterk@livemail.uthscsa.edu
Author Keaton Forrester, DMD
Co-author(s) e-mail
Faculty mentor Stephan J. Haney, DDS
Faculty mentor e-mail haneys2@uthscsa.edu
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
None available