Comparison of caries detection methods using varying numbers of intra-oral digital photographs with visual examination for epidemiology in children.

BACKGROUND: This was a method comparison study. The aim of study was to compare caries information obtained from a full mouth visual examination using the method developed by the British Association for the Study of Community Dentistry (BASCD) for epidemiological surveys with caries data obtained from eight, six and four intra-oral digital photographs of index teeth in two groups of children aged 5 years and 10/11 years. METHODS: Five trained and calibrated examiners visually examined the whole mouth of 240 5-year-olds and 250 10-/11-year-olds using the BASCD method. The children also had intra-oral digital photographs taken of index teeth. The same 5 examiners assessed the intra-oral digital photographs (in groups of 8, 6 and 4 intra-oral photographs) for caries using the BASCD criteria; dmft/DMFT were used to compute Weighted Kappa Statistic as a measure of intra-examiner reliability and intra-class correlation coefficients as a measure of inter-examiner reliability for each method. A method comparison analysis was performed to determine the 95% limits of agreement for all five examiners, comparing the visual examination method with the photographic assessment method using 8, 6 and 4 intra-oral photographs. RESULTS: The intra-rater reliability for the visual examinations ranged from 0.81 to 0.94 in the 5-year-olds and 0.90 to 0.97 in the 10-/11-year-olds. Those for the photographic assessments in the 5-year-olds were for 8 intra-oral photographs, 0.86 to 0.94, for 6 intra-oral photographs, 0.85 to 0.98 and for 4 intra-oral photographs, 0.80 to 0.96; for the 10-/11-year-olds were for 8 intra-oral photographs 0.84 to 1.00, for 6 intra-oral photographs 0.82 to 1.00 and for 4 intra-oral photographs 0.72 to 0.98. The 95% limits of agreement were -1.997 to 1.967, -2.375 to 2.735 and -2.250 to 2.921 respectively for the 5-year-olds and -2.614 to 2.027, -2.179 to 3.887 and -2.594 to 2.163 respectively for the 10-/11-year-olds. CONCLUSIONS: The photographic assessment method, particularly assessment of 8 intra-oral digital photographs is comparable to the visual examination method in the primary dentition. With the additional benefits of archiving, remote scoring, allowing multiple scorers to score images and enabling longitudinal analysis, the photographic assessment method may be used as an alternative caries detection method in the primary dentition in situations where the visual examination method may not be applicable such as when examiner blinding is required and in practice based randomised controlled trials (RCTs).

Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard.

BACKGROUND: The purpose of this study was to compare diagnostic performance for the detection of caries using photographs with an established visual examination method and histological sections as the reference standard. METHODS: 50 extracted permanent teeth were assessed for the presence of occlusal caries by 9 examiners using two methods; traditional visual examination developed by BASCD and photographs produced by an intra-oral camera. For both methods, diagnoses were made at "caries into dentine" level. The teeth were histologically sectioned and the diagnostic decisions using visual and photographic assessment were compared to the histological reference standard. Inter- and intra- examiner reliability for the methods was assessed and weighted kappa values were calculated. RESULTS: The visual examination method had a median sensitivity value of 65.6% and a median specificity value of 82.4%. The photographic assessments method had a median sensitivity of 81.3% and a median specificity of 82.4%. CONCLUSIONS: The photographic assessments method had a higher sensitivity for caries detection than the visual examination. The two methods had comparable specificities and good intra- and inter- examiner reliability.

Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children.

OBJECTIVES: A cross-sectional study was conducted to compare a visual dental examination method developed by the British Association for the Study of Community Dentistry with assessment of intra-oral photographs as means of detecting dental caries in 5-year-olds and 10- to 11-year-olds. METHOD: 130 5-year-olds and 140 10- to 11-year-olds were visually examined by five trained and calibrated examiners. The children also had intra-oral photographs of their teeth taken. The same five examiners assessed the photographs for caries. Both photographic and visual assessments were undertaken at 'caries into dentine' level. RESULTS: Weighted kappas for the outcome DMFT/dmft as a measure of intra-examiner reliability for the visual examinations ranged from 0.94 to 0.98 (median = 0.98) in the 5-year-olds and 0.80 to 1.00 (median = 0.93) in the 10- to 11-year-olds. Weighted kappas as a measure of intra-examiner reliability for the photographic assessments ranged from 0.83 to 1.00 (median = 0.93) in the 5-year-olds and 0.69 to 0.95 (median = 0.81) in the 10- to 11-year-olds. Sensitivity values for the photographic assessment method as compared to the gold standard of the visual examination scores of a benchmark examiner ranged from 87.8% to 95.8% in the 5-year-olds and 58.5% to 71.7% in the 10- to 11-year-olds. CONCLUSION: There was good intra-examiner reliability for both the visual and the photographic methods for all the examiners. There are no clinically significant differences between the photographic scores and the visual assessments using any of the metrics described. The photographic approach is therefore equivalent in diagnostic utility to the visual system and confers considerable advantages in terms of examiner bias reduction, remote scoring and archiving. These advantages must be weighed against the modest costs of the cameras and the increase time required to acquire the images.