Accuracy of tactile assessment in order to detect proximal cavitation of caries lesions in vitro
Discriminating non-cavitated from cavitated proximal lesions without tooth separation is only limitedly possible using visual-radiographic assessment alone. We evaluated how additional tactile assessment might increase the accuracy of this discrimination in vitro.
Surface integrity of 46 primary molars with proximal lesions extending radiographically into outer third of dentin (ICDAS-codes: 2 n = 34, 3 n = 8 and 5 n = 4) were mounted in groups of two in manikin heads and independently assessed by three examiners using visual-radiographic and additional tactile assessment using a cow-horn-ended explorer with or without gingival displacement. After examination, lesion surfaces were evaluated for possible damage using scanning-electronic microscopy. Analysis of variance (ANOVA) was performed for evaluating if tactile assessment and gingival displacement significantly affected accuracy.
Tactile assessment significantly increased sensitivity of detecting cavities (p < 0.001, ANOVA), but decreased specificity (p < 0.05). Sensitivities/specificities varied between 33 (8)%/96 (1)% and 86 (6)%/84 (5)%. Gingival displacement had no significant impact on accuracy (p > 0.05). Scanning-electron microscopy revealed no cavitation.
In vitro, tactile assessment of proximal surfaces was useful and safe.
Analysis of the cavitation level by using a cow-horn-ended probe might be leading to useful information in addition to bitewing assessment under clinical circumstances.
KeywordsCaries Detection Diagnosis Proximal lesion Explorer Probing
We thank Mrs. Regina Marquardt for her help with mounting and preparing the teeth as well as generating the SEM images. We are grateful to Dr. Julian Lausch (mentioned as “JL” in the manuscript) who served as an examiner.
This study was funded by the authors and their institutions.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The use of the teeth was ethically approved (D444/10).
Informed consent for the use of the teeth was provided under the ethics approval D444/10.
- 3.Featherstone JD (2004) The caries balance: the basis for caries management by risk assessment. Oral Health Prev Dent 2(Suppl 1):259–264Google Scholar
- 4.Hintze H, Lussi A, Cuisinier F, Nyvad B (2015) Additional caries detection methods. In: Fejerskov O, Nyvad B, Kidd EAM (eds) Dental caries: the disease and its clinical management, 3rd edn. Wiley Blackwell, OxfordGoogle Scholar
- 6.Nyvad B, Machiulskiene V, Soviero VM, Baelum V (2015) Visual-tactile caries diagnosis. In: Fejerskov O, Nyvad B, Kidd EAM (eds) Dental caries: the disease and its clinical management, 3rd edn. Wiley Blackwell, OxfordGoogle Scholar
- 11.Zentrale-Ethikkommission (2003) Stellungnahme: [The use of human body materials for the purposes of medical research]. http://www.zentrale-ethikkommission.de/stellungnahmen/koerpermaterialien/. Accessed 27 Dec 2018
- 12.Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB (2007) The international caries detection and assessment system (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 35:170–178. https://doi.org/10.1111/j.1600-0528.2007.00347.x CrossRefGoogle Scholar
- 13.Haak R, Wicht MJ (2012) Radiographic and other additional diagnostic methods. In: Meyer-Lueckel H, Paris S, Ekstrand K (eds) Caries Science and clinical practice. Thieme, StuttgartGoogle Scholar
- 15.Pitts NB, Evans DJ, Nugent ZJ, Pine CM (2002) The dental caries experience of 12-year-old children in England and Wales. Surveys coordinated by the British Association for the Study of Community Dentistry in 2000/2001. Community Dent Health 19:46–53Google Scholar
- 17.Mejare I, Grondahl HG, Carlstedt K, Grever AC, Ottosson E (1985) Accuracy at radiography and probing for the diagnosis of proximal caries. Scand J Dent Res 93:178–184Google Scholar
- 19.Ribeiro AA, Purger F, Rodrigues JA, Oliveira PR, Lussi A, Monteiro AH, Alves HD, Assis JT, Vasconcellos AB (2015) Influence of contact points on the performance of caries detection methods in approximal surfaces of primary molars: an in vivo study. Caries Res 49:99–108. https://doi.org/10.1159/000368562 CrossRefGoogle Scholar
- 20.De Araujo FB, De Araujo DR, Dos Santos CK, De Souza MA (1996) Diagnosis of approximal caries in primary teeth: radiographic versus clinical examination using tooth separation. Am J Dent 9:54–56Google Scholar
- 26.Ekstrand KR, Luna LE, Promisiero L, Cortes A, Cuevas S, Reyes JF, Torres CE, Martignon S (2011) The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study. Caries Res 45:93–99. https://doi.org/10.1159/000324439 CrossRefGoogle Scholar