Visual Inspection for Caries Detection: A Systematic Review and Meta-analysis

We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through Ju...

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Veröffentlicht in:	Journal of dental research Jg. 94; H. 7; S. 895
Hauptverfasser:	Gimenez, T, Piovesan, C, Braga, M M, Raggio, D P, Deery, C, Ricketts, D N, Ekstrand, K R, Mendes, F M
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 01.07.2015
Schlagworte:	Dental Caries - diagnosis Humans Odds Ratio Physical Examination - statistics & numerical data Predictive Value of Tests Publication Bias Reproducibility of Results ROC Curve Sensitivity and Specificity Tooth, Deciduous - pathology dental caries oral diagnosis performance ROC curve evidence-based dentistry sensitivity and specificity
ISSN:	1544-0591, 1544-0591
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Abstract	We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.
AbstractList	We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method. We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.
Author	Ekstrand, K R Raggio, D P Braga, M M Gimenez, T Deery, C Ricketts, D N Mendes, F M Piovesan, C
Author_xml	– sequence: 1 givenname: T surname: Gimenez fullname: Gimenez, T organization: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil – sequence: 2 givenname: C surname: Piovesan fullname: Piovesan, C organization: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil School of Dentistry, Centro Universitário Franciscano, Santa Maria, Brazil – sequence: 3 givenname: M M surname: Braga fullname: Braga, M M organization: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil – sequence: 4 givenname: D P surname: Raggio fullname: Raggio, D P organization: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil – sequence: 5 givenname: C surname: Deery fullname: Deery, C organization: School of Clinical Dentistry, University of Sheffield, Sheffield, UK – sequence: 6 givenname: D N surname: Ricketts fullname: Ricketts, D N organization: Dundee Dental Hospital and School, University of Dundee, Dundee, UK – sequence: 7 givenname: K R surname: Ekstrand fullname: Ekstrand, K R organization: Section of Cariology & Endodontics, Section of Pediatric Dentistry & Clinical Genetics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark – sequence: 8 givenname: F M surname: Mendes fullname: Mendes, F M email: fmmendes@usp.br organization: Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil fmmendes@usp.br
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References	26698004 - J Evid Based Dent Pract. 2015 Dec;15(4):182-4. doi: 10.1016/j.jebdp.2015.10.009. 27339234 - Evid Based Dent. 2016 Jun;17(2):41-2. doi: 10.1038/sj.ebd.6401165.
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SubjectTerms	Dental Caries - diagnosis Humans Odds Ratio Physical Examination - statistics & numerical data Predictive Value of Tests Publication Bias Reproducibility of Results ROC Curve Sensitivity and Specificity Tooth, Deciduous - pathology
Title	Visual Inspection for Caries Detection: A Systematic Review and Meta-analysis
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