Comparison of Clinical and Digital Radiographic Detection of Occlusal and Proximal Dental Caries in Caries-Active Adults

Objective. (1) to determine the agreement between a clinical examination (CE) and a radiographic examination (RE) in detecting caries lesions on occlusal and proximal surfaces of posterior teeth of participants enrolled in a longitudinal study; and (2) to determine the additional caries diagnostic yield on occlusal and proximal surfaces of posterior teeth obtained by supplementing CE with RE for those participants. Background. Radiographs have been shown to be an important adjunct to visual-tactile caries exams, but the contribution of radiographs to a CE in caries-active adults has not been fully determined. Methods. Participants were caries-active adults of both sexes with at least 12 erupted teeth who (1) received baseline visual-tactile caries CE, and (2) had a complete set of interproximal radiographs obtained within 7 months of the date of the CE (n = 114). After approval from IRB, two examiners on 114 participants’ records (442 bitewings assessed radiographs independently. Results. A total of 2,415 surfaces were examined by both CE and RE. There were 1,233 (34%) surfaces considered missing. Among all surfaces the Kappa statistic was 0.18 (0.04 for occlusal and 0.18 for proximal). The additional diagnostic yield afforded by RE over CE was 69.2% for all surfaces combined, (54.6% for occlusal surfaces, and 71.0% for proximal surfaces). Conclusions. There is poor agreement between CE and RE when used to detect caries in posterior teeth of caries-active adults. However, a RE performed within 7 months of the date of the CE adds substantial diagnostic yield to the CE, especially on proximal surfaces.