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

Mario D. Ramos: Comparison of clinical and digital radiographic detection of occlusal and proximal dental caries in caries-active adults. (Under the direction of Dr. André V. Ritter) Radiographs have been shown to be an important adjunct to visual-tactile caries exams, but its contribution to a caries examination in caries-active adults has not been fully determined. Aims: to determine the extent of the agreement between a clinical examination (CE) and a radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of participants enrolled in the UNC arm of the Xylitol for Adult Caries Trial (X-ACT); and to determine the additional caries diagnostic yield on occlusal and proximal surfaces of posterior teeth for those participants. Materials and methods: Baseline dental CE data from participants (21-80 years old) enrolled in the UNC arm of the X-ACT study site were used. Participants had a complete set of interproximal radiographs obtained within 7 months of the date of the CE (n=114). After IRB approval, radiographs of proximal and occlusal surfaces of the posterior teeth were assessed independently by two examiners on 114 participants' records (442 bitewings). The raw data for this study therefore consisted of surface-level clinical and radiographic scores coded as disease, non-disease, or missing. Descriptive statistics were obtained for all surfaces and by surface type (occlusal vs. proximal). Kappa statistics were used as an estimate of agreement between the clinical and the radiographic exams. The data were analyzed using Microsoft Excel 2007 and SAS. Results: A total of 2415 surfaces were examined by both CE and RE (722 occlusal and 1693 proximal surfaces). There were 1233 (34%) surfaces considered missing. Among all surfaces combined, Kappa between CE and RE was 0.18. When occlusal and proximal surfaces were analyzed separately, the Kappa between CE and RE were 0.04 and 0.18, respectively. The additional diagnostic yield 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 a CE and RE when used to detect caries in posterior teeth of caries-active adults. However, a radiographic caries exam performed within iv 7 months of the date of the clinical exam adds substantial diagnostic yield to the clinical exam, especially on proximal surfaces. v To my heroes Elizabeth and Mario, whom loves and support make all things possible. To Rosa, my helper, supporter, best friend and …