_______________________________________________________________________________________________________________________________________________________________ Research Article _______________________________________________________________________________________________________________________________________________________________ Validity of caries-detection methods under epidemiological setting RENATO PEREIRA DA SILVA, DDS, MSC. PHD, ANDRÉA VIDEIRA ASSAF, DDS, MSC. PHD, STELA MÁRCIA PEREIRA, DDS, MSC. PHD, FÁBIO LUIZ MIALHE, DDS, MSC. PHD, GLÁUCIA MARIA BOVI AMBROSANO, AGR ENG, MSC. PHD, MARCELO DE CASTRO MENEGHIM, DDS, MSC. PHD & ANTONIO CARLOS PEREIRA, DDS, MPH, DRPH ABSTRACT: Purpose: To evaluate the validity of the visual exam and adjunct diagnostic technologies for posterior permanent teeth under epidemiological conditions. Methods: A probabilistic sample of 165 12-year-old schoolchildren from Piracicaba, São Paulo, Brazil, was examined by visual exam (VI1), visual exam + artificial lighting (VI2), bitewing (BW), fiber optic transillumination (FOTI), DIAGNOdent and the associations among them. The D1+D3 and D3 diagnostics criteria, under epidemiological conditions, were adopted. The sensitivity, specificity and accuracy were calculated to determine the validity of the exams. Results: The most accurate diagnostic method was VI2+BW exam for all dental surfaces under both diagnostic criteria. It was concluded that the BW was the best adjunct diagnostic technology on epidemiological dental caries surveys, increasing the validity of the dental exams. (Am J Dent 2011;24:363-366). CLINICAL SIGNIFICANCE: The most accurate diagnostic method under clinical epidemiologic conditions was visual examination with bitewing radiographs. : Prof. Dr. Antonio Carlos Pereira, Department of Community Dentistry, Piracicaba Dental School – University of Campinas-UNICAMP, Av. Limeira 901, P.O. Box 52, CEP 13414-903, Piracicaba, São Paulo, Brazil. E-: apereira@fop.unicamp.br Introduction While the prevalence of cavitated carious lesions in dentin is in decline worldwide, the amount of initial carious lesions in enamel, especially at occlusal dental surfaces, in children and young adults allocated in polarization groups, is increasing. 1 With this current epidemiological profile of dental caries, the use of adjunct diagnostic technologies to detect carious lesions more precisely, is necessary. 2,3 Under epidemiological settings, the addition of adjunct diagnostic technologies, such as bitewing radiographs and/or transillumination by fiber optic diagnostic, and auxiliary diagnostic resources, such as previous dental brushing and/or drying of dental surfaces to be examined, have demonstrated some success on dental caries detection. 2,4-10 The present study evaluated the validity of visual examination (with or without artificial illumination), bitewing radiography, fiber optic transillumination and laser fluores- cence on the examination of posterior permanent teeth, isolated and in association, performed under D1+D3 and D3 diagnostic criteria in an epidemiological setting. Materials and Methods This study was approved by the Research Ethics Committee of the Piracicaba Dental School/UNICAMP (State University of Campinas) protocol No. 082/2006, and conducted in accordance with resolutions 196/96 from the National Health Council of the Brazilian Ministry of Health, and 179/93 of the Dental Professional Code of Ethics from the Brazilian Dental Council. The participation in this study was voluntary and informed written consent was obtained from all parents/ guardians of the schoolchildren. Design of the study - This transversal study was performed by one gold standard examiner – a highly experienced examiner on epidemiological dental caries surveys, and one examiner with some experience on epidemiological dental caries surveys. The sample was composed of 165 children from public schools from the city of Piracicaba, São Paulo, Brazil, in the 12 year-old age group, randomly selected and presenting low to high caries experience, totaling 2,189 posterior permanent teeth examined. The sample DMF-S index, under WHO diagnostic criterion, 11 was 1.68 (SD=3.01), while the DMF-T was 1.00 (SD=1.65). The DMF-T index from Piracicaba was 1.32 (SD=1.92) in 12 year-old schoolchildren. 12 The sample size was calculated considering an agreement proportion of 90%, a disagreement proportion of 5%, a power of test of 92% and an alpha of 5% for a McNemar test. Children presenting a fixed orthodontic device, severe fluorosis and enamel hypoplasia or a serious systemic disease were substituted for another one (randomly selected) who did not present such conditions. Exam conditions and diagnostic criteria - Previous dental brushing (Bass modified technique for 2 minutes with fluoridated toothpaste) was done for all children. Each dental surface was dried by compressed air through a portable dental unit (Proquest Delivery System, model 4010 a ), for 5 seconds per tooth as in Assaf et al. 7 The visual exam was performed with flat mouth mirrors and CPI probes, under natural illumination (VI1) and under artificial light source (VI2). Diagnostic criteria based on others, 10,11,13,14 were adopted for the examinations of D1+D3 (carious lesions cavitated or not in enamel/dentin) and D3 (carious lesions cavitated or not in dentin exclusively). The bitewing exam (BW) was performed aside from the visual exam by an experienced examiner not involved in the study. An Agfa Dentus M2 Comfort - M2-58, b E/F-speed films and a Spectro x70 b device operating with 70 Kvp and 8 mA, with exposure time of 0.4 second, were developed in an automatic processor and mounted in radiographic charts for individual analysis on a viewing box c without magnification.