Dental Caries Detection in Children Using Intraoral Scanners Featuring Fluorescence: Diagnostic Agreement Study

BACKGROUND Dental caries is a common chronic disease in children, yet large-scale surveillance is limited by the resource demands of clinical examinations. Digital tools like intraoral scanners may offer a scalable alternative for caries detection, enabling more efficient data collection for research and population-level oral health monitoring. OBJECTIVE To assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an intraoral scanner (IOS) in colour and supplemented with fluorescence for caries detection in primary teeth. METHODS Children participating in a clinical trial (n=216, mean age 5.6 years) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS (3Shape TRIOS A/S Denmark). Four trained registered dental practitioners independently assessed each participant’s 3D models in colour, then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again four weeks later. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland–Altman plots were used to visualise agreement. Analyses were performed at the initial (ICDAS>01), moderate (ICDAS>03), and extensive (ICDAS>05) dental caries thresholds. Intraclass Correlation Coefficient (ICC) estimated method agreement and examiner reliability. RESULTS 8,209 visible primary tooth coronal surfaces were analysed. The likelihood of detecting caries using colour assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio 1.1, 95% confidence interval (CI) 1.0–1.3), moderate (0.9, 0.7-1.1) and extensive (1.0, 0.7–1.3). When colour assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (1.3, 1.1-1.5) and similar at the moderate (0.9, 0.7-1.1) and extensive thresholds (0.9, 0.7-1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Examiner reliability using intraoral scans ranged from good to excellent. CONCLUSIONS On-screen assessment of 3D models in colour shows greatest agreement with visual examination for caries detection at all disease thresholds. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12622001237774 INTERNATIONAL REGISTERED REPORT RR2-10.2196/51578

Objectives: This study aimed to assess intra- and inter-examiner reliability of International Caries Detection and Assessment System (ICDAS) and modified epidemiology ICDAS (MOD) code by undergraduate dental students with different clinical experiences. Methods: A total of 150 dental undergraduate students with varying clinical experiences (0, 1 and 2 years of clinical experience) were recruited. Participants received training through a theoretical lecture on ICDAS criteria by an experienced National Benchmark Group (NBG) examiner and underwent e-learning program prior to ICDAS calibration. Visual examination on extracted permanent teeth (N= 45) with different location and stages of caries progression ranging from ICDAS scores 0 to 6, was performed using the ICDAS criteria. The assessments were repeated after one hour. The data were analysed to evaluate inter-examiner and intra-examiner reliability in the form of kappa scores using SPSS 23 Software. Results: Mean kappa values for intra- and inter-examiner reliability for ICDAS code, were between 0.41 to 0.60, and 0.61 to 0.80 respectively. For MOD code, mean kappa values for intra- and inter-examiner reliability were between 0.61 to 0.80. Good intra-examiner agreement (>0.61) was observed in both ICDAS and MOD code for all groups. Conclusion: All students performed similar agreement, therefore, clinical experience within 2 years does not influence the performance of visual inspection in detecting caries using ICDAS. The results of the study shows that ICDAS and modified epidemiology ICDAS codes has good reproducibility and is feasible to be used as a tool in clinical practice as well as patient education.

The International Caries Detection and Assessment System (ICDAS) is a standardised method for recording caries severity. Effective training in ICDAS is essential for dental faculty and students. This pilot study aimed to compare the effectiveness of photographic images versus extracted teeth in ICDAS training and to assess whether restorative and nonrestorative dental faculty achieve similar accuracy in ICDAS coding. Following comprehensive ICDAS training, dental faculty participated in a rotation through diagnostic stations, where they assigned ICDAS codes to tooth surfaces. The specimens consisted of either extracted adult teeth or their corresponding photographic images, each was preassigned a gold standard ICDAS code. Faculty members were categorised as belonging to either restorative or nonrestorative disciplines. After each rotation, individual performance was assessed by calculating linearly weighted Kappa (kw) values comparing each participant's coding to the gold standard. Data were analysed using nonpaired, nonparametric, statistical methods. The study was completed over two end-of-training sessions, one of which included a repeat circuit of stations following a 1 h rest period. With kw scores as measures of ability, dental faculty coded more accurately with extracted teeth carious surfaces than with photographic images (p = 0.0005). When grouped by specialities, there were nearly identical median kw scores (p = 0.482), with extracted teeth suggesting that dental faculty of all types of speciality can use ICDAS effectively. Extracted teeth appear to have value in training ICDAS as well as photographic images. Dental faculty of all types of specialities can use ICDAS effectively after similar amounts of training. This study contributes to the refinement of training strategies for the ICDAS caries detection system, an important component of the dental curriculum and a system which is widely recognised as facilitating effective early reversal of dental caries lesions. Specifically, in this pilot study, the use of extracted teeth as teaching tools appeared to offer additional diagnostic value compared to photographic images, possibly by improving the correct identification of ICDAS codes for early lesions. Also, the study demonstrates that dentists from both restorative and nonrestorative disciplines should be able to successfully adopt, apply and teach ICDAS coding, thereby promoting interdisciplinary collaboration and fostering uniformity in caries management practices.

This paper demonstrates International Caries Detection and Assessment System (ICDAS) training procedures and inter/intra-examiner reliability for lesion severity, activity, and filling criteria in an elementary school setting. ICDAS training was conducted in December 2021 prior to a school-based cluster-randomized controlled trial. A total of 59 children (6-8 years old) in grades 1-2 from one school in Houston, Texas were recruited. Two licensed dentists received a 5-day training from an ICDAS trainer at the participating school. Thirty-eight children were evaluated at least once by each dental trainee, and 18 had repeat examinations. The ICDAS criteria were used to classify dental caries lesion severity (0-6), lesion activity (active/inactive), and filling material (0-9) of all visually available primary and permanent tooth surfaces. Inter and intra-examiner reliability between each dental trainee and the "gold standard" trainer was evaluated using Kappa statistics. For lesion severity, the examination indicated an inter-rater weighted Kappa of 0.77 (95% CI 0.71-0.82) and 0.82 (95% CI 0.77-0.87) for each trainee examiner compared to the gold standard examiner. The Kappas increased slightly from the first to second examinations (lesion-weighted Kappa: 0.76 to 0.84 and 0.82 to 0.84). The intra-rater reliability indicated excellent reliability for lesion and filling (0.83 to 0.94) and moderate for activity (0.58). ICDAS training/calibration were essential to ensure accuracy and reliability of dental caries measurements. The study demonstrated that ICDAS training of dentists with no prior criteria experience is feasible in a community setting and can lead to high reliability and repeatability.

Dental caries remains one of the most prevalent global diseases, and the early detection of occlusal lesions is critical because demineralization often begins deep within pits and fissures where conventional visual–tactile or radiographic inspection cannot detect it. SmarTooth, a newly introduced fluorescence device that irradiates enamel with a 655 nm laser and records the reflected intensity, may provide more objective, quantitative diagnoses. This study assessed its diagnostic performance against the International Caries Detection and Assessment System (ICDAS). We examined 1421 occlusal surfaces from 153 adults, scored each surface with ICDAS codes 0–4, and recorded SmarTooth peak values. Spearman’s rank correlation was used to test the association between codes and peak values; one-way ANOVA with Tukey’s post hoc was used to compare mean values across codes; and sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were calculated at three diagnostic thresholds: D1 (0 vs. 1–4), D2 (0–2 vs. 3–4), and D3 (0–3 vs. 4). The SmarTooth values rose with lesion severity and correlated moderately with ICDAS (r = 0.495, p < 0.001). The AUROC ranged from 0.69 to 0.82, with the best accuracy observed at D2 (cut-off: 7.0; AUC: 0.82; sensitivity: 78.3%; specificity: 77.4%). These findings suggest that SmarTooth can complement ICDAS scoring as an adjunctive tool, potentially enhancing diagnostic accuracy and supporting early intervention for occlusal caries in general dental practice.

To determine whether common polymorphisms in the sweet taste receptor (TAS1R2) and glucose transporter (GLUT2) genes are associated with dental caries, 80 healthy Caucasian individuals aged 21–32 years were genotyped and grouped based on the TAS1R2 (Ile191Val) and GLUT2 (Thr110Ile) polymorphisms. Clinical and radiographic examinations were conducted by a single examiner who was blinded to the genotypes. To assess caries prevalence, three different caries scores were determined: DMFT (decayed, missing, and filled teeth), DMFT + X-ray and ICDAS (International Caries Detection and Assessment System). Associations between genotypes and caries prevalence were analyzed using Student’s t test. Based on the genotypes for each of the GLUT2 and TAS1R2 genes, individuals were stratified into four groups for comparison of caries scores. A higher DMFT score (mean ± SE; 4.3 ± 0.4 vs. 6.1 ± 1.2, p = 0.04) was observed among carriers of the Ile allele for GLUT2 (risk group). Carriers of the Val allele for TAS1R2 (resistant group) demonstrated lower caries scores: DMFT (4.1 ± 0.5 vs. 5.8 ± 0.9, p = 0.05), DMFT + X-ray (4.9 ± 0.6 vs. 7.5 ± 0.9, p = 0.01), and ICDAS (19.5 ± 2.2 vs. 26.14 ± 2.82, p = 0.03). Based on genotype stratification, caries scores were significantly lower in the double resistant group as compared to the double risk groups: DMFT (9.1 ± 0.08 vs. 4.2 ± 0.01, p < 0.01), DMFT + X-ray (10.5 ± 0.07 vs. 5.2 ± 0.01, p < 0.01) and ICDAS (32.9 ± 0.2 vs. 19.9 ± 0.01, p = 0.01). In conclusion, GLUT2 and TAS1R2 genotypes individually and in combination are associated with caries risk. Considering the combination of risk/resistance genotypes might further our understanding of genetic predispositions to dental caries and improve the accuracy of caries prediction models.

The aim of this study was to investigate the in vivo and in vitro validity of International Caries Detection and Assessment System (ICDAS), DIAGNOdent pen and CarieScan PRO in the detection and assessment of occlusal caries in primary teeth. Sixty-four molars were assessed using all three systems under standardised in vivo conditions. They were then extracted and assessed by two examiners in vitro along with an additional 38 teeth (102 teeth in total from 45 children). Downer's histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios and area under the receiver-operator curves were calculated for all caries and dentine caries. Repeatability was analysed using Cohen's Kappa and the performance of the systems between in vivo and in vitro settings by the same examiner were compared. ICDAS showed the highest validity and repeatability. The DIAGNOdent pen's overall clinical validity was comparable to that of ICDAS, but it demonstrated only moderate repeatability. CarieScan PRO had negligible validity in vivo, and there was no relationship between in vivo and in vitro parameters. The in vivo results of ICDAS and DIAGNOdent pen were satisfactory and comparable to those obtained in vitro, with ICDAS performing better. The CarieScan PRO performed poorly under both conditions. ICDAS should be the index of choice when detecting and assessing occlusal caries in the primary dentition, and in vitro data can be safely extrapolated in vivo. The DIAGNOdent pen must be employed with caution. Currently, the CarieScan PRO is unsuitable for use in the primary dentition.

A split-mouth randomized clinical trial was carried out to assess the effectiveness of sealants in preventing carious ICDAS (International Caries Detection and Assessment System) 3–6 lesions within a 2-year follow-up. We evaluated the effectiveness of 2 types of resin-based sealants, with and without fluoride, their retention rates, and the caries risk factors related to their outcomes. The study included 663 tooth pairs in 400 children (aged 5–15 years) considered to be at high individual caries risk (ICR) and presenting permanent molars free of caries or affected by ICDAS 1–2 lesions. In the first randomization, molars were either randomized to the treatment group receiving a dental sealant or the control group (nontreatment), and in the second randomization the sealant material to be used in the intervention group was selected. Uni- and multivariate Cox proportional hazard models were employed. At the 2-year follow-up, 483 tooth pairs were assessed: sealed molars had 83% (adjusted HR = 0.17; 95% CI: 0.15–0.20) less risk of developing ICDAS 3–6 lesions than molars without sealant. The magnitude of the protective effect was lower among teeth with ICDAS 1–2 lesions or with occlusal deep fissures than without. If the total retention rate of sealants was 70% at 2 years, sealant loss was not associated with the risk of caries (HR = 1.29, 95% CI: 0.92–1.79, p = 0.14). Sealants allow the prevention of new ICDAS 3–6 lesions or progression of noncavitated carious lesions in children at high ICR, and the effect of the sealant was similar regardless of whether it contained fluoride or not.

to compare two methods of in vitro examiner calibration in populations and settings where clinical (in vivo) calibration is not practical. Study design was cross-sectional and fully-crossed. The units of analysis were 880 tooth surfaces, from ten children ages 3 to 4 years. The study had three data components: (1) Examiner training and calibration using the International Caries Detection and Assessment System (ICDAS) e-Learning programme (2) In vivo community-based visual examination and (3) Intra-oral digital photographs of the same tooth surfaces from the in vivo visual examination. Kappa and weighted kappa scores were used to study reliability estimates. Systematic differences in caries assessments were determined using the Stuart Maxwell test. Data were analysed using STATA 13.1 and SAS 9.2. Weighted kappa scores for the in vivo component ranged from 0.50 to 0.66 and from 0.64-0.74, for inter- and intraexaminer reliability, respectively. Caries lesions detected in vivo were also detected on photographs, albeit with more false positives when using photographs. For example, of 46 tooth surfaces assessed as being sound in the in vivo examination, 22 (48%) of these were assessed as having caries when photographs were used as the diagnostic method. From this research it appears that good quality photographs alone may be used for training and calibration among challenging populations or settings without adversely affecting data quality.

The International Caries Detection and Assessment System (ICDAS) offers clinical criteria and codes, together with a framework to support and enable personalized comprehensive caries management for improved long-term health outcome. Based on the ICDAS, this publication provides an up-to-date synthesis of the fields of detection, assessment, diagnos

Pulpal blood supply can be measured noninvasively and objectively via laser-Doppler fluxmetry. The aim of the study was to measure and compare pulpal laser-Doppler (LD) flux values for permanent non-carious teeth and carious teeth with different degrees of caries progression. Conventional sensitivity tests were also conducted for a comparative analysis to clarify the difference between tooth sensitivity and vitality. Carious lesions were detected and assessed in 15 adult subjects using the International Caries Detection and Assessment System (ICDAS) criteria. Pulpal sensitivity of selected carious teeth (without previous prosthetic restoration or endodontic treatment) and suitable caries-free teeth were then tested with a cold stimulus and subsequently with a weak electric current, whereas their pulpal LD flux was recorded at a separate visit using individually designed silicone probe holders. The LD flux values for teeth with an ICDAS score 6 were significantly lower compared to the values for teeth with an ICDAS score 1 (p < 0.05). Pulpal LD flux values of teeth with active caries were significantly lower than those of teeth with solely inactive carious lesions (p < 0.05). The degree of agreement between sensitivity and vitality testing was fair within both of the pairs: cold test/LDF (κk = 0.232, p = 0.00) and electric test/LDF (κk = 0.354, p = 0.00). Pulpal LD flux measurement proved to be reliable in the pulp vitality assessment of carious and non-carious teeth and might improve the reliability of clinical decisions when used in addition to standard clinical diagnostic protocols.

Dental caries is a complex multifactorial disease of the calcified tissues of the teeth, caused by interaction of various factors including the host, agent, substrate and time as demonstrated by the Keyes circle. Detecting carious lesion at the earliest possible stage of its development is definitely helpful in appropriate treatment planning for the same. The lack of consistency among the contemporary criteria systems for detecting carious lesions limits the comparability of outcomes measured in epidemiological and clinical studies. Therefore, the ICDAS criteria was developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. It is a clinical scoring system for use in dental education, clinical practice, research, and epidemiology, and provides a framework to support and enable personalized total caries management for improved long-term health outcomes.

Fluoride varnish application is an effective intervention in controlling dental caries. Objective of this study was to evaluate the effectiveness of six monthly application of sodium fluoride varnish in prevention of dental caries in deciduous teeth, permanent incisors and molars in children between six and seven years in a low resource setting, Sri Lanka. This was an open-label, randomized controlled trial (NCT02877888) in school children aged six to seven years, living in a district of Sri Lanka. Recruited children were randomly assigned to either a treatment (n=161) or to control group (n=162). Children in the treatment group received fluoride varnish professionally applied every 6 months combined with counselling on maintenance of oral hygiene and diet for a period of 2 years. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The primary outcome studied was the number of new caries in the two study groups. At each time interval, the mean number of new dental caries was significantly lower in the intervention group. When independent effect of the intervention on development of new dental caries was assessed, application of fluoride varnish every 6 months for a period of 2 years was significantly associated with less number of new dental caries compared to controls. Fluoride varnish application in a low resource setting is an effective method of preventing dental caries among children. A national level programme would contribute to the reduction of dental caries in this age group. Keywords: Clinical trial, Fluoride varnish, Dental caries, Caries prevention, Effectiveness

This study compared the performance of fluorescence-based methods, radiographic examination, and International Caries Detection and Assessment System (ICDAS) II on occlusal surfaces. One hundred and nineteen permanent human molars were assessed twice by 2 experienced dentists using the laser fluorescence (LF and LFpen) and fluorescence camera (FC) devices, ICDAS II and bitewing radiographs (BW). After measuring, the teeth were histologically prepared and assessed for caries extension. The sensitivities for dentine caries detection were 0.86 (FC), 0.78 (LFpen), 0.73 (ICDAS II), 0.51 (LF) and 0.34 (BW). The specificities were 0.97 (BW), 0.89 (LF), 0.65 (ICDAS II), 0.63 (FC) and 0.56 (LFpen). BW presented the highest values of likelihood ratio (LR)+ (12.47) and LR– (0.68). Rank correlations with histology were 0.53 (LF), 0.52 (LFpen), 0.41 (FC), 0.59 (ICDAS II) and 0.57 (BW). The area under the ROC curve varied from 0.72 to 0.83. Inter- and intraexaminer intraclass correlation values were respectively 0.90 and 0.85 (LF), 0.93 and 0.87 (LFpen) and 0.85 and 0.76 (FC). The ICDAS II ĸ values were 0.51 (interexaminer) and 0.61 (intraexaminer). The BW ĸ values were 0.50 (interexaminer) and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 and 40.0 (LFpen) and 1.12 and 0.80 (FC), for intra- and interexaminer reproducibilities. The posttest probability for dentine caries detection was high for BW and LF. In conclusion, LFpen, FC and ICDAS II presented better sensitivity and LF and BW better specificity. ICDAS II combined with BW showed the best performance and is the best combination for detecting caries on occlusal surfaces.

ABSTRACTObjectivesThis study assessed dental caries prevalence and dietary habits among elite athletes in Ireland, and analysed dietary intake with particular focus on potentially cariogenic foods and nutrients to determine associations between potentially cariogenic dietary factors and dental caries prevalence using cluster analysis.MethodsA cross‐sectional study was conducted on a convenience sample of elite athletes. Oral examinations were performed by calibrated examiners using validated indices, including the International Caries Detection and Assessment System (ICDAS) to assess dental caries at both individual and tooth levels. Demographics and lifestyle metrics were recorded using a web‐based platform, while dietary information was collected using multiple 24‐h dietary recalls (24HR) via FoodBook24. Clustering, profiling of clusters and and binary logistic regression were used to determine if associations exist between dental caries prevalence and potentially cariogenic food groups or nutrients.ResultsEighty‐eight athletes from seven sports participated, with a mean age of 25.6 years (SD 5.7) and 63% male. The prevalence of untreated dental caries (ICDAS ≥ 3) was 90% at an individual level (presence of caries in any tooth in an individual) and 13% at tooth level (percentage of teeth affected in the population). The mean energy intake was 2678 ± 1352 kcal/day, mean sugar intake was 128 ± 94 g/day and mean starch intake was 169 ± 90 g/day. Cluster analysis identified two distinct groups based on caries prevalence, diet, age, gender, and ethnicity. Binary logistic regression revealed a significant association between cariogenic starch intake from snacks and cluster membership (p = 0.005).ConclusionsThe study found a high prevalence of untreated carious lesions in this cohort, exceeding previously reported levels for elite athletes. Cluster analysis revealed that nutrient consumption patterns, particularly the timing of starch intake, may provide insights beyond those offered by traditional food‐group classifications for understanding dietary factors associated with caries risk. These findings underscore the need for prioritising dietary advice and caries prevention strategies in this population, with particular attention on snacking patterns rather than focusing solely on cariogenic food categories.