Cochrane · DTA · CD013806
Tests to detect and inform the diagnosis of root caries
Fee, PA, Macey, R, Walsh, T, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
10
current version
GRADE rated
8
No studies
2
Included studies
4
as reported
No studies 2 · 20%Ungraded 0 · 0%Very low 8 · 80%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults seemingly asymptomatic for root caries (in vivo); extracted teeth of adults (in vitro). Studies explicitly recruiting participants with root caries lesions, or participants referred to secondary care for restorative treatment, were excluded; studies with artificially created carious lesions were excluded | 4997 root surfaces from 4 cross-sectional studies (published 2009 to 2016); 2 in vivo studies in Hong Kong (community-dwelling elders over 60; primary root caries) and 2 in vitro studies in Switzerland (extracted restored teeth; secondary root caries); root caries prevalence 5% to 67% (n=4997) |
| Intervention | Visual or visual-tactile examination; Intra and extraoral radiographs (conventional film and digital imaging); Fluorescence-based devices (laser fluorescence and quantitative light-induced fluorescence, QLF); Electrical conductance; Fibre-optic transillumination (including white light scattering and near infrared); Any new innovative test | Laser fluorescence (DIAGNOdent and DIAGNOdent pen) (n=4); Radiographic examination (bitewing) (n=2); Visual examination (n=1); Radiograph and visual examination combined (n=1) |
| Comparison | Reference standard: histology or enhanced visual-tactile examination (visual-tactile examination included as an index test only where histology was the reference standard); comparator index test or index tests in combination | Histology (n=2); Visual-tactile examination (n=2) |
| Outcomes | Diagnostic test accuracy (sensitivity and specificity with 95% CI) for detecting/diagnosing root caries; comparative accuracy of index tests; accuracy of single tests versus tests in combination | Sensitivity and specificity per index test (8 datasets); no meta-analysis/pooling performed (n=4997 root surfaces) |
| Study designs | Diagnostic test accuracy study designs comparing a test with a reference standard; prospective studies of single index tests; studies directly comparing two or more index tests; RCTs of test accuracy; case-control type accuracy studies. In vitro and in vivo eligible; tooth/surface-level reporting for primary analysis | Cross-sectional diagnostic test accuracy studies (n=4) |
| Timing | In vivo: interval between index test and reference standard less than 3 months; in vitro: no time limit if teeth stored appropriately | Not specified |
Search date: 2018-12. Databases: MEDLINE Ovid; Embase Ovid
Questions and results
Laser fluorescence (DIAGNOdent and DIAGNOdent pen) vs Reference standard: histology (in vitro studies) or visual-tactile examination (in vivo studies)
Population: Adults presenting asymptomatically or suspected of having root caries (in vivo studies); extracted teeth of adults (in vitro studies). 2 in vivo studies in community-dwelling elders over 60 years (Hong Kong; primary root caries) and 2 in vitro studies (Switzerland; extracted restored teeth; secondary root caries)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity | 4 studies (4997 root surfaces) investigated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. 2 studies evaluated tests on in vivo primary… | 4 studies | Very low Downgraded: risk of bias, imprecision |
Sensitivity | 4 studies (4997 root surfaces) investigated laser fluorescence and reported estimates of sensitivity ranging from 0.50 to 0.81 and specificity ranging from 0.40 to 0.80. 2 studies evaluated tests on in vivo primary… | 4 studies | Very low Downgraded: risk of bias, imprecision |
Radiographic examination (bitewing radiographs) vs Reference standard: histology
Population: Extracted teeth of adults with restored approximal surfaces (in vitro studies; secondary root caries; Switzerland)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity | 2 in vitro studies (59 root surfaces) using extracted, restored teeth and a histological reference standard investigated the accuracy of radiographs. Reported estimates of sensitivity ranged from 0.40 to 0.63 and… | 2 studies | Very low Downgraded: risk of bias, imprecision |
Sensitivity | 2 in vitro studies (59 root surfaces) using extracted, restored teeth and a histological reference standard investigated the accuracy of radiographs. Reported estimates of sensitivity ranged from 0.40 to 0.63 and… | 2 studies | Very low Downgraded: risk of bias, imprecision |
Visual examination vs Reference standard: histology
Population: Extracted molar teeth of adults with resin composite approximal restorations (in vitro; secondary root caries; Switzerland)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity | Specificity 0.38 [0.14, 0.68] | 1 study | Very low Downgraded: risk of bias, imprecision |
Sensitivity | Sensitivity 0.75 [0.48, 0.93] | 1 study | Very low Downgraded: risk of bias, imprecision |
Radiograph and visual examination in combination vs Reference standard: histology
Population: Extracted molar teeth of adults with resin composite approximal restorations (in vitro; secondary root caries; Switzerland)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Specificity | Specificity 0.54 [0.25, 0.81] | 1 study | Very low Downgraded: risk of bias, imprecision |
Sensitivity | Sensitivity 0.81 [0.54, 0.96] | 1 study | Very low Downgraded: risk of bias, imprecision |
Electrical conductance (e.g. electronic caries monitor, ECM) vs Reference standard: histology or enhanced visual-tactile examination
Population: Adults presenting asymptomatically or suspected of having root caries (in vivo); extracted teeth of adults (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Electrical conductance was a pre-specified eligible index test but no diagnostic test accuracy study of electrical conductance was included. A study evaluating the electronic caries monitor (ECM) (Wicht 2002) was… | 0 studies | No studies |
Fibre-optic transillumination (FOTI, including white light scattering and near infrared) vs Reference standard: histology or enhanced visual-tactile examination
Population: Adults presenting asymptomatically or suspected of having root caries (in vivo); extracted teeth of adults (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Fibre-optic transillumination was a pre-specified eligible index test but no diagnostic test accuracy study of fibre-optic transillumination was included. | 0 studies | No studies |