Cochrane · DTA · CD013811
Fluorescence devices for the detection of dental caries
Macey, R, Walsh, T, Riley, P, 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
28
current version
GRADE rated
3
No studies
1
Included studies
133
as reported
No studies 1 · 3.6%Ungraded 24 · 85.7%Very low 0 · 0%Low 3 · 10.7%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 | Participants seemingly asymptomatic for dental caries, including those who may have carious lesions undetected at enrolment; children, adolescents, and adults all eligible; participants explicitly recruited with caries into dentine or frank cavitation were excluded | 21,283 tooth surfaces from 79 studies in the meta-analysis (114 datasets); 133 studies in the review; 62% (83/133) performed on extracted teeth (in vitro); permanent dentition (70) and primary dentition (40); studies published 1998-2019 |
| Intervention | Fluorescence-based devices used alone or as an adjunct to a conventional visual examination (red fluorescence: DIAGNOdent, DIAGNOdent pen, MidWest, Canary System; blue fluorescence: VistaProof, SoproLife, Spectra; green fluorescence: QLF) | Red fluorescence (n=84 datasets; DIAGNOdent n=46, DIAGNOdent pen n=34, MidWest n=4); Blue fluorescence (n=21 datasets; VistaProof n=18, SoproLife n=3); Green fluorescence/QLF (n=9); Combined visual+radiograph+DIAGNOdent (n=1) |
| Comparison | Reference standard: histology; enhanced visual examination; radiographs; excavation; composite reference standards also accepted | Histology (n=78 datasets); Enhanced visual assessment (n=25); Radiograph (n=6); Excavation (n=5) |
| Outcomes | Diagnostic test accuracy (sensitivity and specificity) for detection/diagnosis of coronal early/initial (non-cavitated) enamel caries at the D1 threshold; QUADAS-2 quality | Diagnostic accuracy at enamel (D1) threshold (n=114 datasets): DOR 14.12 (95% CI 11.17 to 17.84); sensitivity 0.70 (0.64 to 0.75) at fixed specificity 0.78 and 0.60 (0.54 to 0.65) at fixed specificity 0.90 |
| Study designs | Diagnostic accuracy study designs (single-gate studies comparing a fluorescence test with a reference standard; RCTs of diagnostic test accuracy; case-control accuracy studies); in vitro and in vivo | All included studies were cross-sectional single-gate design; no case-control or randomised controlled trials were identified |
| Timing | A period of up to three months between the index test and the reference standard was deemed acceptable | Not reported |
Search date: 2019-05. Databases: MEDLINE Ovid; Embase Ovid; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
All fluorescence-based devices (red, blue, and green fluorescence combined) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic odds ratio (DOR) by subgroup: Medium dentine-caries prevalence (15% to 34%) (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Medium dentine-caries prevalence (15% to 34%) | DOR 15.39 [11.07, 21.41] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Single site per tooth (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Single site per tooth | DOR 15.96 [12.26, 20.77] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Histology or excavation reference standard (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Histology or excavation reference standard | DOR 13.49 [10.25, 17.76] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Permanent/mixed dentition (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Permanent/mixed dentition | DOR 15.21 [11.35, 20.37] | NR | Ungraded |
Sensitivity at fixed upper-quartile specificity 0.90 (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.60 [0.54, 0.65] | 79 studies | Low Downgraded: risk of bias, inconsistency, indirectness |
Diagnostic odds ratio (DOR) by subgroup: Enhanced visual examination reference standard (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Enhanced visual examination reference standard | DOR 19.32 [12.37, 30.17] | NR | Ungraded |
Diagnostic odds ratio (DOR) (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | DOR 14.12 [11.17, 17.84] | 79 studies | Low Downgraded: risk of bias, inconsistency, indirectness |
Sensitivity at fixed median specificity 0.78 (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.70 [0.64, 0.75] | 79 studies | Low Downgraded: risk of bias, inconsistency, indirectness |
Diagnostic odds ratio (DOR) by subgroup: Low dentine-caries prevalence (<=14%) (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Low dentine-caries prevalence (<=14%) | DOR 11.10 [6.88, 17.91] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Radiography reference standard (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Radiography reference standard | DOR 6.21 [2.58, 14.97] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: High dentine-caries prevalence (>=35%) (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · High dentine-caries prevalence (>=35%) | DOR 14.59 [9.18, 23.22] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Primary dentition (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Primary dentition | DOR 12.34 [8.44, 18.04] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Multiple sites per tooth (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Multiple sites per tooth | DOR 9.46 [5.91, 15.14] | 18 studies | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Smooth or secondary-caries surfaces (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Smooth or secondary-caries surfaces | DOR 13.41 [5.58, 32.25] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Proximal surfaces (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces | DOR 13.06 [7.52, 22.67] | NR | Ungraded |
Diagnostic odds ratio (DOR) by subgroup: Occlusal surfaces (detection of early enamel caries, D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces | DOR 14.29 [10.92, 18.72] | NR | Ungraded |
Red fluorescence devices (DIAGNOdent, DIAGNOdent pen, MidWest; excitation wavelength >655 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic odds ratio (DOR) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | DOR 12.75 [9.74, 16.68] | 68 studies | Ungraded |
Blue fluorescence devices (VistaProof, SoproLife, Spectra; wavelength 400-450 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic odds ratio (DOR) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | DOR 18.47 [10.59, 32.20] | 20 studies | Ungraded |
Green fluorescence devices (quantitative light-induced fluorescence, QLF; wavelength ~370-405 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic odds ratio (DOR) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | DOR 19.49 [9.01, 42.18] | 9 studies | Ungraded |
DIAGNOdent (KaVo; red laser fluorescence, 655 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 46 datasets, 7316 tooth sites. | 45 studies | Ungraded |
DIAGNOdent pen (KaVo; red laser fluorescence, 655 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 34 datasets, 6842 tooth sites. | 32 studies | Ungraded |
VistaProof (Durr Dental; blue fluorescence, 405 nm) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Analysed as a separate index test (coupled forest plot and SROC plot, Figure 24 / Figure 25; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 18 datasets, 2402 tooth sites. | 17 studies | Ungraded |
SoproLife (ACTEON; blue fluorescence) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Analysed as a separate index test (coupled forest plot and SROC plot, Figure 24 / Figure 25; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 3 datasets, 1027 tooth sites. | 3 studies | Ungraded |
MidWest (DENTSPLY; red fluorescence, red/green light and sound signal) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Analysed as a separate index test (coupled forest plot and SROC plot, Figure 22 / Figure 23; Appendix 5); no summary DOR or sensitivity/specificity point reported numerically in the text. 4 datasets, 356 tooth sites. | 4 studies | Ungraded |
Combined index test: visual examination + radiograph + DIAGNOdent (Alomari 2015) vs Reference standard: histology
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sensitivity for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Sensitivity 0.82 [0.75, 0.88] | 1 study | Ungraded |
Specificity for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | Specificity 0.65 [0.38, 0.86] | 1 study | Ungraded |
Canary System (Quantum Dental Technologies; red fluorescence, scale 0-100) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Up to 3 months between index test and reference standard (in vivo studies) | The Canary System was not used by any included study. | 0 studies | No studies |
Spectra caries detection device (Air Techniques; blue fluorescence) vs Reference standard: histology, enhanced visual examination with or without radiographs, or excavation
Population: Children or adults presenting asymptomatically or suspected of having enamel caries (in vivo/clinical studies); extracted teeth of children or adults (in vitro studies); participants explicitly recruited with caries into dentine or frank cavitation were excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diagnostic accuracy (sensitivity and specificity) for detection of early enamel caries (D1 threshold) Up to 3 months between index test and reference standard (in vivo studies) | The Spectra caries detection device fits into the blue fluorescence category but no studies provided data for inclusion in the meta-analysis (Markowitz 2015). | 1 study | Ungraded |