Fluorescence-based caries detection methods need more work to establish diagnostic accuracy

shutterstock_34500700 - caries sign

Earlier this week (Dental Elf 15th Oct 2013) we looked at a systematic review that looked at a range of the newer aids for detecting caries.  The aim of this review was to synthesize the findings about the accuracy of fluorescence-based methods in detecting caries lesions on occlusal, approximal and smooth surfaces of both permanent and primary teeth

The Medline, Embase and Scopus databases were searched together with OpenSIGLE and the Annals of ORCA Congress (European Organisation for Caries Research) for the last 10 years. The reference lists of included articles were also searched.   Two reviewers independently assessed studies with data being extracted by one reviewer and independently verified.   Studies that assessed the accuracy of fluorescence-based methods for caries detection in primary, permanent teeth in the laboratory or clinical setting that used a reference standard were included. A modified QUADAS (Quality assessment of studies of diagnostic performance included in systematic reviews) checklist was used to assess the quality of included studies. A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve[sROC]). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated.

  • Seventy-five studies met the inclusion criteria.
  • In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings.
  • There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions.
  • We also observed moderate to high heterogeneity and evidenced publication bias.

The authors concluded

Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed.


This review pulls together a large number of studies of these fluorescence-based technologies. The analysis for this study uses sROC analysis and Diagnostic odds ratios. While these types of analysis are useful for the meta-analysis they are not so readily interpreted by the clinician. Those with a particular interest in this area might like to look at the Cochrane Diagnostic Test Accuracy Working Group Handbook, which is currently in development.   The combined use of both clinical and laboratory studies is also likely to mean that the conclusions cannot easily be translated to the clinical situation. Consequently, the conclusions presented by the review we considered earlier this week is more likely to be relevant in that there is still insufficient evidence for their diagnostic accuracy.


Gimenez T, Braga MM, Raggio DP, Deery C, Ricketts DN, Mendes FM. Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity. PLoS One. 2013 Apr 4;8(4):e60421. doi: 10.1371/journal.pone.0060421. Print 2013. PubMed PMID: 23593215; PubMed Central PMCID: PMC3617206.

Cochrane Diagnostic Test Accuracy Working Group Handbook    

Dental Elf -15th Oct 2013 – Little evidence for the diagnostic accuracy of new caries detection aids


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