The comparison of caries detection agreement between smartphone imaging and visual examination in primary school students

Abstract

This study aimed to compare caries detection agreement between smartphone imaging and visual examination using the International Caries Detection and Assessment System (ICDAS). Sixty-two primary school students (86.1% of the student population), aged 6 to 12 years, were recruited for the study. One experienced dentist performed the visual examination by clinically assessing the lower first permanent molars and upper anterior permanent incisors and then examined blinded and randomly intra-oral photographs from a smartphone on the computer screen. The weighted kappa, sensitivity, specificity, and percentage of error were analyzed. The weighted kappa of caries detection between smartphone photographs and visual examination was 1.0 for anterior and 0.8 for posterior teeth, showing high agreement in caries detection. There was no misdiagnosis for severe caries of the ICDAS-5 and 6. Nevertheless, errors at a percentage lower than 50% were found when differentiating the diagnosis of initial caries at ICDAS-2, 3, or 4 lesions in dentin. The most visualized surfaces, the occlusal surface of lower molars and the labial surface of upper incisors, showed higher sensitivity (96.8% and 100%, respectively) than specificity (95.9% and 99.4%, respectively) for caries detection. In contrast, the buccal surface of molars had higher specificity (86.4%) than sensitivity (75.0%). These findings suggested that when one examiner performed caries detection in permanent lower molars and upper incisors using smartphone intra-oral photographs was accurate compared to visual examination. Smartphone photography might be an alternative tool for caries assessment in permanent teeth, especially in deprived areas.