Sbu • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care

Author

Year, ref-

erence

Country

Type 

of 

study

Blin-

ding

Num-

ber of 

obser-

vers

Obser-

ver

relia-

bility

Popu-

lation

Caries 

preval-

ence and 

type of 

lesions

Num-

ber of 

indivi-

duals

Num-

ber of 

teeth

Drop-

out/

missing 

data

Method 

or tech-

nique

Com-

parison 

method

Out-

come 

measure

Results 

enamel 

caries

Results 

dentine 

caries

Study 

quality 

and rele-

vance

Com-

ments

Verdon- 

schot et al

1993 [25]

The 

Nether-

lands

Valid-

ity, 

relia-

bility

Yes

4

Not 

reported

Molars

from 

Danish

recruits, 

18–20 yrs

27 (33%)

sound +

enamel

26 (32%)

D3

28 (35%)

D4

81 teeth

Not 

repor-

ted

VI

Histology, 

(1 obser-

ver?)

Se, Sp, 

PPV, NPV

–

Se: 48%

Sp: 89%

At a 67% 

caries pre-

valence

PPV: 0.90

NPV: 0.46

At a 20% 

caries pre-

valence

PPV: 0.53

NPV: 0.46

Low

Wenzel 

et al

1991 [26]

Denmark

Valid-

ity, 

relia-

bility

Yes

8

Not 

reported

Molars and

premolars 

from a 

pool

84 (51%)

sound +

enamel

55 (33%)

D3

27 (16%)

D4

166 

teeth, 

145 

molars, 

21 pre-

molars

Not 

repor-

ted

VI

Histo-

logy, 1 

observer 

validated 

25 of the 

specimens 

twice

PPV, NPV,

LR

–

PPV mean:

0.85

NPV mean:

0.56

LR mean:

6.50

Low

105

K A P I T E L   4   •   d I A g n o s T I K

Author

Year, ref-

erence

Country

Type 

of 

study

Blin-

ding

Num-

ber of 

obser-

vers

Obser-

ver

relia-

bility

Popu-

lation

Caries 

preval-

ence and 

type of 

lesions

Num-

ber of 

indivi-

duals

Num-

ber of 

teeth

Drop-

out/

missing 

data

Method 

or tech-

nique

Com-

parison 

method

Out-

come 

measure

Results 

enamel 

caries

Results 

dentine 

caries

Study 

quality 

and rele-

vance

Com-

ments

Verdon- 

schot et al

1993 [25]

The 

Nether-

lands

Valid-

ity, 

relia-

bility

Yes

4

Not 

reported

Molars

from 

Danish

recruits, 

18–20 yrs

27 (33%)

sound +

enamel

26 (32%)

D3

28 (35%)

D4

81 teeth

Not 

repor-

ted

VI

Histology, 

(1 obser-

ver?)

Se, Sp, 

PPV, NPV

–

Se: 48%

Sp: 89%

At a 67% 

caries pre-

valence

PPV: 0.90

NPV: 0.46

At a 20% 

caries pre-

valence

PPV: 0.53

NPV: 0.46

Low

Wenzel 

et al

1991 [26]

Denmark

Valid-

ity, 

relia-

bility

Yes

8

Not 

reported

Molars and

premolars 

from a 

pool

84 (51%)

sound +

enamel

55 (33%)

D3

27 (16%)

D4

166 

teeth, 

145 

molars, 

21 pre-

molars

Not 

repor-

ted

VI

Histo-

logy, 1 

observer 

validated 

25 of the 

specimens 

twice

PPV, NPV,

LR

–

PPV mean:

0.85

NPV mean:

0.56

LR mean:

6.50

Low

K A R I E S   –   d I A G N O S T I K ,   R I S K B E d ö M N I N G   O C H   I C K E - I N vA S I v   B E H A N d L I N G

106

Table 4.1.7 Excluded studies.

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Extracted teeth

Alwas-Danowska et al, 2002 [27] VI, LF

Occlusal

Not validated

Ando et al, 2000 [28]

VI, LF ECM, QLF

Occlusal

Small sample

Ando et al, 2004 [10]

VI, LF, QLF

Smooth 

surfaces, 

proximal

Small sample

Ashley et al, 1998 [29]

VI, FOTI, BW,

ECM

Occlusal

<3 examiners

Ashley, 2000 [30]

VI, ECM

Occlusal, 

primary

<3 examiners

Attrill et al, 2001 [31]

VI, LF, BW

Occlusal, 

primary

<3 examiners

Cayley et al, 1997 [32]

VI+BW

Molars

VI can not be  

separated

Chong et al, 2003 [33]

VI, BW, LF

Occlusal

<3 examiners

Côrtes et al, 2000 [34]

VI, FOTI

Occlusal

Small sample        

Côrtes et al, 2003 [35]

VI, FOTI, LF, ECM

Occlusal

<3 examiners

Ekstrand et al, 1995 [36]

VI

Occlusal

<3 examiners

El-Housseiny et al, 2001 [37]

VI, VIP

Occlusal

Small sample

Erten et al, 2006 [38]

VI, VIM, VI

Camera

Occlusal

Incomplete end-

point measure

Espelid et al, 1991 [11]

VI, BW

Secondary, 

proximal

VI cannot be  

separated  

from BW

Ferreira Zandoná et al, 1998 [39] VI, LF

Occlusal

<3 examiners

Hintze et al, 2003 [40]

VI, BW

Occlusal, 

proximal

<3 examiners

Jeon et al, 2004 [41]

VI, LF, BW

Occlusal

Small sample

Ketley et al, 1993 [42]

VI, BW

Occlusal

<3 examiners

Kidd et al, 2003 [43]

VI

Occlusal, 

proximal

<3 examiners

Mendes et al, 2006 [44]

VI, VIM, LF, BW

Occlusal, 

primary

<3 examiners

The table continues on the next page

107

K A P I T E L   4   •   d I A g n o s T I K

Table 4.1.7 continued

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Peers et al, 1993 [45]

VI, BW, FOTI

Proximal

<3 examiners

Pereira et al, 2001 [46]

VI, LF, ECM

Occlusal

<3 examiners

Reis et al, 2004 [47]

VI

Occlusal

Small sample

Ricketts et al, 1995 [48]

VI

Occlusal

Small sample

Ricketts et al, 1997 [49]

VI, ECM

Occlusal

<3 examiners

Sikri et al, 1991 [50]

VI, BW

Root

<3 examiners

Souza-Zaroni et al, 2006 [51]

VI, LF, BW

Occlusal

Small sample

Thomas et al, 2000 [52]

VIP, VI + dying

Occlusal

Incomplete end-

point measure

Tonioli et al, 2002 [53]

VI, BW, LF, CDD

Occlusal

Small sample

Tveit et al, 1992 [12]

VI

Proximal

Not answering  

the question

Wenzel et al, 1992 [54]

VI, FOTI, BW

Occlusal

See Verdonschot  

et al 1993 [25]

Verdonschot et al, 1991 [55]

VI, BW

Proximal

Small sample

Wicht et al, 2002 [56]

VI

Root

<3 examiners

Virajsilp et al, 2005 [57]

VI, LF

Proximal

<3 examiners

Clinical studies

Amerise et al, 2001 [58]

VI, BW

Occlusal

Not validated

Anttonen et al, 2003 [59]

VI, LF

Occlusal

1 examiner,  

not validated

Anttonen et al, 2004 [60]

VI, LF

Occlusal

1 examiner

Anttonen et al, 2005 [61]

VI, LF

Occlusal

1 examiner

Assaf et al, 2004 [62]

CE

All

1 examiner

Banerjee et al, 2000 [63]

–

–

Not adequate  

for the question

Bauer et al, 1988 [64]

CE

Root

Not adequate  

for the question

Bjarnason et al, 1996 [65]

CE, BW

Smooth 

surfaces, 

proximal

1 examiner

Chesters et al, 2002 [66]

CE, BW, FOTI

All

1 examiner

The table continues on the next page

K A R I E S   –   d I A G N O S T I K ,   R I S K B E d ö M N I N G   O C H   I C K E - I N vA S I v   B E H A N d L I N G

108

The table continues on the next page

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Cleaton-Jones et al, 2001 [67]

VI, VIP, FOTI

Primary

Not validated

Deery et al, 2000 [68]

CE, FOTI, ECM, TS All

1 examiner

Disney et al, 1992 [69]

CE

All

Not adequate  

for the question

Ekstrand et al, 1998 [70]

CE

Occlusal

Activity not  

validated

Ekstrand et al, 2005 [71]

VI, VIT

Initials

Small sample,  

pilot study

Fennis-Ie et al, 1998 [72]

VI, FOTI, ECM

Occlusal

1 examiner

Fracaro et al, 2001 [73]

CE, BW

Occlusal

Different examiners

Fyffe et al, 2000 [74]

VI

All

Not validated

Galal et al, 1985 [75]

CE, VIP, BW

All

1 examiner

Heinrich-Weltzien, 2002 [76]

VI, LF, BW

Occlusal

1 examiner

Heinrich-Weltzien, 2003 [77]

VI, LF

Occlusal

1 examiner

Katz et al, 2004 [78]

CE, FOTI, ECM

All

Not adequate  

for the question

Longbottom et al, 1990 [79]

VI, endoscope

Posterior

Small sample,  

one examiner

Lunder et al, 1996 [80]

BW

Proximal

1 examiner

Lussi et al, 2001 [81]

VI, BW, LF

Occlusal

Different examiners

Machiulskiene et al, 1999 [82]

CE, BW

Proximal

1 examiner,  

not validated

Machiulskiene et al, 2004 [83]

CE, BW

All

1 examiner,  

not validated

Mialhe et al, 2003 [84]

VI, FOTI, BW, TS

Proximal

1 examiner

Mojon et al, 1995 [85]

CE

Root, crown Not validated

Nyvad et al, 2003 [86]

VI

All   

Does not fulfill

inclusion criteria

Pitts et al, 1992 [87]

CE

Proximal,  

posterior

1 examiner

Table 4.1.7 continued

109

K A P I T E L   4   •   d I A g n o s T I K

Table 4.1.7 continued

Author, year, reference

Diagnostic  

methods

Caries, 

type 

Main reason

for exclusion

Ratledge et al, 2001 [88]

CE, BW

Proximal

1 examiner

Richardson et al, 1996 [89]

CE, BW

Occlusal,  

proximal

Not validated

Ricketts et al, 1995 [90]

CE, BW, ECM

Occlusal

1 examiner

Ricketts et al, 1995 [91]

VI, BW, ECM

Occlusal

1 examiner

Ricketts et al, 2002 [92]

VI, BW

Occlusal

1 examiner

Rosén et al, 1996 [93]

CE

Crown, root Small sample,  

not validated

Sheehy et al, 2001 [94]

VI, LF

Occlusal

1 examiner

Tetuan et al, 2005 [95]

VI, LF

All

Endpoint not  

applicable

Thompson et al, 2006 [96]

VI

All

1 examiner

Waly, 1995 [97]

CE, FOTI, BW

Proximal,  

primary

1 examiner

Wenzel et al, 1990 [98]

VI, BW, dBW

Occlusal, 

3rd molar

1 examiner for  

each method

Wolwacz et al, 2004 [99]

VI, BW

Occlusal,  

primary

1 examiner

de Vries et al, 1990 [100]

VI, BW

Proximal

Not validated

BW = Bitewing radiographs; CDD = Caries detection dye; CE = Clinical examination;

dBW = Digital bitewing radiographs; ECM = Electronic caries measurement, electrical

conductance measurements; FOTI = Fibre optic transillumination; LF = Laser fluores-

cence; QLF = Quantitative light-induced fluorescence; TS = Tooth separation; VI = Visual

inspection; VI Camera = Visual inspection with camera; VIM = Visual inspection with

magnification; VIP = Visual inspection and probing

K A R I E S   –   d I A G N O S T I K ,   R I S K B E d ö M N I N G   O C H   I C K E - I N vA S I v   B E H A N d L I N G

110

Tabell 4.1.8 Fördelning av inkluderade studier  

med avseende på typ av studier och tandyta.

Yta/kariestyp

Primära tänder

Extraherade    I munnen

Permanenta tänder

Extraherade       I munnen

På tuggytan

1

1

14

3*

Approximalt

–

–

3

2

Aktivitet/progression

–

–

–

–

Rotytekaries

–

–

–

–

Sekundärkaries

–

–

–

–

  

Tabell 4.1.9 Medelvärde (± standardavvikelse) och spridning av redovisade 

utfallsmått vid diagnostik av emalj- och dentinkaries på de bakre tändernas 

tuggytor med hjälp av visuell-taktil undersökning. ”n” anger antalet inkluderade 

undersökningar som ligger till grund för beräkningarna.

Utfallsmått

n

Emaljkaries

n

Dentinkaries

Sensitivitet

6

0,64±0,26 (0,43–1,0)

12

0,44±0,29 (0,10–0,95)

Specificitet

5

0,65±0,21 (0,38–0,92)

11

0,91*±0,09 (0,68–0,99)

PPV

3

0,64± 0,34 (0,29–0,97)

6

0,74±0,22 (0,31–0,97)

NPV

3

0,54±0,48 (0,04–1,0)

6

0,69±0,21 (0,46–0,96)

* Dessa studier baseras på ett och samma material.

* Statistiskt säkerställd skillnad mellan emalj- och dentinkaries (p<0,01, Student’s  

two-tailed t-test; skillnad i medelvärde 0,26, 95% konfidensintervall 0,10–0,42).

NPV = Negativt prediktionsvärde; PPV = Positivt prediktionsvärde

 

111

K A P I T E L   4   •   d I A g n o s T I K

Yta/kariestyp

Primära tänder

Extraherade    I munnen

Permanenta tänder

Extraherade       I munnen

På tuggytan

1

1

14

3*

Approximalt

–

–

3

2

Aktivitet/progression

–

–

–

–

Rotytekaries

–

–

–

–

Sekundärkaries

–

–

–

–

  

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