A Comparison of Clinical and Radiographic Caries Diagnoses in Posterior Teeth of 12–Year–Old Lithuanian Children

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Abstract
Bite–wing radiography has been recommended for use in adolescents as clinical examinations alone may lead to underestimation of carious lesions in approximal and occlusal surfaces. The aim of this study was to describe the relationship between clinical and radiographic caries diagnoses among 12–year–old Lithuanians using a new clinical scoring system which differentiates between cavitated and non–cavitated caries lesions. Eight hundred and seventy–two children were examined clinically and two standardized posterior bite–wing radiographs were taken of each participant. Bite–wing radiography contributed significantly to the total number of lesions diagnosed only at the dentin level in approximal surfaces. Clinical examination performed better than radiographic examination at the non–cavitated/enamel level, particularly on occlusal surfaces. Less than 2% of the clinically sound surfaces were diagnosed with dentin lesions/fillings radiographically. When using the cavitated level of clinical diagnosis, the frequency of ‘hidden’ caries lesions increased from 1.9 to 2.9% in approximal surfaces, and from 1.7 to 5.2% in occlusal surfaces. The intra–examiner reliability data for the clinical and radiographic recordings supported the conclusion of an additional diagnostic value of bite–wings only for approximal surfaces. The findings demonstrate that the diagnostic yield of bite–wing radiography is higher for approximal than for occlusal surfaces. The efficacy of bite–wings depends on the refinement of the clinical caries diagnostic criteria. ‘Hidden’ caries does not seem to be a major problem when the clinical caries diagnostic criteria include non–cavitated diagnoses.