Radiographic diagnosis of dental caries.

The purpose of this report was to respond to aspects of the RTI/UNC systematic review relating to the radiographic diagnosis of dental caries. The systematic review was commissioned as part of the NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. The systematic review evaluated the dental literature from 1966 to 1999. Well-defined search criteria along with clear inclusion and exclusion criteria were used to perform the review. Some of the inclusion and exclusion criteria used in the systematic review may have limited the evidence supporting the use of radiography, especially for the diagnosis of proximal surface caries. The RTI/UNC review only included studies in which sensitivity and specificity were reported or could be derived from the data presented. Studies that used the receiver operating characteristic as a measure of diagnostic accuracy were not included. Although the strength of evidence is considered poor, this does not mean that the use of radiographic methods is of no diagnostic value. It simply means that, using the criteria established by the systematic review, the evidence is inadequate to validate the method. Guidelines should be developed for assessing diagnostic methods that assist researchers in developing study designs that will hold up to critical review.