Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population.

OBJECTIVES: The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination.
METHODS: Between November 2002 and March 2003 a total of 879 subjects aged 17-30 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately and blind. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs.
RESULTS: Between 22.9-32.9% of approximal caries and 75.9-82.9% of occlusal caries was detected by clinical examination, while 93.1-97.1% of approximal caries and 33.1-42.6% of occlusal caries was detected by radiographic examination. In addition, while only 0.97% of clinically sound approximal surfaces and 0.83% of clinically sound occlusal surfaces were diagnosed with dentine caries on the radiographs, 67.1-77.1% of approximal caries was detected by radiographs alone, an additional diagnostic yield of 204-336%. The DS score increased 45-46% and the DMFS score increased 6-11% from the clinical examination with the addition of the radiographic information (P<0.001).
CONCLUSIONS: The prevalence of approximal and occlusal caries was underestimated when clinical means only were employed. There was a significant increase in DS and DMFS scores from the clinical examination only when radiographic information was added across all age groups (P<0.001). This study confirms the value of bitewing radiographs in caries diagnosis.