Screening with conventional and digital bite-wing radiography compared to clinical examination alone for caries detection in low-risk children.

The study compared conventional and digital bite-wing screening, performed in combination with a clinical examination for caries detection, in 168 14-year-old children with little caries experience. Radiography revealed 2-3 times more carious lesions than did clinical examination. Conventional and digital radiography detected dentinal caries in only 1.6 and 1.1%, respectively, of the clinically sound surfaces. Conventional, as well as digital radiography revealed caries in 7% of occlusal surfaces suspected of caries after a clinical examination. Of the suspected approximal surfaces, conventional radiography found caries in 25%, and digital radiography in 19%. From these results, it may be appropriate to perform radiographic screening in combination with clinical examination when the purpose is to assess caries prevalence, and as a basis for individual treatment decisions, if treatment is offered to surfaces with enamel lesions. However, if treatment is offered only to surfaces with clinically detected lesions and to surfaces with radiographically perceived dentinal lesions, it may not be appropriate to perform radiographic bite-wing screening, as less than 2% of the treatment-demanding surfaces will be overlooked by clinical examination alone. Instead, selective radiography should be conducted of surfaces suspected clinically as being carious.