What is the best method for detecting dental cavities?

Best Method for Detecting Dental Cavities

Bitewing radiography is the best method for detecting dental cavities, serving as the primary radiographic examination of choice for both primary and permanent teeth. 1, 2

Primary Detection Methods

Visual Inspection + Bitewing Radiography

• Visual inspection serves as the initial assessment method, but has limited sensitivity when used alone
• Bitewing radiography significantly improves detection capabilities:
  • Provides adequate visualization of the entire crown of permanent teeth 2
  • Detects interproximal (between teeth) cavities that visual inspection often misses 1, 2
  • Has higher sensitivity (0.80) compared to clinical examination (0.14) for detecting approximal caries 3

Diagnostic Algorithm

1. First line: Visual inspection combined with bitewing radiography

   • This combination identifies up to 95.7% of all enamel and dentin caries lesions on occlusal surfaces 4
   • Bitewing radiography is particularly valuable for detecting:
     • Interproximal caries
     • Early dentin involvement
     • Recurrent caries around restorations

2. Second line: Periapical radiography

   • Indicated as supplementary examination for:
     • High caries risk patients
     • Suspected pulpal or apical involvement 1, 2
   • Should be taken using paralleling technique with film holders and beam aiming devices

Special Considerations

Patient Risk Assessment

• High caries risk patients: Require more aggressive diagnostic approach with both bitewing and periapical radiographs 2
• Low to moderate risk patients: May require only visual examination for accessible surfaces, with bitewing radiographs for interproximal areas 2

Limitations and Pitfalls

• Visual examination alone detects only 48.7% of lesions in dentin 5
• While radiography improves sensitivity, it may lead to false positives 5
• Superimposition of bony structures in posterior areas may obscure periapical pathology 1

Adjunctive Methods

• Near-infrared light transillumination (NIR-LT):

  • X-ray free alternative
  • Shows good potential for detection of proximal caries (sensitivity 0.86 for enamel caries) 6
  • Provides limited additional diagnostic benefit beyond visual inspection 2, 4

• Laser fluorescence:

  • Not currently viable as an alternative to radiographic diagnostics due to insufficient scientific evidence 1, 2
  • Shows lower sensitivity (0.38) and accuracy (0.39) compared to other methods 6

Radiation Protection

• Thyroid collar should be used, especially for pediatric patients 2
• CBCT is not recommended as first-line examination for caries detection due to higher radiation dose 1, 2

Conclusion

For optimal caries detection, a combination of visual inspection and bitewing radiography provides the most comprehensive assessment. Bitewing radiography remains the gold standard for detecting interproximal caries and early dentin involvement, while visual examination is essential for accessible surfaces.