Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination

OBJECTIVES This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children. METHODS Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index. RESULTS One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87). CONCLUSIONS The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.