Comparison of caries detection in clinic using ICDAS and QLF-I

Among new methods for caries detection the visual ICDAS (International Caries and Assessment System) and the QLF (Quantitative light-induced fluorescence) have qualities that complement each other. The ICDAS has high specificity while the QLF has high sensitivity.

Objectives: This longitudinal study examines combining ICDAS and QLF scoring for caries detection. Reported here are the agreement of the two methods, and reproducibility of each of them at baseline.

Methods: A total of 569 children aged 5-13 years-old were enrolled from a rural school district in the Commonwealth of Puerto Rico. ICDAS and QLF examinations were performed by one examiner on occlusal (O) and buccal (B) surfaces of all erupted permanent molars, along with lingual (L) surfaces of upper molars. Lingual grooves (LG) and buccal pits (BP) were scored separately. Surfaces with fillings or sealants were excluded from QLF examination. The visual scoring was done according to the ICDAS system, while the QLF examination included acquiring images of the surfaces and performing a ranked scoring of the lesions on the computer screen using a ranked scale similar to the ICDAS. Reproducibility was assessed using Weighed Kappa.

Results: Overall, the QLF examination revealed 23% more lesions than the visual examination. By surface, the percentage increase in lesions by QLF examination was O=27%, B=11%, L=21%, LG=37%, and BP=29%. Reproducibility for pit and fissure caries (O,LG,BP) was WK=0.81 for either method, and for smooth surfaces (B,L) was WK=0.76 and WK=0.77 for ICDAS and QLF, respectively.

Conclusions: While combining these two methods for early caries detection resulted in an increase in the overall number of lesions scored, the increase by QLF was greater in pit and fissure locations than on smooth surfaces.

Supported by NIH/NIDCR RO1DE017890-01