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Original Research

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Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children

  • Sigalit Blumer1,*,
  • Johnny Kharouba1
  • Lazar Kats2
  • Dora Schachter1
  • Hanaa Azem1

1Department of Pediatric Dentistry, Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

2Department of Oral Pathology, Oral Medicine and Maxillofacial Radiology, Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

DOI: 10.17796/1053-4625-45.3.2 Vol.45,Issue 3,July 2021 pp.152-157

Published: 01 July 2021

*Corresponding Author(s): Sigalit Blumer E-mail:


Objectives: To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6–14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Study design: Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. Results: All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Conclusion: Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.


Caries detection; First permanent molars; Occlusal caries fluorescence-aided caries excavation

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Sigalit Blumer,Johnny Kharouba,Lazar Kats,Dora Schachter,Hanaa Azem. Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children . Journal of Clinical Pediatric Dentistry. 2021. 45(3);152-157.


1. Bernabe E, Sheiham A. Extent of differences in dental caries in permanent teeth between childhood and adulthood in 26 countries. Int Dent J; 64(5): 241-245. 2014.

2. Lagerweij MD, van Loveren C. Declining Caries Trends: Are We Satisfied? Curr Oral Health Rep; 2(4): 212-217. 2015.

3. Marthaler TM. Changes in dental caries 1953-2003. Caries Res; 38(3): 173-181. 2004.

4. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet; 392(10159): 1789-1858. 2018.

5. Carvalho JC, Thylstrup A, Ekstrand KR. Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol; 20(4): 187-192. 1992.

6. Nikiforuk G. Understanding Dental Caries. Vol 1: Etiology and Mechanisms Basic and Clinical Aspects Toronto ON: Karger; 1985.

7. Silverstone LM, Johnson NW, Hardie JM, Williams RAD. Dental Caries: Macmillan Education UK; 1981.

8. von der Fehr FR. Epidemiology of Dental Caries. In: Thylstrup A, Fejerskov O, eds. Textbook of Cariology. Copenhagen: Munksgaard; 1986:266-275.

9. Bille J, Hesselgren K, Thylstrup A. Dental caries in Danish 7-, 11- and 13-year-old children in 1963, 1972 and 1981. Caries Res; 20(6): 534-542. 1986.

10. Miller J, Hobson P. Determination of the presence of caries in fissures. . British Dental Journal; 100: 15-18. 1956.

11. Batchelor PA, Sheiham A. Grouping of tooth surfaces by susceptibility to caries: a study in 5-16 year-old children. BMC Oral Health; 4(1): 2. 2004.

12. Carvalho JC, Van Nieuwenhuysen JP, D’Hoore W. The decline in dental caries among Belgian children between 1983 and 1998. Community Dent Oral Epidemiol; 29(1): 55-61. 2001.

13. Van Nieuwenhuysen JP, Carvalho JC, D’Hoore W. Caries reduction in belgian 12-year-old children related to socioeconomic status. Acta Odontol Scand; 60(2): 123-128. 2002.

14. Carvalho JC, Mestrinho HD. Diagnosing non-cavitated lesions in epidemiological studies: practical and scientific considerations. Braz Oral Res; 28 Spec No: 1-7. 2014.

15. Fukada H, Yanagisawa M, Araki Y, et al. Studies on the caries susceptibility of first molars. J Nihon Univ Sch Dent; 24(1): 35-55. 1982.

16. Parfitt GJ. The speed of development of the carious cavity. . British Dental Journal; 100: 204-207. 1956.

17. Boyd JD, Wessels KE, Leighton RE. Epidemiologic studies in dental caries. IV. Variability of progression rates of dental cavities in the occlusal surfaces of second molar teeth. J Dent Res; 31(1): 124-128. 1952.

18. Norrisgaard PE, Qvist V, Ekstrand K. Prevalence, risk surfaces and inter-municipality variations in caries experience in Danish children and adolescents in 2012. Acta Odontol Scand; 74(4): 291-297. 2016.

19. Milicich G. Clinical applications of new advances in occlusal caries diagnosis. N Z Dent J; 96(423): 23-26. 2000.

20. Kidd EA, Ricketts DN, Pitts NB. Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists. J Dent; 21(6): 323-331. 1993.

21. Ball IA. The ‘fluoride syndrome’: occult caries? Br Dent J; 160(3): 75-76. 1986.

22. Weerheijm KL. Occlusal ‘hidden caries’. Dent Update; 24(5): 182-184. 1997.

23. Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res; 33(4): 252-260. 1999. 24. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet; 369(9555): 51-59. 2007.

25. Stookey GK, Gonzalez-Cabezas C. Emerging methods of caries diagnosis. J Dent Educ; 65(10): 1001-1006. 2001.

26. Kuhnisch J, Dietz W, Stosser L, Hickel R, Heinrich-Weltzien R. Effects of dental probing on occlusal surfaces—a scanning electron microscopy evaluation. Caries Res; 41(1): 43-48. 2007.

27. Mattos-Silveira J, Oliveira MM, Matos R, Moura-Netto C, Mendes FM, Braga MM. Do the ball-ended probe cause less damage than sharp explorers?- An ultrastructural analysis. BMC Oral Health; 16: 39. 2016.

28. Ricketts DN, Kidd EA, Smith BG, Wilson RF. Clinical and radiographic diagnosis of occlusal caries: a study in vitro. J Oral Rehabil; 22(1): 15-20. 1995.

29. Machiulskiene V, Nyvad B, Baelum V. A comparison of clinical and radiographic caries diagnoses in posterior teeth of 12-year-old Lithuanian children. Caries Res; 33(5): 340-348. 1999.

30. White SC, Pharoah MJ. Oral radiology: Principles and Interpretation. 4 ed. St. Louis: Mosby; 2000.

31. Wenzel A, Kirkevang LL. Students’ attitudes to digital radiography and measurement accuracy of two digital systems in connection with root canal treatment. Eur J Dent Educ; 8(4): 167-171. 2004. 32. Celiberti P, Carvalho TS, Raggio DP, Mendes FM. Influence of dental materials used for sealing caries lesions on laser fluorescence measurements. Lasers Med Sci; 27(2): 287-295. 2012.

33. Baelum V, Hintze H, Wenzel A, Danielsen B, Nyvad B. Implications of caries diagnostic strategies for clinical management decisions. Community Dent Oral Epidemiol; 40(3): 257-266. 2012.

34. Karlsson L. Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue. Int J Dent; 2010: 270729. 2010.

35. Lennon AM, Attin T, Buchalla W. Quantity of remaining bacteria and cavity size after excavation with FACE, caries detector dye and conventional excavation in vitro. Oper Dent; 32(3): 236-241. 2007.

36. Lennon AM, Attin T, Martens S, Buchalla W. Fluorescence-aided caries excavation (FACE), caries detector, and conventional caries excavation in primary teeth. Pediatr Dent; 31(4): 316-319. 2009.

37. Lennon AM. Fluorescence-aided caries excavation (FACE) compared to conventional method. Oper Dent; 28(4): 341-345. 2003.

38. Lennon AM, Buchalla W, Switalski L, Stookey GK. Residual caries detection using visible fluorescence. Caries Res; 36(5): 315-319. 2002.

39. Konig K, Flemming G, Hibst R. Laser-induced autofluorescence spectroscopy of dental caries. Cell Mol Biol (Noisy-le-grand); 44(8): 1293-1300. 1998.

40. Koenig K, Schneckenburger H. Laser-induced autofluorescence for medical diagnosis. J Fluoresc; 4(1): 17-40. 1994.

41. Buchalla W, Lennon AM, Attin T. Comparative fluorescence spectroscopy of root caries lesions. Eur J Oral Sci; 112(6): 490-496. 2004.

42. Alfano RR, Yao SS. Human teeth with and without dental caries studied by visible luminescent spectroscopy. J Dent Res; 60(2): 120-122. 1981.

43. Jablonski-Momeni A, Kneib L. Assessment of caries activity using the CALCIVIS Caries Activity Imaging System. . 2016;4. Open Access Journal of Science and Technology; 4. 2016.

44. Jablonski-Momeni A, Moos J, Sakhaei Manesh V, Stoll R. Diagnostic Accuracy of a Bioluminescence System for the Assessment of Caries Activity on Occlusal Surfaces. Caries Res; 52(4): 279-287. 2018.

45. Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res; 31(3): 224-231. 1997.

46. American Academy of Pediatric D. Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatr Dent; 35(5): E157-164. 2013.

47. Bahrololoomi Z, Ezoddini F, Halvani N. Comparison of Radiography, Laser Fluorescence and Visual Examination for Diagnosing Incipient Occlusal Caries of Permanent First Molars. J Dent (Tehran); 12(5): 324-332. 2015.

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