Comparative evaluation of visual-tactile examination and near-infrared transillumination in the diagnosis of dental caries in children aged 5–9 years

Background: Near-infrared light transillumination (NILT) has been proposed as a radiation-free alternative to traditional visual-tactile (VT) examination, yet comparative evidence in pediatric populations remains limited. To compare the detection rates of dental carious lesions using NILT (DIAGNOcam) and VT methods in children aged 5–9 years, and to explore potential associations between dietary habits and caries indices. Methods: A cross-sectional study was conducted on 185 children (89 girls, 96 boys; mean age 7.2 ± 1.4 years) attending routine dental check-ups. Each participant underwent both VT and NILT examinations performed by two calibrated examiners (κ = 0.86 intra-; κ = 0.82 inter-examiner reliability). Statistical analyses included the Wilcoxon signed-rank test, McNemar’s test, Cohen’s κ, and Spearman’s correlation. Radiographs were excluded in alignment with the As Low As Reasonably Achievable (ALARA) principle. Results: NILT identified significantly more carious lesions than VT in both dentitions Decayed, Missing, and Filled Teeth (permanent dentition)(DMFT): 1.38 ± 1.31 vs. 0.79 ± 1.11, p < 0.001; decayed, missing, and filled teeth (primary dentition) (dmft): 4.68 ± 2.53 vs. 4.51 ± 2.52, p < 0.001. Agreement between methods was moderate (κ = 0.71). Weak but significant associations were observed between juice consumption and dmft indices (ρ = 0.195, p = 0.008). Conclusions: NILT demonstrated a higher detection rate for early enamel lesions compared with VT, particularly on interproximal surfaces. While not a replacement for radiographs in diagnosing deeper lesions, NILT represents a valuable non-invasive adjunct. Dietary findings were exploratory and require longitudinal confirmation.

Dental caries in children; Caries diagnosis; Visual-tactile examination; Near-infrared light transillumination; DIAGNOcam; Minimally invasive dentistry

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