Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis

Abstract

Aim: To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection.

Design: Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes.

Results: Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection.

Conclusion: Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

Keywords: dental; dental caries; detection; diagnosis; evidence-based dentistry; reproducibility; sensitivity and specificity; students.