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Background: When diagnosing caries using clinical judgment only, the prevalence of approximal caries is highly underestimated. Yet, surveys on this topic predominantly included adolescents and young adults., Aim: To determine the additional diagnostic value of bitewing radiographs in 6-year-old children and to detect approximal dentin caries in the primary dentition., Design: A total of 50 children were assessed both clinically (dmfs, oral hygiene) and radiographically by two experienced dentists. The relation between dmfs-scores and amount of plaque was established using Pearson's correlation coefficients at a significance level of 0.05., Results: In nine patients (18%) it was impossible to make radiographs. Bitewing radiography appeared to have an additional effect of 97% when only caries in dentin is considered. The additional value for detecting inadequate restorations was 600%. Furthermore, the dmfs was highly correlated to the amount of plaque found., Conclusion: Although not possible to achieve in all 6-year-old children, bitewing radiographs can reveal a considerable amount of carious surfaces and inadequate restorations, which appear clinically sound or adequate.

As a result of the caries prevalence of the Dutch population the character of the routine dental examination is changing. Caries screening remains relevant for high caries risk individuals but the interpretation of early caries lesions deserves more attention, especially the assessment of progression of caries lesions in time. Diagnosis of caries by dental practitioners in the Netherlands mainly consists of visual inspection in combination with bitewing radiography and both methods play an important role in the timing of bitewing radiographs and forthcoming recall visits for oral health examination. The content and frequency of the routine dental examination are discussed in relation to the individual risk prediction as relevant aspects of quality of dental care in the Netherlands.

In 1987, 1993 and 1999 an epidemiological study was performed on oral health in youngsters, aged 5, 11, 17 or 23 years, in whom oral health care was covered by a health insurance fund. The prevalence of caries in the deciduous teeth of the 5-year-olds (examined without radiographs) did not change significantly between 1987 and 1999. Only a small proportion of dmfs was filled. Caries prevalence in permanent teeth of the 11-, 17- and 23-year olds decreased significantly. The number of filled surfaces decreased also. Between 1993 and 1999 the number of clinically found DS increased. However, this rise in dentinal caries lesions was not confirmed by similar findings in a simultaneous performed study with bitewing radiographs.

It is well-known that dentists differ in judgement when confronted with the same clinical situation. To study this phenomenon, 2 groups of 5 general dental practitioners have assessed the material of 20 patients, each consisting of a set of 2 bite wing radiographs and 2 photographs of the (pre)molar region. The teeth were examined for caries and the quality of the restorations, supported by a protocol which was mailed in advance. The examiner variability was expressed as Cohen's kappa, calculated per pair of GDPs and subsequently averaged per group. The interexaminer agreement was fair for the diagnosis of caries and was highest for the assessment of approximal caries on the bite wing radiograph. The agreement with respect to the quality assessment of dental restorations proved to be poor on average. The intra-examiner agreement varied widely between examiners. No difference could be established between the groups. It can be concluded that, without training and calibration, a sufficient inter- and intra-examiner agreement among GDPs is difficult to reach. Consequently, a substantial variation is found in the individual GDP's restorative treatment planning.

The decline in caries prevalence in The Netherlands has incited dentists to focus their attention to the detection of small carious lesions rather than large cavities. The diagnosis of primary caries is, however, still predominantly being accomplished by the traditional diagnostic methods, used in the high caries prevalence era. Today's appearance and behaviour of caries lesions have led to the situation that incipient enamel lesions, dentinal caries and cavities are frequently missed during routine recall examinations. There is increasing concern with the occurrence of large caries lesions underneath visually intact enamel. These problems have induced diagnostic research aimed at developing and evaluating new caries diagnostic methods and some of them are already used in general practice. Visual inspection and bitewing radiography, however, still constitute the most important methods in the diagnosis of primary caries. The results from these examinations are used to classify an individual's caries risk, to monitor the progression of existing caries lesions, and to aid preventive or restorative treatment decision making.