Visual Clinical Examination Research Articles

English

Dental caries, a progressive bacterial damage to teeth, is one of the most commondiseases that affects 95% of the population and is still a major cause of tooth loss.Recent years have seen an increase in research activity surrounding diagnostic methods, particularly in the assessment of early caries lesions. The use of technologies as adjunct to clinical visual examination for caries diagnosis will facilitate preventive care in dentistry to lower treatment cost as well as reduce the cost and time for testing potential anticaries agents. This article describes the various technologies available to aid the dental practitioners in detecting and diagnosis ofdental caries at the earliest stage of its formation, assessing the activities of the detected carious lesion, and quantitatively or qualitatively monitoring of the lesion over time.

An objective assessment of melanin in vitiligo skin treated with Balneo PUVA therapy

Visual clinical methods of skin color evaluation for diagnostic purposes are so far mostly subjective and thus inaccurate. We present a modified method of melanin amount measurement based on diffuse reflectance spectroscopy (DRS). This method is non-invasive and objective, and allows easy quantification and comparison of melanin levels. Skin pigmentation was measured by DRS method in 0-18 year old patients at the Department of Pediatric Dermatovenerology, School of Medicine Comenius University Bratislava. Patients were treated for their vitiligo by Balneo PUVA treatment twice weekly. Each patient had measured his remittance spectra from the treated vitiliginous skin before the treatment was started, after 10 irradiations of Balneo PUVA and at the end of the treatment after 25 irradiations of Balneo PUVA. In our study as a reference skin for spectroscopic assessment of melanin in vivo was used the averaged remittance spectra (measured on the inner arm) from the sample of 10 albino patients. The remittance spectra obtained from the vitiligo patients were ratioed against the newly described remittance reference albino skin. We exploited the linear behavior of the spectral curve in the 620-720 nm interval (significant for melanin absorption) and used the slope of the regression line to compute the quantification index α. By clinical examination before the Balneo PUVA therapy, after the 10th dose of Balneo PUVA therapy as well as at the end of the complete course of Balneo PUVA therapy (after 25 irradiations) we recorded a marked increase of pigmentation in all treated patients for their vitiligo. In each patient the values of melanin quantification angle α were calculated. Statistically we found a significant difference between the melanin quantification angle α in vitiliginous skin before, during the 10th dose of treatment and after the treatment. Similar significant difference was also observed between treated and non-involved skin. We could confirm a clear association between clinical visual examination of treated vitiligo lesions, objective data collected by DRS and melanin quantification angle α. By using a new standard for the reference skin (albino skin) we could more exactly compare melanin levels in different subjects. Our proposed melanin quantification angle α expresses the extent of the difference in melanin levels between the examined skin lesions. We successfully used this index to quantify the variations of melanin (progress of repigmentation) throughout different stages of treatment of the same lesion and also to objectively evaluate the final effect of the therapy. In the present study, we showed that the diffuse reflectance spectroscopy (DRS) may be suitable method to measure skin colour and the content of human skin melanin in vivo.

In vivo assessment of secondary caries and dentin characteristics after traditional amalgam restorations

This study aimed to evaluate in vivo the occurrence of secondary caries and dentin characteristics in permanent molars after traditional amalgam restorations, by means of clinical visual examination, radiographs and laser-induced fluorescence (LF) (DIAGNOdent). Thirty first permanent molars of 30 schoolchildren in the 7 to14 year-old age group were included. Caries was removed by hand. Thus, indirect pulp capping was performed with glass-ionomer cement (GIC), the cavity was varnished and amalgam filled. LF was measured before and after cavity preparation and after a 12-month observation period. Dentin color after cavity preparation and after the 12-month observation period was recorded. Recurrent caries was also investigated by visual clinical and radiographic examinations, in addition to dentin thickness between pulp and indirect GIC pulp capping. Data was analyzed by ANOVA for repeated measurements, paired "t" test and descriptive statistic. There were statistically significant differences (P<.05) among LF scores for dentin in all periods evaluated, with the lowest scores shown after 12 month of observation. There was no statistical difference between dentin color after cavity preparation and following 12 months of observation. Moreover, there was no recurrent caries attack at 12-month follow-up; dentin thickness between pulp and indirect GIC pulp capping was similar between baseline and final observation periods. It was concluded that the clinical restorative procedure using hand caries removal, indirect pulp capping with GIC, varnishing and amalgam filling the cavity did not provide secondary caries and increased dentin mineral content after 12 months.

How valid are the vision testers for visual screening? A comparative study with a clinical assessment

ObjectivesVision testers -such as OPTEC-6500- are widely available in occupational health services for visual screening, probably because they are inexpensive and easy to use. Few studies have evaluated their validity....

Significant Inhibition of Corneal Scarring In Vivo with Tissue-Selective, Targeted AAV5 Decorin Gene Therapy

This study tested a hypothesis that tissue-selective targeted decorin gene therapy delivered to the stroma with adeno-associated virus serotype 5 (AAV5) inhibits corneal fibrosis in vivo without significant side effects. An in vivo rabbit model of corneal fibrosis was used. Targeted decorin gene therapy was delivered to the rabbit cornea by a single topical application of AAV5 (100 μL; 6.5 × 10(12) μg/mL) onto the bare stroma for 2 minutes. The levels of corneal fibrosis were determined with stereomicroscopy, slit lamp biomicroscopy, α-smooth muscle actin (αSMA), fibronectin, and F-actin immunocytochemistry, and/or immunoblotting. CD11b, F4/80 immunocytochemistry, and TUNEL assay were used to examine immunogenicity and cytotoxicity of AAV5 to the cornea. Transmission electron microscopy (TEM) was used to investigate ultrastructural features. Slot-blot-quantified the copy number of AAV5-delivered decorin genes. Selective decorin delivery into the stroma showed a significant (P < 0.01) decrease in corneal haze (1.3 ± 0.3) compared with the no-decorin-delivered control rabbit corneas (3 ± 0.4) quantified using slit lamp biomicroscopy. Immunostaining and immunoblot analyses detected significantly reduced levels of αSMA, F-actin, and fibronectin proteins (59%-73%; P < 0.001 or <0.01) in decorin-delivered rabbit corneas compared with the no-decorin-delivered controls. The visual clinical eye examination, slit lamp clinical studies, TUNEL, CD11b, and F4/80 assays revealed that AAV5-mediated decorin gene therapy is nonimmunogenic and nontoxic for the cornea. TEM studies suggested that decorin gene delivery does not jeopardize collagen fibrillogenesis as no significant differences in collagen fibril diameter and arrangement were observed in decorin-delivered and no-decorin-delivered control corneas. Tissue-targeted AAV5-mediated decorin gene therapy is effective and safe for treating corneal fibrosis in vivo.

Advances in Diagnostic Adjuncts for Oral Squamous Cell Carcinoma

Oral cancer is the 8 th most common cancer in males and the 15 th most common in females in the United States. Each year, it affects approximately 22,000 Americans and results in approximately 5300 deaths. The five-year survival rate of oral cancer remains low (53% to 60%) for the past three decades and delayed diagnosis has been suggested to be one of the major reasons. The detection and diagnosis of oral cancer is currently based on clinical visual examination and histopathological evaluation of the biopsy material. In responding to the need for early detection of oral cancer, several diagnostic adjuncts have been developed over the years. The purpose of this article is to review the current knowledge about the commercially available diagnostic adjuncts as well as to review the research on the development of the promising tools for the early detection of oral cancer.

The use of toluidine blue in the detection of pre-malignant and malignant oral lesions

The purpose of this study was to evaluate the efficacy of the toluidine blue (TB) test as a diagnostic tool in the detection of malignant and dysplastic lesions of the oral cavity. This study was carried out because of a lack of consensus among different authors on the utility of TB, as well as to determine useful adjuncts to detect oral pre-cancer and cancer. The study included 160 patients with oral mucosal disorders that included suspicious or malignant lesions detected at clinical visual examination, confirmed by histopathological evaluation. All lesions were submitted to TB staining. The sensitivity and specificity for the detection of malignant or dysplastic lesions by this test were 65.5% and 73.3%, respectively. Overall, the detection rate with TB (sensitivity) was slightly lower compared with those reported by other authors but the specificity was comparable to several reports. Positive predictive value (35.2%) was also lower than previous studies, whereas negative predictive value (90.6%) was similar. The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.

Evaluación a largo plazo de la eficacia de un tratamiento para la eritrosis, cuperosis y/o rosácea grado I

Introduction and objective The treatment of facial erythema, irrespective of its etiology, is not a simple task. Erythema is accompanied by a variety of facial skin disorders, such as sensitive skin, redness in the case of reactive skin, persistent or transient facial redness in the case of people with telangiectases, and episodes of exacerbation of erythematous telangiectatic rosacea. The objective of the study was to evaluate, under dermatological control, the efficacy of the topical treatment LetiSR Anti-Redness Cream and LetiSR Tinted Anti-Redness Cream in patients with erythrosis, couperosis and/or Rosacea (grade I) in the facial area. Patients and method The study was carried out on 20 women with erythrosis, couperosis and/or Rosacea (grade I). The volunteers applied the treatment that consisted of 2 creams (tinted and colourless) with a sun protection factor of 20, twice a day for 60 days. The following instrumental measurements were taken from the cheeks at 0, 30 and 60 days: skin moisture content, transepidermal water loss (TEWL), skin redness, blood micro-circulation, and skin thickness. Digital images were also obtained. The dermatologist performed a visual clinical examination at 0, 30 and 60 days, and the volunteers filled in a self-assessment questionnaire at the end of the study. Results The treatment increased skin moisturization by 24% in 30 days and by 33% in 60 days; skin thickness was increased by 1% in 30 days and by 3% in 60 days. The treatment reduced TEWL by 2% in 30 days and by 12% in 60 days; skin redness was reduced by 5% in 30 days and by 19% in 60 days; blood micro-circulation was reduced by 11% in 30 days and by 33% in 60 days. The dermatologist observed a reduction of erythema to 24% after 30 days and to 59% after 60 days, and a reduction of telangiectasia to 45% after 60 days. Neither product had comedogenic properties. The parameters with the highest satisfaction ratings from the volunteers were that their skin felt less sensitive and reactive, that it felt smoother and more moisturized, that there was reduced capillary dilation, that the treatment provided protection against environmental aggressions, that skin redness decreased, that flushing periods were reduced, that there was a soothing effect, that the treatment concealed skin imperfections and that the creams were absorbed very well. Conclusions The results of this study show that the creams LetiSR Anti-Redness Cream and LetiSR Tinted Anti-Redness Cream are indicated in the daily care and treatment of facial erythrosis of sensitive and reactive skin, couperosis and erythematous telangiectatic rosacea, by supplying moisture to the skin, strengthening the functional integrity of the capillary endothelium and mechanical properties of the connective skin tissue.

Does acute loss of vision in Autosomal Dominant Optic Atrophy occur early in childhood?

Purpose: In contrast to Autosomal dominant optic atrophy (ADOA), acute loss of vision is normally observed in Leber’s hereditary optic neuropathy (LHON) patients. We present a case of a young child with ADOA with a confirmed OPA1 mutation who appeared to have had an acute visual loss in the third year of life.Methods: Differentiating between ADOA and LHON requires careful documentation of visual symptoms, family history, clinical examination and genetic testing if available.Conclusions: This clarifies the clinical diagnosis, ensuring appropriate genetic counselling is provided so that affected individuals are accurately informed on inheritance patterns and implications for family members.

Emerging technologies for diagnosis of dental caries: The road so far

It is now universally recognized that the development of new technologies for early detection and quantitative monitoring of dental decay at an early stage of formation could provide health and economic benefits ranging from timely preventive interventions to reduction in the time required for clinical trials of anticaries agents. The use of technologies as adjunct to clinical visual examination for caries diagnosis will facilitate preventive care in dentistry to lower treatment cost as well as reduce the cost and time for testing potential anticaries agents. This article describes the various technologies available to aid the dental practitioners in detecting dental caries at the earliest stage of its formation, assessing the activities of the detected carious lesion, and quantitatively or qualitatively monitoring of the lesion over time. The need and the importance of these technologies were also discussed. The data discussed are primarily based on published scientific studies and reviews from case reports, clinical trials, and in vitro and in vivo studies. References have been traced manually by MEDLINE® or through manufacturer’s websites. While some of the devices are fully developed and commercially available, others are still under development. The devices vary in their modes of action as well as their capability as caries diagnostic aids. It is clear that the differences in caries presentations and behavior in different anatomical sites make it unlikely that any one diagnostic modality will have adequate sensitivity and specificity of detection of carious lesions for all sites; a combination of diagnostic tools will help us diagnose lesions earlier and detect failing restorations sooner, all to avoid more costly, destructive dental procedures and truly take dentistry into the preventive rather than the reactive mode.

Estudo do posicionamento de língua e lábios em sujeitos com disfunção temporomandibular e dor orofacial

OBJETIVO: verificar a posição de repouso de língua e lábios em sujeitos com Disfunção Temporomandibular (DTM) e analisar a intensidade da dor em músculos mastigatórios. MÉTODOS: foram avaliados 44 sujeitos de ambos os sexos com média de idade de 42,52 anos. Foram realizadas três avaliações: exame clínico visual, averiguando a posição de repouso da língua, seguido de avaliação subjetiva e objetiva da dor pela Escala Visual Analógica (EVA) e palpação dos músculos mastigatórios. RESULTADOS: 23 (52,27%) posicionaram a língua no palato e 21 (47,73%) na posição baixa. Dos sujeitos que posicionaram a língua no palato, 73,91% deles referiram dor à palpação em masseter; 56,52% na região cervical; 43,48% em temporais; 39,13% em digástricos e 52,17% em região articular. Encontraram-se relações estatisticamente significantes entre queixa subjetiva e objetiva da dor relativo aos músculos cervicais (p=0,026), temporais (p=0,019), digástricos (p=0,005) e região articular (p=0,013). Na amostra foram encontrados 88,63% de componente miálgico e 56,81% artrálgico. CONCLUSÃO: a posição não elevada da língua não se confirmou em pacientes com DTM, uma vez que a distribuição foi equitativa, com ausência de correlação entre dor e posição de língua, predomínio de lábios fechados e dores miálgicas mais freqüentes que as artrálgicas.

Assessing Caries Removal by Undergraduate Dental Students Using Quantitative Light‐Induced Fluorescence

The purpose of this study was to compare detection of enamel and dentinal caries by dental students' and faculty members' visual inspection and by quantitative light-induced fluorescence (QLF). The overall aim was to determine whether QLF is an appropriate technique for use in clinical skills laboratories as a teaching aid for dental undergraduates to detect and assess the removal of enamel and dentinal caries. Sixty students who had no clinical experience with dental caries were asked to select . suitably decayed teeth and mount them in plaster. After recording baseline QLF images, students removed caries according to instructions given by the clinical tutor. On completion of the exercise, the teeth were visually determined to be caries-free by the student, then confirmed by the clinical tutor. A fluorescein in alcohol solution was injected into the cavity for two minutes, rinsed, and dried before QLF images were captured. The images were visually analyzed by two examiners for the presence or absence of caries. From seventy-four images recorded, seventeen were excluded due to exposure of the pulp chamber. The remaining fifty-seven teeth, which by clinical visual examination were judged to be caries-free, were examined using QLF. Fifty-three percent were found to be caries-free, while 47 percent were carious. In this sample of fifty-seven teeth judged to be caries-free by both dental students and faculty members, QLF thus detected caries in almost half of these teeth. These findings suggest that QLF is a useful, noninvasive, nondestructive technique for the detection of caries and can serve as an adjunct to chair-side diagnosis and management of dental caries, which is typically accomplished by visual inspection. QLF may be useful and appropriate as an objective clinical teaching aid for the assessment of dental caries.

CLINICAL STUDY: Biodegradability of naltrexone‐poly(DL) lactide implants in vivo assessed under ultrasound in humans

Ultrasound was used to assess the in vivo biodegradability of a sustained release poly(DL)lactide naltrexone implant in 71 persons previously treated for heroin dependence. We assessed 139 implant sites ranging from 2 to 1808 days post implant. Ultrasound assessment showed that implant tablets were initially well demarcated from each other and from the surrounding tissues. Biodegradation resulted in less demarcated tablets followed by clumping into a single mass-like structure. This mass subsequently dispersed by approximately 1201 days post implant with no implant material visualized by ultrasound. The biodegradation was also assessed by visual clinical examination and palpation of the implant site as well as patient self-report. These measures were generally well correlated with ultrasound results. Clinical assessment of the biodegradation process concluded that the implant changed from 'firm' to 'less firm' and from 'initial square edge' to 'rounded edge' tablets. Collectively, these data provide direct evidence of the in vivo absorption of the Go Medical implant over time, and its biodegradability in humans.

Radiographic diagnosis of incipient proximal caries: an ex-vivo study

The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-microm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6% and 83.3% for clinical examination and 29.7% and 95.8% for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.

Effect of Placing a Clear Sealant on the Validity and Reproducibility of Occlusal Caries Detection by a Laser Fluorescence Device: An in vitro Study

The principal aim of this in vitro study was to assess the validity and reproducibility of the detection of occlusal caries using laser fluorescence (LF), prior to and following the placement of a clear fissure sealant. It also aimed to compare the manufacturer’s standard cut-off recommendations with those published for in vitro studies and to compare the validity and reproducibility of LF with clinical visual examination (CVE) for the detection of occlusal caries under sealants. Three clinicians independently examined visually and with LF 37 extracted teeth (25 molars, 12 premolars), with a range of clinical caries from apparently sound to cavitated dentinal caries. Examinations were conducted under dental surgery conditions. Subsequently, the teeth were serially sectioned to provide the validating criterion. Following placement of the sealant, the specificity generally increased but there was an associated loss of sensitivity, at both the D₁(enamel and dentine) and D₃ (dentine) diagnostic thresholds. The LF readings were significantly lower after placement of the sealant (p < 0.05). The manufacturer’s recommended cut-offs appear to be the most appropriate to use. The CVE had superior validity and reproducibility when compared to LF. Overall, the placement of a clear sealant does influence the detection of caries by LF but does not prevent the detection of caries by this method.

Breast‐feeding and early childhood caries: an assessment among Brazilian infants

The purpose of the present study was to evaluate early childhood caries among 12-36-month-old children from families living in poor socio-economic conditions in the city of Recife, Brazil, its association with the type and duration of feeding (e.g. natural, sugared, bottle and glass), as well as the relationship between a supplementary diet and the occurrence of this type of caries. The present study consisted of a visual clinical examination of teeth that had been previously cleaned with gauze. This was carried out under natural light in a waiting room. Four calibrated examiners performed the examination and the kappa test value was 8.0. The parents or guardians were interviewed for the following information: name, address, age, type of feeding, number of sugary meals, sugar intake and habitual diet. Some 468 children were included in this study. Their ages ranged from 12 to 36 months. The sample was comprised of 222 (47.4%) males and 246 females (52.6%). Of the 468 children included in this study, 133 (28.4%) had caries. Only 59 (12.6%) of the children examined had been breast-fed, 20 (33.9%) of whom presented with caries. Three hundred and twenty-seven (69.9%) subjects had been bottle-fed with sugared milk, 86 (26%) of whom had caries. Two hundred and eight children had five or more sugary meals per day, 70 (33.6%) of whom had caries. No statistically significant relationship was seen between breast-feeding and the prevalence of tooth decay. The results of the present study show that the prevalence of early childhood caries in 12-36-month-old children from poor backgrounds in Recife is in accordance with the rate found in other Brazilian cities and is extremely high compared with that of the world population as a whole. Early childhood caries was not clearly related to the type of feeding in this sample. The prevalence of early childhood caries increased with age, and the number of sugary snacks between meals and a cariogenic diet were strongly related to early childhood caries. The lack of fluoridated water and high rates of early childhood caries in lead the authors to suggest that fluoride dentifrice should be introduced at 12 months of age as a fluoride supplement and an important aid in the prevention of childhood caries. Additional studies in different cultures and societies need to be undertaken before a definitive conclusion can be drawn.

Correlation between visual and radiographic examinations of non-cavitated occlusal caries lesions -- an in vivo study.

The aim of this study was to conduct an in vivo investigation of the correlation between the visual and radiographic scoring systems by Ekstrand et al.7 (1997) for the diagnosis of occlusal caries lesions. The study sample comprised 147 occlusal sites from 23 patients. Two trained and experienced examiners performed the clinical visual examinations. A third examiner, which was also trained, experienced and blind to the results of the visual clinical examination, performed the analysis of the bitewing radiographs. The correlation between visual and radiographic scores was assessed by Goodman & Kruskal's gamma correlation coefficient. Results showed a strong correlation between the scores for occlusal caries found in the visual and radiographic diagnosis systems used in this study.

The utility of tolonium chloride rinse in the diagnosis of recurrent or second primary cancers in patients with prior upper aerodigestive tract cancer.

The clinical utility of tolonium chloride rinse was compared with unaided visual examination alone in the diagnosis of oral carcinoma in patients previously treated for carcinoma of the upper aerodigestive tract. A total of 668 patients were enrolled in this multicenter study. At each site, an oral clinical visual examination was completed by one investigator followed by tolonium chloride rinse and examination by a second investigator blinded to the examination findings of the first investigator. If a lesion was considered suspicious (urgent biopsy required at the first visit), the lesion was biopsied after tolonium chloride rinsing. Patients with lesions characterized at the first visit as not suspicious (biopsy not urgent) or that stained with tolonium chloride were asked to return for a second visit. At the second visit, any residual lesion or lesions that retained tolonium chloride were biopsied. A total of 96 biopsies was performed in 81 of the 668 patients (12.1%), of which 30 (31.3%) were diagnosed histologically as carcinoma/carcinoma in situ (CIS) and the remainder as inflammation (31.3%), keratosis (26.6%), dysplasia (21.9%), ulcer (2.1%), other (3.1%), or no abnormality (1.0%). Of the 30 lesions with the diagnosis of carcinoma/CIS, 12 (sensitivity 40.0%) were considered to be clinically suspicious (CS+), whereas 29 (sensitivity 96.7%) retained tolonium chloride (p =.0002). The predictive values of a positive test for clinical examination and tolonium chloride staining were similar (36.4% vs 32.6%; p =.5871), indicating that the greater sensitivity of tolonium chloride was not associated with an excessive number of unnecessary biopsies (false positives). Tolonium chloride rinse is more sensitive than clinical examination alone in detecting lesions that might be found on biopsy to be carcinoma or CIS. The increased sensitivity is largely attributed to lesions that stain but were not detected clinically on visual examination.

Using Electroencephalogram to Investigate Stages of Visual Search in Visually Impaired Computer Users: Preattention and Focal Attention

Researchers have shown that computer users with impaired vision perform visual search more slowly than their fully sighted counterparts. However, little is known about intermediate stages of visual search that exist between stimuli detection and identification. Therefore, the primary focus of this research is to investigate 2 intermediate stages of visual search in visually impaired computer users: preattention and focal attention. A total of 10 volunteers, 1 participant who possessed normal vision and 9 participants possessing impaired vision, underwent clinical visual examinations consisting of assessments of visual acuity, contrast sensitivity, visual field, and color perception. The involvement of each participant's visual cortex while performing a continuous matching task of visual icons on a computer screen was recorded. Results demonstrated that additional time required by visually impaired computer users is not a result of delayed engagement of the visual cortex, but rather due to time spent in active search once the visual cortex has already been engaged. Directions for future research are provided.

Prevalence of Dental Caries in Latvian 11– to 15–Year–Old Children and the Enhanced Diagnostic Yield of Temporary Tooth Separation, FOTI and Electronic Caries Measurement

The aim of this study was to test the feasibility of employing clinical visual examination at the D₁ (enamel and dentine caries) diagnostic threshold, fibre–optic transillumination (FOTI), elective temporary tooth separation (ETTS) and electronic caries measurement (ECM) in the environment of an epidemiological study or clinical trial. It also aimed to compare the diagnostic yield of these diagnostic aides and methods. The sample consisted of 182 Latvian children, mean age 13.3 years (range = 10.6–15.7). For 12–year–old subjects the mean D₃MFS was 10.58 (SD 6.05) and the mean D₁MFS was 19.97 (SD 10.47). The additional diagnostic yield from FOTI examination of approximal sites was 40.0% at the D₁ threshold. The additional apparent yield for ETTS was 52.8% at the D₁ threshold. ETTS detected 38.3% more carious surfaces than FOTI at the D₁ threshold. Conversely 57 surfaces thought to be carious on FOTI examination were judged sound following ETTS. Although the ECM appeared practical to use, it broke early in the trial and the results obtained prior to breakdown appeared inaccurate. In conclusion, all diagnostic methods were feasible under the conditions of an epidemiological study or clinical trial.