Accuracy of Clinical Photography for the Detection of Dental Caries: A Systematic Review and Meta-Analysis

To evaluate the accuracy of visual caries detection using clinical photographs in comparison with visual clinical intraoral examination for the detection of dental caries. This review followed PRISMA-DTA guidelines and was registered in PROSPERO (CRD42024598814). Accuracy parameters of sensitivity, specificity and diagnostic odds ratio (DOR), area under summary receiver operating characteristic curve (AUC), and partial AUC (pAUC) were generated. Risk of bias was assessed using QUADAS-2 tool. Publications from PubMed, Web of Science, Scopus, and EMBASE databases. Eighteen studies including 1300 participants were included in this review. Risks of bias and applicability concerns were frequently encountered in one or more domains. The pooled sensitivity (95% Confidence Interval, CI), specificity (95%CI), DOR (95%CI) and AUC (pAUC) of the visual assessment of clinical photographs were 0.74 (0.70-0.77), 0.95 (0.88-0.98), 52.94 (22.13-126.66), and 0.813 (0.753) for enamel caries; 0.81 (0.75-0.86), 0.98 (0.94-0.99), 142.01 (67.50-298.77), and 0.935 (0.857) for dentine caries; 0.81 (0.70-0.89), 0.99 (0.96-1.00), 245.04 (83.75-716.96), and 0.957 (0.902) for any caries depth. Subgroup analysis suggested that caries depth (enamel caries v.s. dentine caries v.s. any caries depth; p=0.072), dentition (primary v.s. permanent; p=0.584 (dentine caries data), p=0.923 (any caries data)), technology (smartphone camera v.s. intra-oral camera; p=0.993), and photographer (dental professional v.s. layperson; p=0.466) did not modify the diagnostic performance. Visual assessment of clinical photographs for caries detection demonstrated clinically acceptable accuracy when compared with visual clinical intraoral examination. High specificity values across diagnostic thresholds suggest a high level of accuracy in correctly identifying sound tooth structure. Clinical photography is useful for dental caries detection and can facilitate clinical decision-making.