Diagnostic Performance of a Laser Fluorescence Device for the In Vivo Detection of Occlusal Caries in Permanent Teeth

Dental caries remains one of the most prevalent global diseases, and the early detection of occlusal lesions is critical because demineralization often begins deep within pits and fissures where conventional visual–tactile or radiographic inspection cannot detect it. SmarTooth, a newly introduced fluorescence device that irradiates enamel with a 655 nm laser and records the reflected intensity, may provide more objective, quantitative diagnoses. This study assessed its diagnostic performance against the International Caries Detection and Assessment System (ICDAS). We examined 1421 occlusal surfaces from 153 adults, scored each surface with ICDAS codes 0–4, and recorded SmarTooth peak values. Spearman’s rank correlation was used to test the association between codes and peak values; one-way ANOVA with Tukey’s post hoc was used to compare mean values across codes; and sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC) were calculated at three diagnostic thresholds: D1 (0 vs. 1–4), D2 (0–2 vs. 3–4), and D3 (0–3 vs. 4). The SmarTooth values rose with lesion severity and correlated moderately with ICDAS (r = 0.495, p < 0.001). The AUROC ranged from 0.69 to 0.82, with the best accuracy observed at D2 (cut-off: 7.0; AUC: 0.82; sensitivity: 78.3%; specificity: 77.4%). These findings suggest that SmarTooth can complement ICDAS scoring as an adjunctive tool, potentially enhancing diagnostic accuracy and supporting early intervention for occlusal caries in general dental practice.