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Caries

245 - Evaluation of Tooth Decay: Comparing Visual Inspection to BlueCheck Diagnostic Tool

Saturday, May 23, 2026
10:45 AM - 11:00 AM PST
Has Audio

    Presenting Author(s)

  • Alexa S. Griffiths, DMD (she/her/hers)

    Pediatric Dental Resident
    Case Western Reserve University — UH Rainbow Babies and Children’s Hospital, Cleveland, OH
    Cleveland, Ohio, United States

    • Co-Author(s)

  • MF

    Margeret S. Ferretti, DMD, MPH

    Program Director
    Case Western Reserve University — UH Rainbow Babies and Children’s Hospital, Cleveland, OH
    Rainbow Babies and Children's Hospitals, Case Western Reserve University
    Cleveland, Ohio, United States

  • Meredith R. Guggenheim, DDS (she/her/hers)

    Pediatric Dentistry Resident - PGY2
    Case Western Reserve University — UH Rainbow Babies and Children’s Hospital, Cleveland, OH
    Case Western Reserve University
    Chagrin Falls, Ohio, United States

    • Research Mentor(s)

  • MF

    Margaret S. Ferretti, DMD, MPH

    Program Director
    Case Western Reserve University — UH Rainbow Babies and Children’s Hospital, Cleveland, OH
    Cleveland, Ohio, United States

    • Program Director(s)

  • MF

    Margeret S. Ferretti, DMD, MPH

    Program Director
    Case Western Reserve University — UH Rainbow Babies and Children’s Hospital, Cleveland, OH
    Rainbow Babies and Children's Hospitals, Case Western Reserve University
    Cleveland, Ohio, United States

Abstract:

Purpose: The aim of this study was to compare caries detection using a standardized visual examination based on the International Caries Detection and Assessment System (ICDAS) with the BlueCheck diagnostic tool in children enrolled in a Head Start program.

Methods: This prospective, non-randomized diagnostic comparison study was conducted at two Head Start sites in Stark County, Ohio. Children presenting for routine Head Start dental examinations received an ICDAS-based visual exam, toothbrush prophylaxis, and fluoride varnish application. Cooperative children were additionally evaluated with BlueCheck by a separate, calibrated team blinded to visual exam findings. BlueCheck was applied to teeth and assessed for areas of blue discoloration indicative of caries. Caries detection was compared within subjects.

Results: The mean participant age was 3.69 years (range: 3–5). An average of 2.53 lesions per child were detected using visual examination alone compared to 4.60 lesions per child with BlueCheck. A total of 514 lesions were identified with BlueCheck versus 285 lesions detected visually. Overall, lesions were 1.8 times more likely to be detected with BlueCheck. Early caries lesions (ICDAS 1–2) were 2.9 times more likely to be identified with BlueCheck, while visual examination alone detected 34.4% of these lesions. For ICDAS 1 lesions, visual detection alone identified 15.9%.

Conclusion: BlueCheck detected more carious lesions than visual examination alone, particularly early-stage lesions, suggesting potential value as an adjunctive diagnostic tool for Head Start dental screenings.

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