Objective: To compare the sensitivity and specificity of four different methods of caries detection: the visual criteria, International Caries Detection and Assessment System (ICDAS), DIAGNOdent (DD; Kavo, Germany), Quantitative Light-induced Fluorescence (QLF, Inspektor Pro System, The Netherlands), and D-Carie (NEKS Technologies Inc., Laval, QC, Canada) on smooth surfaces of permanent teeth using histology as the gold standard. Methods: Seventy smooth surfaces on extracted permanent teeth were selected based on the ICDAS criteria, with 10/categories. Each surface was digitally imaged, 1:1 macro lens, (FUJIFILM FinePixS2Pro) wet and dry (5sec). The teeth were dried (5sec) imaged with QLF, visually interpreted as yes/no for lesion presence and then analyzed for lesion area(mm2), mean change in fluorescence(df%), and area x df (dQ). DD peak readings were taken on dry teeth (5sec). D-Carie measurements were taken on wet teeth. DD and D-caries measurements were repeated. All teeth were hemi-sectioned with a Gillings_Hamco thin sectioning Machine (Hamco Machines, INC). Stereomicroscopic (Nikon SMZ1500, NIKON INC.) images (1X) were taken of wet sections. The sections were classified according to Ekstrand et al criteria (1998). Results: DD and D-caries had significantly higher specificity (100% and 89% respectively) than QLF Score (81%) ICDAS (87%), QLF area (81%), QLF dF (79%), and QLF dQ (81%). DD and D-caries had significantly lower sensitivity (84% and 80% respectively) than QLF Score or parameters and ICDAS (all at 100% sensitivity). The area under the ROC curve was higher for ICDAS (0.99) followed by QLF dF (0.98), QLF dQ (0.97), QLF area (0.97), DD (0.97), QLF score (0.88), D caries (0.87). D-carie and DD had excellent repeatability (D-carie Kappa score 0.91; DD ICC score 0.99). Conclusions: All methods were performed at acceptable levels in terms of sensitivity and specificity and repeatability, with some significant difference between some methods.

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