Comparative diagnostic accuracy of laser fluorescence and conventional caries detection methods in children: a systematic review and meta analysis

Background Early detection of dental caries in children is essential for implementing preventive and minimally invasive treatment strategies. Laser fluorescence–based devices have been proposed as adjunctive diagnostic tools; however, their diagnostic accuracy compared with conventional methods remains uncertain. Objective To evaluate the diagnostic accuracy of laser fluorescence devices compared with conventional visual and radiographic methods for caries detection in pediatric populations. Methods A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251274327). Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library from inception to December 2025. Clinical studies involving children (<18 years) that evaluated laser fluorescence devices for caries detection were included. Risk of bias was assessed using QUADAS-2. Where sufficient data were available, quantitative synthesis was performed using bivariate random-effects and hierarchical summary receiver operating characteristic (HSROC) models. Results Twenty-one studies were included in the qualitative synthesis. Quantitative meta-analysis was conducted for enamel-level (D1) and dentinal-level (D3) diagnostic thresholds. At the D1 threshold (8 studies), pooled sensitivity was 0.84 (95% CI 0.80–0.87) and specificity was 0.77 (95% CI 0.67–0.84), with an area under the curve (AUC) of 0.86. At the D3 threshold (10 studies), pooled sensitivity was 0.81 (95% CI 0.77–0.85) and specificity was 0.89 (95% CI 0.84–0.92), with an AUC of 0.81. Heterogeneity was influenced by lesion thresholds, dentition type, reference standards, and diagnostic protocols. Studies with higher risk of bias tended to report greater sensitivity estimates. Conclusion Laser fluorescence devices demonstrate good sensitivity for detecting early carious lesions in children and may be useful adjuncts for preventive diagnosis and monitoring. However, variability in specificity and methodological heterogeneity across studies indicate that these devices should complement, rather than replace, conventional visual and radiographic examination. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251274327 , identifier CRD420251274327.