Holt 1989.

Study characteristics
Patient Sampling	Method of sampling: not reported Included conditions: not reported; "bitewing radiographs were indicated" Teeth: primary canines and molars Sealants: not reported Restorations: not reported Surface: approximal
Patient characteristics and setting	Age: 5 to 10 years Sex: not reported Ethnicity: not reported Country: UK Setting: community dental clinic Number of participants/teeth/sites: 54 participants, 781 surfaces Prevalence: enamel 0.08
Index tests	Category of test: FOTI Sequence of test(s): index tests prior to reference standard Examiner training and calibration: not reported ‐ examiners viewed independently Threshold applied: sound, any caries Device specifics: "150H universal light source, housing a 150 watt tungsten bulb, a 2 mm diameter fibre optic cable and a fibre optic probe tip of 0.5 mm diameter"
Target condition and reference standard(s)	Category: radiographs Sequence of index test and reference standard: reference standard completed prior to transillumination Training of examiner: not reported Blinding to index test: yes ‐ completed after index test Site selection: all approximal surfaces Target condition: sound, enamel, or dentine
Flow and timing	Participants with index test but no reference standard: 0 Participants with reference standard but no index test: 0 Time interval between tests: minimal Participants receiving both tests but excluded from results: 209 deemed unreadable by radiograph
Comparative
Notes	Examiner 1 results used for data analysis
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Unclear
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
Could the selection of patients have introduced bias?		Unclear risk
Are there concerns that the included patients and setting do not match the review question?			Low concern
DOMAIN 2: Index Test (All tests)
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
If multiple tests were applied were different examiners used for each (in vivo)?
Could the conduct or interpretation of the index test have introduced bias?		Low risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	No
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
Could the reference standard, its conduct, or its interpretation have introduced bias?		High risk
Are there concerns that the target condition as defined by the reference standard does not match the question?			High
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
Could the patient flow have introduced bias?		High risk