Chong 2003.

Study characteristics
Patient Sampling	Method of sampling: selected Included conditions: no cavitation and early lesions Teeth: permanent premolars Sealants: no Surface: occlusal
Patient characteristics and setting	Age: 12 to 15 years Sex: not reported Ethnicity: not reported Country: Australia Setting: extracted teeth Number of participants/teeth/sites: 320 teeth Prevalence: enamel 0.50, dentine 0.35
Index tests	Category of test: DIAGNOdent Sequence of test(s): index tests (visual, radiograph then DIAGNOdent) prior to reference standard Examiner training and calibration: not reported Teeth cleaning prior to examination: brush and slurry Tooth drying prior to examination: 5 seconds air spray Threshold applied: < 5 sound, 5‐25 enamel, 26‐35 dentine, > 35 advanced dentine Device specifics: not reported
Target condition and reference standard(s)	Category: visual Sequence of index test and reference standard: reference standard then index test Training of examiner: not reported Blinding to index test: yes Multiple tests: yes Site selection: not reported Target condition: visual: C0 sound, C1 no opacity, C2 opacity and not sticky, C3 opacity and sticky, C4 frank cavitation
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: 0
Comparative
Notes	Data used for fluorescence versus visual as this is the most clinically relevant, no sites identified as sound by index test
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Yes
Could the selection of patients have introduced bias?		High risk
Are there concerns that the included patients and setting do not match the review question?			High
DOMAIN 2: Index Test (All)
Were the index test results interpreted without knowledge of the results of the reference standard?	No
If a threshold was used, was it pre‐specified?	Yes
If multiple tests were applied were different examiners used for each (in vivo)?	No
Could the conduct or interpretation of the index test have introduced bias?		High risk
Are there concerns that the index test, its conduct, or interpretation differ from the review question?			Low concern
DOMAIN 2: Index Test (Green fluorescence)
DOMAIN 2: Index Test (Blue fluorescence)
DOMAIN 2: Index Test (Red fluorescence)
Were the index test results interpreted without knowledge of the results of the reference standard?	No
If a threshold was used, was it pre‐specified?	Yes
If multiple tests were applied were different examiners used for each (in vivo)?	No
Could the conduct or interpretation of the index test have introduced bias?		High 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?	No
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?			Low concern
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?	Yes
Could the patient flow have introduced bias?		Low risk