Kuhnisch 2008.

Study characteristics
Patient Sampling	Method of sampling: selected Included conditions: unclear on exact level of severity to be included in sample Teeth: primary and permanent molars Sealants: yes ‐ labelled where present Surface: occlusal
Patient characteristics and setting	Age: 8 to 12 years Sex: not reported Ethnicity: not reported Country: Germany Setting: primary school Number of participants/teeth/sites: 311 participants/840 occlusal sites Prevalence: 0.71 enamel, 0.06 dentine (ICDAS 4 and above)
Index tests	Category of test: DIAGNOdent Sequence of test(s): reference standard then index test Examiner training and calibration: calibrated Teeth cleaning prior to examination: yes but technique not described Tooth drying prior to examination: 5 seconds air drying Threshold applied: 0‐15 sound, 16‐17 enamel, 18‐31 dentine, 31 deep dentine Device specifics: conical probe A
Target condition and reference standard(s)	Category: visual (ICDAS) Sequence of index test and reference standard: reference standard before index test Training of examiner: calibrated before study Blinding to index test: yes Multiple tests: no Site selection: all occlusal surfaces Target condition: ICDAS
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
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?			Low concern
DOMAIN 2: Index Test (All)
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
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 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?	Unclear
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?			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