The study aimed to evaluate the impact of image size, area of detection (IoU) thresholds and confidence thresholds on the performance of the YOLO models in the detection of dental caries in bitewing radiographs. A total of 2575 bitewing radiographs were annotated with seven classes according to the ICCMS™ radiographic scoring system. YOLOv3 and YOLOv7 models were employed with different configurations, and their performances were evaluated based on precision, recall, F1-score and mean average precision (mAP). Results showed that YOLOv7 with 640 × 640 pixel images exhibited significantly superior performance compared to YOLOv3 in terms of precision (0.557 vs. 0.268), F1-score (0.555 vs. 0.375) and mAP (0.562 vs. 0.458), while the recall was significantly lower (0.552 vs. 0.697). The following experiment found that the overall mAPs did not significantly differ between 640 × 640 pixel and 1280 × 1280 pixel images, for YOLOv7 with an IoU of 50% and a confidence threshold of 0.001 (p = 0.866). The last experiment revealed that the precision significantly increased from 0.570 to 0.593 for YOLOv7 with an IoU of 75% and a confidence threshold of 0.5, but the mean-recall significantly decreased and led to lower mAPs in both IoUs. In conclusion, YOLOv7 outperformed YOLOv3 in caries detection and increasing the image size did not enhance the model's performance. Elevating the IoU from 50% to 75% and confidence threshold from 0.001 to 0.5 led to a reduction of the model's performance, while simultaneously improving precision and reducing recall (minimizing false positives and negatives) for carious lesion detection in bitewing radiographs.