Dental Caries Diagnosis

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 2/20/2009
Article title: Dental Caries Diagnosis
Author(s): Stookey GK, Jackson RD, Zandona AGF, et al.
Journal: Dental Clinics of North America
Volume (number): 43 (4)665-678, October 1999
Major topic: Review of caries detection devices
Type of Article: Literature review
Main Purpose: The purpose of this paper was to review current and future methods of caries detection and its applications in a clinical setting. The introduction of fluoride resulted in a decline in caries and change in paradigm from treatment to early detection and prevention of treatment.
Findings: The goal of these new diagnostic methods is to detect caries in its earliest stages or monitor the dynamic process of demineralization and remineralization that occurs during caries development. Researchers are developing new tools that are sensitive enough and specific enough for accurate caries detection. These include Quantitative light-induced fluorescence (QLF), electron conductivity measurements (ECM), direct digital radiography (DDR), and digital imaging fiberoptic with transillumination (DiFOTI)
QLF- light scattering is a measure of whiteness of a carious lesion. Its use is primarily in smooth surface lesions whereby a differential in fluorescence is detected in sound vs carious enamel. Using fluorescent dyes and argon light, carious detection was improved over bitewing radiographs. Most studies evaluated interproximal lesions. The technique dye-enhanced laser fluorescence appeared to improve sensitivity and specificity. However, the presence of plaque reduced specificity. Further development led to the Diagnodent, a potable diode laser-based system. Studies comparing it to electro-conductivity measurements showed it to have higher specificity and sensitivity
ECM- The basis of ECM is that sound tooth surfaces should have little or no conductivity whereas carious or demineralized enamel should have measurable conductivity. Various studies showed a high sensitivity and specificity when saliva was removed from pit and fissures with air flow or isolation and saline flowed in groves. Airflow seems to have an effect on measurement. It is suggested that this method is an adjunct test along with other methods to determine occlusal caries
DDR- standardized radiographs have a significant degree of human variability in assisting in the diagnosis of caries. Digital radiographs have the advantage of reduced radiation, and image manipulation. However its diagnostic advantages were not statistically significant over conventional radiographs.
DiFOTI- FOTI consists of a measurement of fiberoptic light source traversing a tooth and recorded and analyzed. DiFOTI combines FOTI with a digital CCD sensor on a cameral which is analyzed on a computer. Results indicate that DiFOTI is 2x as sensitive in detecting interproximal lesins and 3x as sensitive in detecting occlusal caries as compared to conventional radiographs
Key points/Summary : No single diagnostic test is capable of early detection of all types of carious lesions. However continued research should reveal methods to reliably detect caries.
Assessment of article: Well presented article that needs an update for 2009 as there is much use and abuse of these techniques in private practice