Caries risk assessment: methods available to clinicians for caries detection

Performance of the caries diagnosis feature of intraoral scanners and near-infrared imaging technology-A narrative review

PURPOSE

To describe and discuss the benefits and drawbacks of various dental caries diagnostic techniques, including the use of intraoral scanners for caries diagnosis based on near-infrared imaging (NIR) technology.

MATERIAL AND METHODS

A MEDLINE search from 1980-2023 focused on dental caries diagnostic techniques, emphasizing intraoral scanners using NIR technology. Alternative caries detection methods were also evaluated for their advantages and limitations, enabling a comparison with NIR. The review included traditional caries tools, the latest detection methods, and NIR's role in intraoral scanners, drawing from case reports and both in vivo and in vitro studies. Keywords like "caries detection," "intraoral scanners," and "Near Infrared Imaging (NIRI)" guided the search. After screening titles and abstracts for relevance, full texts with valuable insights were thoroughly analyzed. The data was grouped into three: traditional diagnostics, advanced digital methods, and intraoral scanner-based detection.

RESULTS

This comprehensive narrative review described and discussed the current state of dental caries diagnostic methods, given the insufficient number of clinical investigations suitable for a systematic review. Traditional caries diagnosis techniques have shown variable accuracy dependent on a dentist's experience and the potential over-removal of healthy tooth structures. Intraoral scanners have emerged as a novel caries detection method, because of their integration of NIR technology. Various studies have confirmed the efficacy of NIR in detecting interproximal caries and in the early diagnosis of non-cavitated caries. Specifically, intraoral scanners have demonstrated promising results, proving comparable to established diagnostic methods like bitewing radiography. Nevertheless, while the integration of NIR into intraoral scanners seems promising, the technology still faces challenges, notably its accuracy in detecting secondary and subgingival cavities. However, with anticipated integrations of AI, NIR in intraoral scanners could revolutionize early caries detection.

CONCLUSIONS

Intraoral scanners with NIR technology offer non-destructive imaging, real-time lesion visuals, and enhanced patient communication. Although comparable to bitewing radiography in some studies, a universally accepted diagnostic tool is lacking. Future research should compare them with existing methods, focusing on clinical outcomes, cost-effectiveness, and patient acceptance.

Surface analysis of dental caries using a wireless pH sensor and Raman spectroscopy for chairside diagnosis

A chairside tool for quantitative analysis of dental caries would improve clinical dental inspections. The wireless caries sensing tool with dental-explorer size has been developed comparing two sensing methods, Raman reading and pH reading for evaluating dental caries. The Raman spectra at 575 cm^-1 and 960 cm^-1 for in inorganic compounds, as well as 1450 cm^-1 and 2940 cm^-1 for organic compounds reinforced and supported the pH results. An Iridium/Iridium oxide (Ir/IrOx) pH sensing probe and wireless pH sensor (comprising an ESP8266 ESP-01 wireless module and ADS1115 analog digital converter) has been developed to quantitatively evaluate dental caries. All the operations of the wireless pH sensor were performed with a developed LabVIEW-based real-time data monitoring program. The slope and the linear fitting regression value (R²) of the wireless pH sensor using seven standards were -54.9 mV/pH and 0.999, respectively, showing high accuracy and stability for the pH measurements. The pH on the dental caries surface was measured with the wireless pH sensor, and the pH mapping results in the non-caries and caries areas were 6.9 and 5.7, respectively. The developed wireless pH sensor would be useful to understand the condition of dental caries and support dentists' inspection to remove only the caries part while keeping the non-caries structure.

Current Novel Caries Diagnostic Technologies: Restorative Dentists' Attitude and Use Preferences

Early detection of caries lesions is key to a successful restorative dental treatment plan. The aim of this study was to investigate the preferences and attitude of graduate restorative dentistry residents (RDRs) regarding novel caries diagnostic technologies (NCDT) and to provide a brief overview of available technologies for both specialized and general dental practice. This cross-sectional study used an online questionnaire (17 questions) concerning RDRs’ attitude, preferences, and insights regarding five available NCDTs. It was distributed among twenty RDRs at a local government dental school following a review session about NCDTs. Collected responses were analyzed statistically using one-way analysis of variance (ANOVA), chi-squared with Bonferroni correction, and Kruskal-Wallis tests at a 0.05 significance level. Sixty-five percent of RDRs reported an interest in NCDTs as a discussion topic and almost half of them were positive towards their use, however, sixty percent of respondents were hesitant to diagnose caries solely using NCDTs. Fiber-optic-transillumination (FOTI) systems were ranked the best overall and with regard to all the investigated criteria (p < 0.05). Chosen reasons for FOTI included price followed by ease of use. In general, high price rated as the most perceived reason for not choosing a given NCDT followed by low practical applicability. Meanwhile, ease of use followed by relevant application ranked as the main reported reasons to choose an NCDTs.

Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review

Background:

Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.

Objectives:

The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.

Methods:

Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.

Results:

The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.

Conclusion:

Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.

Knowledge and Use of Caries Detection Methods among Dental Students and Dental Practitioners in Riyadh, Saudi Arabia

Aim

Accurate detection and diagnosis of dental caries is an integral part of achieving adequate comprehensive dental care. Furthermore, the high prevalence of caries and generally poor oral health in Saudi Arabia is a public health concern. In addition to necessary preventive programs and awareness initiatives, understanding diagnostic practices plays an important role in garnering broad background knowledge regarding the routine diagnostic means utilized by our targeted respondents. Therefore, this study aimed to assess the methods of caries detection among dental students and dental practitioners in Riyadh using a cross-sectional observational study design.

Methods

The sample comprised 496 dental students, interns, postgraduate residents, general dental practitioners, specialists, and consultants from the Riyadh region of Saudi Arabia. A survey was designed to assess caries detection methods, risk assessment practices, and knowledge of advanced diagnostic methods. The responses were correlated with demographic and educational variables. Regression models were used to predict associations.

Results

42.3% and 32.7% use sharp explorers in diagnosing caries always and most of the time, respectively. When conducting caries risk assessment practices, 64.4% was very likely to review the patient's medical history and lifestyle. In terms of knowledge of advanced diagnostic methods, 47.8% know “much” to “very much” about FOTI. The knowledge of advanced caries diagnostic methods and practices of advanced diagnostic methods were significantly positively correlated (r = 0.388, P < 0.001). Linear regression analysis indicated that higher experience (10+ years) was associated with higher knowledge regarding advanced caries diagnostic methods (β = 0.27, P=0.009). The mean rank for risk assessment practices was significantly lower in GPs compared to consultants (P < 0.05).

Conclusions

The use of traditional and invasive methods of caries detection is prevalent among our respondents, while the usage of advanced diagnostic methods is for the most part low. Therefore, we advocate for more minimally invasive approaches and as such encourage the practice and availability of advanced diagnostic methods.

Investigations of the optical properties of enamel and dentin for early caries detection

INTRODUCTION

The aim of this study was to experimentally investigate the potential of different light wavelengths to distinguish between healthy and carious tissue using a two-circle goniometer.

MATERIALS AND METHODS

Tooth slices were prepared from extracted human teeth that were caries free (n = 15) or had occlusal caries lesions (n = 10). The tooth slices were irradiated with diode laser modules of different wavelengths (532, 650, 780 nm). The transmitted and scattered laser light was spatially measured with a detector rotating on a two-circle goniometer. The anisotropy factor and attenuation coefficients were calculated.

RESULTS

Enamel was more transparent than dentin and showed wavelength-dependent attenuation. Healthy dentin showed strong light scattering at all wavelengths, independent of the tested wavelength. The calculated attenuation coefficients of carious and healthy tooth tissue differed significantly (p < 0.05; t test). In contrast to healthy enamel, carious enamel showed lower light transmission and an increase in scattering. Differences in the light attenuation of carious versus healthy dentin were less pronounced than those for enamel. Carious dentin was slightly more transparent than healthy dentin. The light of longer wavelengths showed a better penetration of all tooth structures compared with shorter wavelengths.

CONCLUSION

Healthy and carious dentin and enamel exhibited distinct optical properties using laser light at different wavelengths. In dentin, changes in the optical properties caused by caries are significantly less pronounced.

CLINICAL RELEVANCE

The clear distinction between healthy and carious enamel makes optical caries diagnostic systems ideal tools for early caries detection.

Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

Abstract Introduction The detection of small caries lesions is still a challenge for dental professionals who in their clinical practice have a wide variety of methods to detect caries on occlusal surfaces. Objective To clinically assess the effectiveness of the Vista Proof fluorescence camera, the Vista Cam digital intraoral micro camera and the International Caries Detection and Assessment System (ICDAS) visual criterion for detecting caries lesions on occlusal surfaces of permanent teeth. Material and method One hundred and seven posterior teeth from adult patients were examined visually and by means of digital radiographs by an examiner who rated them according to the presence or absence of occlusal caries. The teeth were then assessed by the other examiner using ICDAS, fluorescence and magnified digital images. The effectiveness of the methods was measured based on sensitivity, specificity, positive and negative likelihood ratio. For each method, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC curve (AUROC) were estimated. Result There was exceptional discrimination capacity for the intraoral images (AUROC=.93) and the ICDAS (AUROC=.91), with no significant statistical difference between them (z=.35, p=.73). The fluorescence exhibited an acceptable discrimination capacity (AUROC=0.78), although it was lower than the others. The positive likelihood ratio for the fluorescence was only 2.32, compared to 20.58 for the intraoral image and 58.11 for the ICDAS. Conclusion Both methods and the ICDAS exhibited an adequate clinical performance, although the ICDAS and intraoral image were more effective than the fluorescence.

The wolf in sheep's clothing: Microtomographic aspects of clinically incipient radiation-related caries

Background

Radiation-related caries (RRC) can cause rapid progression, with a high potential for dental destruction affecting mainly cervical and incisal areas. Unlike the injuries that occur in the conventional caries, incipient RRC present in unusual surfaces have difficult diagnosis and classification stages of cavitation.

Material and Methods

Evaluate the radiographic patterns of demineralization of RRC by using micro-CT. Ten teeth with incipient RRC and 10 teeth with incipient conventional caries (control group) matched by anatomic teeth group and caries affected surfaces were evaluated by X-ray microtomography (micro-CT) Skyscan 1174V2 (50Kv, 1.3 megapixel, Kontich, Belgium). Teeth were placed in a standard position for micro-CT (coronal, transaxial and sagittal sections) during images acquisition. Lesions were classified according to the depth of invasion and relationship with enamel, dentin and pulp.

Results

RRC samples presented deeper lesions with higher involvement of enamel and dentin. Control group presented focal and superficial lesions with lower involvement of enamel and dentin.

Conclusions

Incipient RRC present aggressive microtomographic patterns of demineralization when compared to conventional caries, as indicated by deep lesions, regardless of its clinically incipient aspects.

Key words:Head and neck cancer, radiotherapy, microtomography, radiation caries.

Clinical imaging of vascular disease in chronic kidney disease

Arterial wall calcification, once considered an incidental finding, is now known to be a consistent and strong predictor of cardiovascular events in patients with chronic renal insufficiency. It is also commonly encountered in radiologic examinations as an incidental finding. Forthcoming bench, translational, and clinical data seek to establish this and pre-calcification changes as surrogate imaging biomarkers for noninvasive prognostication and treatment follow-up. Emerging paradigms seek to establish vascular calcification as a surrogate marker of disease. Imaging of pre-calcification and decalcification events may prove more important than imaging of the calcification itself. Data-driven approaches to screening will be necessary to limit radiation exposure and prevent over-utilization of expensive imaging techniques.

SOPROLIFE system: an accurate diagnostic enhancer

Objectives. The aim of this study was to evaluate a light-emitting diode fluorescence tool, the SOPROLIFE light-induced fluorescence evaluator, and compare it to the international caries detection and assessment system-II (ICDAS-II) in the detection of occlusal caries. Methods. A total of 219 permanent posterior teeth in 21 subjects, with age ranging from 15 to 65 years, were examined. An intraclass correlation coefficient (ICC) was computed to assess the reliability between the two diagnostic methods. Results. The results showed a high reliability between the two methods (ICC = 0.92; IC = 0.901–0.940; P < 0.001). The SOPROLIFE blue fluorescence mode had a high sensitivity (87%) and a high specificity (99%) when compared to ICDAS-II. Conclusion. Compared to the most used visual method in the diagnosis of occlusal caries lesions, the finding from this study suggests that SOPROLIFE can be used as a reproducible and reliable assessment tool. At a cut-off point, categorizing noncarious lesions and visual change in enamel, SOPROLIFE shows a high sensitivity and specificity. We can conclude that financially ICDAS is better than SOPROLIFE. However SOPROLIFE is easier for clinicians since it is a simple evaluation of images. Finally in terms of efficiency SOPROLIFE is not superior to ICDAS but tends to be equivalent with the same advantages.

Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding, using the ICDAS-II and the DIAGNOdent Pen

OBJECTIVES

To clinically evaluate the prevalence of buccal caries and white spot lesions (WSLs) at debonding in governmental and private orthodontic patients, using the International Caries Detection and Assessment System (ICDAS-II) and the DIAGNOdent Pen, and to study the correlation between the two methods.

MATERIALS AND METHODS

A cross-sectional study was carried out on the nonextracted premolars and anterior teeth of 89 orthodontic patients. They were recruited into two groups based on the treatment center they attended: governmental group (G; n=45) and private group (P; n=44). Immediately after debonding, the examination of buccal caries and WSLs on premolars and anterior teeth was carried out using the ICDAS-II and the DIAGNOdent Pen. Cross-tabulation was applied to study the correlation between the ICDAS-II index and the DIAGNOdent Pen by calculating the Spearman correlation coefficient.

RESULTS

The G group showed a significantly higher (P<.0001) prevalence of WSLs and/or buccal caries compared to that of the P group based on evaluation by the two methods. Based on ICDAS-II, 43% of the patients in the P group and 9% in the G group were free from any WSLs. In the G group, 22% of the patients had ≥16 LESIONS, whereas there were none for the P group. The Spearman correlation coefficient between the two methods was .71.

CONCLUSIONS

The prevalence of caries and/or WSLs at debonding was significantly higher in the G group compared to the P group. The clinical index (ICDAS-II) showed a good correlation with the DIAGNOdent Pen.

Cut off values of laser fluorescence for different storage methods at different time intervals in comparison to frozen condition: A 1 year in vitro study

Aims:

The aim of the following study is to evaluate the change in laser fluorescence (LF) values for extracted teeth stored in different solutions over 1 year period, to give cut-off values for different storage media at different time intervals to get them at par with the in vivo conditions and to see which medium gives best results with the least change in LF values and while enhancing the validity of DIAGNOdent in research.

Materials and Methods:

Ninety extracted teeth selected, from a pool of frozen teeth, were divided into nine groups of 10 each. Specimens in Groups 1-8 were stored in 1% chloramine, 10% formalin, 10% buffered formalin, 0.02% thymol, 0.12% chlorhexidine, 3% sodium hypochlorite, a commercially available saliva substitute-Wet Mouth (ICPA Pharmaceuticals) and normal saline respectively at 4°C. The last group was stored under frozen condition at −20°C without contact with any storage solution. DIAGNOdent was used to measure the change the LF values at day 30, 45, 60, 160 and 365.

Statistical Analysis Used:

The mean change in LF values in different storage mediums at different time intervals were compared using two-way ANOVA.

Results:

At the end of 1 year, significant decrease in fluorescence (P < 0.05) was observed in Groups 1-8. Maximum drop in LF values occurred between day 1 and 30. Group 9 (frozen specimens) did not significantly change their fluorescence response.

Conclusions:

An inevitable change in LF takes place due to various storage media commonly used in dental research at different time intervals. The values obtained from our study can remove the bias caused by the storage media and the values of LF thus obtained can hence be conveniently extrapolated to the in vivo condition.

Determinants of preventive dental practice for children among final-year dental students in Nigeria

BACKGROUND

This study aims to identify the determinants of caries prevention-oriented practice for children among final-year dental students in Nigeria.

METHOD

A questionnaire was distributed to 179 final-year dental students in six dental schools in Nigeria. It requested information on age, gender, knowledge of caries prevention measures, self-perceived competency in providing caries-preventive care for children, and caries prevention-oriented practice for two hypothetical cases with high and low risk of caries. Chi-squares tests and logistic regression analysis were done.

RESULTS

Between 24% and 41% of the respondents indicated their inability to determine the appropriate treatment modality for children with high and low caries risk. Majority of the students failed to differentiate between the caries-preventive practice for children with high and low risk of caries: preventive strategies for children with high caries risk were also used for those with low caries risk. Age, gender, knowledge of caries prevention measures, and self-perceived competency in providing caries-preventive care were not associated with student's capacity to provide caries-preventive practice for children.

CONCLUSION

Caries-preventive practice among dental students in Nigeria could be improved. It may be important to explore the possible role of problem-based learning approach in addressing this challenge.

In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions

Objective:

Early detection of smooth surface lesions is important for appropriate management and monitoring of dental caries. The purpose of this in vitro study was to evaluate the efficacy of laser fluorescence to detect demineralization and remineralization of smooth enamel surfaces.

Materials and Methods:

In this in vitro study, 132 enamel blocks of semi-impacted human third molars were obtained; artificial caries lesions were induced and they were submitted to the pH-cycling process to create remineralization. Superficial microhardness (SMH) and laser fluorescence (LF) analysis were performed at baseline, after demineralization, and remineralization processes. The data were analyzed by Statistical Package for Social Sciences (SPSS)-16 using analysis of variance (ANOVA), Paired samples t-test, and Pearson's correlation test.

Results:

There was a significant difference between SMH values at baseline, after demineralization and after remineralization. Also, a statistically significant difference was observed between LF values in these three stages. The LF values increased after demineralization and then decreased after remineralization, and the SMH values decreased after demineralization and increased after remineralization. There was an inverse relationship between SMH and LF only at baseline and after demineralization, but not after remineralization.

Conclusion:

The results showed that LF is an appropriate method for detection of demineralization in an in vitro condition in smooth enamel lesions, but it was not so efficient in the detection of remineralization.

Evaluation of an oral health scale of infectious potential using a telematic survey of visual diagnosis

Objective: To compare the results of a subjective estimation of oral health through review of a set of intraoral photographs with those of an objective oral health scale of infectious potential. Method: The pool of patients was made up of 100 adults. Using an infectious-potential scale based on dental and periodontal variables, we assigned 1 of the 4 grades of the scale (range, 0 to 3; 0 corresponds to an excellent oral health status and 3 to the poorest oral health status) to each subject. A total of 20 representative subjects were selected from the pool of patients, 5 subjects for each one of the grades of the scale, and a standardized photographic record was made. One thousand dentists practicing in Spain were sent the survey by e-mail and 174 completed forms were received. We then calculated the concordance of the oral health status indicated by the respondents after visualising the photographs on comparison with the results of the oral health scale of infectious potential; concordance was termed correct grade allocation (CGA). Results: The majority of respondents (69.1%) achieved a CGA in 8 to 12 cases and none achieved more than 15 CGAs. The poorest CGA rates were found with grades 1 and 2, with a mean of 1.74 ± 1.09 and 1.87 ± 1.18, respectively, out of a maximum of 5. The concordance in terms of CGA was high for grade 0 (70.5%), very low for grade 1 (10.8%), low for grade 2 (37.3%), and moderate for grade 3 (42.6%). Conclusion: In comparison with visual examination of the oral cavity, the use of objective scale that establishes a reliable diagnosis of oral health in terms of infectious potential was found to be advantageous.

Key words:Diagnosis, intraoral photographies, oral health scale, objective estimation, visual examination.

Evaluation of two imaging techniques: near-infrared transillumination and dental radiographs for the detection of early approximal enamel caries

OBJECTIVES

The aim of this paper was to evaluate a transillumination (TI) system using near-infrared (NIR) light and bitewing radiographs for the detection of early approximal enamel caries lesions.

METHODS

Mesiodistal sections of teeth (n = 14) were cut with various thicknesses from 1.5 mm to 4.75 mm. Both sides of each section were included, 17 approximal surfaces with natural enamel caries and 11 surfaces considered intact. The approximal surfaces were illuminated by NIR light and X-ray. Captured images were analysed by two calibrated specialists in radiology, and re-analysed after 6 months using stereomicroscope images as a gold standard.

RESULTS

The interexaminer reliability (Kappa test statistic) for the NIR TI technique showed moderate agreement on first (0.55) and second (0.48) evaluation, and low agreement for bitewing radiographs on first (0.26) and second (0.32) evaluation. In terms of accuracy, the sensitivity for the NIR TI system was 0.88 and the specificity was 0.72. For the bitewing radiographs the sensitivity ranged from 0.35 to 0.53 and the specificity ranged from 0.50 to 0.72.

CONCLUSION

In the same samples and conditions tested, NIR TI images showed reliability and the enamel caries surfaces were better identified than on dental radiographs.

A novel LED-based device for occlusal caries detection

The aim of this in-vitro study was to compare the performance of laser-based (DIAGNOdent, KaVo, Biberach, Germany) and LED-based (Midwest Caries I.D., DENTSPLY Professional, New York, USA) caries detectors in the detection of occlusal caries in permanent molars. The study consisted of 129 visually sound or non-cavitated pits or fissures in 82 extracted permanent human molar teeth. Two trained examiners used the laser-based and LED-based caries detectors to examine the fissures for caries. The teeth were then sectioned at the surfaces suspected of containing occlusal caries and histologically evaluated using stereomicroscopy as a gold standard. Inter-examiner reliability of the caries detector examination was assessed using Cohen's Kappa statistics. The sensitivity, specificity, and accuracy in diagnosing occlusal caries using the two devices were calculated according to appropriate cut-off scores. Receiver operating characteristic (ROC) curves were also determined to compare the diagnostic performance of the devices in occlusal caries diagnosis. The cut-off level of significance was taken as p = 0.005. Cohen's Kappa showed substantial agreement for the laser-based caries detector (0.74), and almost perfect agreement for the LED-based (0.89) caries detector. The specificity of the laser-based device varied from 0.49 to 0.97 at T1 and T2. Its sensitivity varied from 0.33 to 0.65 at T1 and T2. The specificity of the LED-based device varied from 0.48 to 0.56 at T1 and T2. Its sensitivity varied from 0.65 to 0.84 at T1 and from 0.80 to 0.84 at T2. Taking the limitations of the current study into consideration, the DIAGNOdent laser pen was more accurate in determining when teeth were free of occlusal caries than was the Midwest Caries I.D. LED-based device, although the Midwest Caries I.D. device more often revealed the presence of occlusal caries than did the DIAGNOdent pen.

Methods used by Dental Practice-based Research Network (DPBRN) dentists to diagnose dental caries

OBJECTIVES

To (1) identify the methods that dentists in The Dental Practice-Based Research Network (DPBRN) use to diagnose dental caries; (2) quantify their frequency of use and (3) test the hypothesis that certain dentist and dental practice characteristics are significantly associated with their use.

METHODS

A questionnaire about methods used for caries diagnosis was sent to DPBRN dentists who reported doing some restorative dentistry; 522 dentists participated. Questions included the use of dental radiographs, the dental explorer, laser fluorescence, air-drying and fiber-optic devices and magnification as used when diagnosing primary, secondary/recurrent or non-specific caries lesions. Variations on the frequency of their use were tested using multivariate analysis and Bonferroni tests.

RESULTS

Overall, the dental explorer was the instrument most commonly used to detect primary occlusal caries and caries at the margins of existing restorations. In contrast, laser fluorescence was rarely used to help diagnose occlusal primary caries. For proximal caries, radiographs were used to help diagnose 75%–100% of lesions by 96% of the DPBRN dentists. Dentists who use radiographs most often to assess proximal surfaces of posterior teeth were significantly more likely to also report providing a higher percentage of patients with individualized caries prevention (p=.040) and seeing a higher percentage of pediatric patients (p=.001).

CONCLUSION

The use of specific diagnostic methods varied substantially. The dental explorer and radiographs are still the most commonly used diagnostic methods..

Demineralization Depth Using QLF and a Novel Image Processing Software

Quantitative Light-Induced fluorescence (QLF) has been widely used to detect tooth demineralization indicated by fluorescence loss with respect to surrounding sound enamel. The correlation between fluorescence loss and demineralization depth is not fully understood. The purpose of this project was to study this correlation to estimate demineralization depth. Extracted teeth were collected. Artificial caries-like lesions were created and imaged with QLF. Novel image processing software was developed to measure the largest percent of fluorescence loss in the region of interest. All teeth were then sectioned and imaged by polarized light microscopy. The largest depth of demineralization was measured by NIH ImageJ software. The statistical linear regression method was applied to analyze these data. The linear regression model was Y = 0.32X + 0.17, where X was the percent loss of fluorescence and Y was the depth of demineralization. The correlation coefficient was 0.9696. The two-tailed t-test for coefficient was 7.93, indicating the P-value = .0014. The F test for the entire model was 62.86, which shows the P-value = .0013. The results indicated statistically significant linear correlation between the percent loss of fluorescence and depth of the enamel demineralization.

Near-infrared transillumination of teeth: measurement of a system performance

Transillumination (TI) of dental enamel with near-infrared light is a promising nonionizing imaging method for detection of early caries lesion. Increased mineral loss (caries lesion) leads to increased scattering and absorption. Caries thus appear as dark regions because less light reaches the detector. The aim of this work was to characterize the performance of a TI system from the resolution of acquired images using the modulation transfer function at two wavelengths, 1.28 and 1.4 mum. Test charts with various values of spatial periods, mimicking a perfect caries lesion, were attached to tooth sections, followed by capture of the transmitted image, using both wavelengths. The sections were then consecutively reduced in thickness, and a sequence of all sizes of the test charts were used for repeatedly imaging procedures. The results show that the TI system can detect feature size of 250 mum with 30% modulation. From the information about how the image degrades as it propagates through enamel, we also examined the possibility of estimating the position of a simulated approximal caries lesion by comparing images obtained from the two sides of a tooth section.

Time-resolved fluorescence spectroscopy of white-spot caries in human enamel

The objective is to differentiate noncavitated caries enamel through time-resolved fluorescence and to find excitation and emission parameters that can be applied in future clinical practice for detection of caries lesions that are not clearly visible to the professional. Sixteen human teeth with noncavitiated white-spot caries were selected for this work. Fluorescence intensity decay was measured by using an apparatus based on the time-correlated single-photon counting method. An optical fiber bundle was employed for sample excitation (440 nm), and the fluorescence collected by the same bundle (500 nm) was registered. The average lifetime for sound enamel was 7.93+/-0.09, 2.46+/-0.04, and 0.51+/-0.02 ns, whereas for the carious enamel the lifetimes were 4.84+/-0.06, 1.35+/-0.02, and 0.16+/-0.01 ns. It was concluded that it is possible to differentiate between carious and sound regions by time-resolved fluorescence and that, although the origin of enamel fluorescence is still uncertain, the lifetime values seem to be typical of fluorophores like collagen I.

Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue

A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages.

Specific binding and mineralization of calcified surfaces by small peptides

Several small (<25aa) peptides have been designed based on the sequence of the dentin phosphoprotein, one of the major noncollagenous proteins thought to be involved in the mineralization of the dentin extracellular matrix during tooth development. These peptides, consisting of multiple repeats of the tripeptide aspartate-serine-serine (DSS), bind with high affinity to calcium phosphate compounds and, when immobilized, can recruit calcium phosphate to peptide-derivatized polystyrene beads or to demineralized human dentin surfaces. The affinity of binding to hydroxyapatite surfaces increases with the number of (DSS)(n) repeats, and though similar repeated sequences-(NTT)(n), (DTT)(n), (ETT)(n), (NSS)(n), (ESS)(n), (DAA)(n), (ASS)(n), and (NAA)(n)-also showed HA binding activity, it was generally not at the same level as the natural sequence. Binding of the (DSS)(n) peptides to sectioned human teeth was shown to be tissue-specific, with high levels of binding to the mantle dentin, lower levels of binding to the circumpulpal dentin, and little or no binding to healthy enamel. Phosphorylation of the serines of these peptides was found to affect the avidity, but not the affinity, of binding. The potential utility of these peptides in the detection of carious lesions, the delivery of therapeutic compounds to mineralized tissues, and the modulation of remineralization is discussed.

Do school break-time policies influence child dental health and snacking behaviours? An evaluation of a primary school programme

OBJECTIVE

The aim of the two-year controlled trial was to evaluate the effectiveness of the 'Boosting Better Breaks' (BBB) break-time policy to reduce obvious decay experience and sugar snacking in a cohort of nine-year-old children attending intervention and control primary schools.

STUDY DESIGN

A matched controlled prospective trial design.

PARTICIPANTS

Children in Year 5 were invited with their parents/guardians to take part. The children were assessed at baseline and at 24-month follow-up. One hundred and eighty-nine children attended intervention schools and 175 attended control schools which were matched for socio-economic status (SES), school location and co-education status.

METHOD

The outcome variables were obvious decay experience and evidence of sugar snacks found in the children's rubbish bags. All children were asked to complete a questionnaire and keep evidence of the snacks they consumed starting from school-time break to when they retired for bed in a numbered and coded 'rubbish bag' on a specific collection day at baseline and 24-month follow-up. All children had a dental examination at baseline and 24-month follow-up.

RESULTS

Sixty percent of children at baseline and all of the children at follow-up had at least one sugar snack in their rubbish bag. The most popular snacks at follow-up were sweets, chocolate, crisps and carbonated drinks. In the school environment children attending BBB policy schools had significantly lower mean scores for sugar snacks scores at baseline but equivalent mean sugar snacks scores at follow-up compared with children attending control schools. In the outside school environment there was no effect of school intervention on sugar snack scores. Decay into dentine at follow-up was predicted by school intervention status and evidence of sugar snacks consumption outside school and at home.

CONCLUSIONS

The BBB break-time policy did not achieve its health promotion goals of promoting child dental health or encouraging children to adopt healthier dietary habits in school or in the wider environment in which they lived.

In vitro detection and quantification of enamel and root caries using infrared photothermal radiometry and modulated luminescence

Artificially created demineralized and remineralized carious lesions on the root and enamel of human teeth were examined by photothermal radiometry (PTR) and modulated luminescence (LUM). Fourteen extracted human teeth were used and a lesion was created on a 1 mmx4 mm rectangular window, spanning root to enamel, using a lactic acid-based acidified gel to demineralize the tooth surface. The lesion was then exposed to a remineralization solution. Each sample was examined with PTR/LUM on the root and enamel before and after treatment at times from 1 to 10 (5 on root) days of demineralization and 2 to 10 days of remineralization. Ten-day (5 on root) demineralized samples were remineralized. After completing all the experiments, transverse microradiography (TMR) analysis was performed to compare and correlate the PTR/LUM signals to the depth of lesions and mineral losses. The PTR and LUM amplitudes and phases showed gradual and consistent changes with treatment time. In this study, TMR showed good correlation coefficients with PTR and LUM. It was also found that the length of the treatment time did not correlate very well to any technique, PTR/LUM or TMR, which implies a significant degree of inhomogeneity of the demireralization and remineralization rates in each and every tooth.

In vivo comparison of laser fluorescence measurements with conventional methods for occlusal caries detection

The purpose of this study was to evaluate the efficiency of the laser fluorescence (LF) (DIAGNOdent) measurements comparing with visual examination and conventional bitewing radiography for occlusal caries detection. The study comprised 44 occlusal surfaces. Three examiners independently evaluated the teeth by visual examination, LF measurements, and bitewing radiographs. After the evaluations, the teeth were opened, and the clinical lesion depth was determined. One-way variance analysis (ANOVA) was performed for comparison of observers. The diagnostic performance of three methods was assessed by using non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation). No statistically significant difference was found between observers (p > 0.05), and statistically significant difference was found between diagnostic systems (p < 0.01). The correlation of LF measurements with the clinical lesion depth was better than visual examination and bitewing radiography. This result concluded that LF may be a useful adjunct to visual examination, and the diagnostic performance of this device seems to be good for occlusal caries detection.

Visual field magnification and touch perception when exploring surfaces with the index finger and a rigid instrument

OBJECTIVE

The aim of this project was to compare texture discrimination when both touch and vision were perturbed.

BACKGROUND

Texture discrimination is important in the workplace. How textures are identified with the finger and with instruments when vision is magnified with lenses or video cameras is unclear.

METHOD

Sandpaper was explored with the index finger or a metal instrument (hemostat), using normal or magnified vision. The forces generated during exploration were measured, and participants rated surface roughness.

RESULTS

With the finger, the perception of roughness was unaffected with magnification; with the instrument, magnified surfaces were perceived as rougher (p < .05). Forces during finger exploration were unaffected by magnification; forces with the instrument increased under magnification (p < .05).

CONCLUSION

Visual characteristics of the working field can influence the exploration and perception of materials. With the finger, mechanoreceptors that directly detect textures are activated, and with the instrument, receptors sensitive to vibrations are stimulated.

APPLICATION

The higher forces produced when using instruments under magnification could lead to material damage. Attenuated perception of texture when exploring with tools may lead to difficulty in accurate touch perception. This could create problems in industrial tasks such as grading wool or identifying surface imperfections on manufactured materials, as well as in clinical settings such as dentistry or surgery in which instruments are used during tissue identification.

Service patterns associated with coronal caries in private general dental practice

OBJECTIVES

To describe the pattern of dental services associated with dental caries by level of carious lesion severity.

METHODS

Data were collected by a mailed survey from a random sample of dentists from each State/Territory in Australia in 2003-2004. Dentists provided service data on patients treated on a typical clinical day for patients attending with a diagnosis of dental caries.

RESULTS

Restorative rates were higher for insured patients, radiograph rates were higher for emergency visits, prophylaxis and topical fluoride rates were higher for non-emergency visits and at capital city locations with topical fluoride also higher for patients from higher socio-economic status areas, endodontic rates were higher for emergency visits and at non-capital city locations, while extraction rates were higher for males, uninsured patients and for emergency visits. Poisson regression models compared the rates of services from different service areas for initial and cavitated carious lesions with gross carious lesions, controlling for patient demographics, visit type, location and socio-economic status. Restorative services were provided at higher rates (P<0.05) for cavitated carious lesions (RR=2.38), radiographs were provided at lower rates for both initial (RR=0.28) and cavitated carious lesions (RR=0.31), both prophylaxis and topical fluoride services were provided at higher rates for initial carious lesions (RR=2.33 and 3.00, respectively), endodontic services were provided at lower rates for both initial (RR=0.03) and cavitated carious lesions (RR=0.07), and extractions were provided at lower rates for both initial (RR=0.23) and cavitated carious lesions (RR=0.16) compared to the reference category of gross caries.

CONCLUSION

Service patterns varied by level of carious lesion severity with initial carious lesions managed by more preventive services, cavitated carious lesions with more restorative services, gross carious lesions with more radiographic, endodontic and extraction services. However, initial carious lesions tend to be managed with restorative rather than preventive service, suggesting scope for increased management by minimum intervention approaches.

Absence of soluble CD14 in saliva of young patients with dental caries

It is generally accepted that salivary components are important for dental health, but to date no clear correlation has been found between one or more of these components and the outcome of dental caries. The identification of salivary factors preventing, favoring or signaling dental caries might help to control the disease. In the present study, western blotting analysis of whole saliva from 20 healthy caries-free children showed the presence of the soluble form of CD14, a bacterial pattern-recognition receptor for many bacterial components that is involved in the innate immune response. The identity of the protein was confirmed through N-terminal sequencing by Edman degradation, and by partial sequencing with mass spectrometry of tryptic peptides. Conversely, CD14 was completely absent in the saliva of 20 age-matched patients affected by two to eight carious lesions, but appeared in their saliva a few weeks after dental restoration. These results suggest that the absence of salivary soluble CD14 could represent an useful index of caries activity, and might be used to detect early carious lesions not visible by oral inspection.

Use of bioelectrical impedance analysis in the evaluation, treatment, and prevention of overweight and obesity

PURPOSE

To present an overview of bioelectrical impedance analysis (BIA) and to familiarize nurse practitioners (NPs) with the potential benefits of using BIA in prevention, monitoring, and long-term follow-up of healthy individuals and those with chronic conditions (e.g., obesity).

DATA SOURCES

Original research articles and comprehensive review articles identified through Medline, CINAHL, OVID, and electrical engineering databases.

CONCLUSIONS

Obtaining serial measurements of percent body fat using BIA can identify patients at greatest health risk and gives NPs an additional tool to assess treatment response in patients seeking to lose or maintain body weight and/or increase muscle mass.

IMPLICATIONS FOR PRACTICE

Traditionally, height/weight tables and body mass index have been used to assess body composition and diagnose overweight and obesity. More recently, BIA has emerged as a portable and simple-to-operate instrument to evaluate body composition in the clinical setting.

Dental caries paradigms in diagnosis and diagnostic research

In this article, the fundamentals of caries diagnosis are reviewed from the three component perspectives, namely the strategy, the logics, and the tactics. Strategy concerns the objectives of the diagnostic process (i.e. why we diagnose caries). The logics describe how we assemble and evaluate the information collected and how this leads to an assessment of diagnostic value. Finally, tactics are about how we collect the information necessary to arrive at a correct diagnosis. We argue that the hitherto-dominant essentialistic caries paradigm should be replaced by a nominalistic caries concept. This allows us to circumvent the problem of a lack of a caries gold standard and to proceed in caries-diagnostic research to find the diagnostic methods that result in the best health outcomes for our patients. We also demonstrate the limitations of the medical model when attempting to understand caries diagnosis, and adhere to the Bader & Shugars caries script model. It is concluded that the current caries profile, characterized by lower prevalence and extent, and slower progression, has increased the need for an academic strengthening of the dental curriculum with respect to diagnostic reasoning and clinical decision-making processes.