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Al-Nerabieah Z, AlKhouli M, Dashash M. Assessment of diagnostic accuracy and reliability of reveal fluorescence dental loupes in detecting molar incisor hypomineralization in children. Photodiagnosis Photodyn Ther 2024; 46:104033. [PMID: 38432500 DOI: 10.1016/j.pdpdt.2024.104033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Molar-Incisor Hypomineralization (MIH) poses challenges to accurate diagnosis, impacting children's oral health. Traditional methods exhibit limitations, necessitating innovative approaches. This study aimed to evaluate the reliability and diagnostic accuracy Reveal Fluorescence Dental Loupes (RFDLs) for the detection of MIH METHODS: This cross-sectional study, adhering to STRAD guidelines, involved 38 healthy children (age 7-9) with MIH. Ethical approval and informed consent were obtained. Microscope images and Reveal loupes were employed for examinations. Validity was assessed against microscope results, and inter- and intra-examiner reliability were measured using ICC and Kappa coefficients. Sensitivity, specificity, and overall accuracy were calculated, with an AUC-ROC analysis for discriminatory ability. RESULTS Intra-examiner reliability scores were excellent (Examiner 1: ICC 0.92, Examiner 2: ICC 0.94). Inter-examiner reliability (Kappa 0.92) indicated almost perfect agreement. Reveal demonstrated high sensitivity (82.61 %) and specificity (92.59 %), with an overall accuracy of 88.70 %. AUC-ROC analysis supported its robust discriminatory ability (AUC: 0.871). CONCLUSIONS Reveal Fluorescence Dental Loupes emerged as a promising diagnostic tool for accurate MIH detection, particularly in outreach settings. The study highlights the transformative impact of accessible and reliable diagnostic tools on pediatric oral health outcomes. While acknowledging limitations and the absence of a gold standard, the findings contribute to advancing MIH diagnostic capabilities. Further research in diverse populations is warranted for comprehensive validation.
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Affiliation(s)
- Zuhair Al-Nerabieah
- Paediatric dentistry department, Faculty of Dentistry, Damascus University, Syria.
| | - Muaaz AlKhouli
- Paediatric dentistry department, Faculty of Dentistry, Damascus University, Syria
| | - Mayssoon Dashash
- Professor, Paediatric dentistry department, Faculty of Dentistry, Damascus University, Syria
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2
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Wongkhuenkaew R, Auephanwiriyakul S, Theera-Umpon N, Teeyapan K, Yeesarapat U. Fuzzy K-Nearest Neighbor Based Dental Fluorosis Classification Using Multi-Prototype Unsupervised Possibilistic Fuzzy Clustering via Cuckoo Search Algorithm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3394. [PMID: 36834094 PMCID: PMC9959423 DOI: 10.3390/ijerph20043394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Dental fluorosis in children is a prevalent disease in many regions of the world. One of its root causes is excessive exposure to high concentrations of fluoride in contaminated drinking water during tooth formation. Typically, the disease causes undesirable chalky white or even dark brown stains on the tooth enamel. To help dentists screen the severity of fluorosis, this paper proposes an automatic image-based dental fluorosis segmentation and classification system. Six features from red, green, and blue (RGB) and hue, saturation, and intensity (HIS) color spaces are clustered using unsupervised possibilistic fuzzy clustering (UPFC) into five categories: white, yellow, opaque, brown, and background. The fuzzy k-nearest neighbor method is used for feature classification, and the number of clusters is optimized using the cuckoo search algorithm. The resulting multi-prototypes are further utilized to create a binary mask of teeth and used to segment the tooth region into three groups: white-yellow, opaque, and brown pixels. Finally, a fluorosis classification rule is created based on the proportions of opaque and brown pixels to classify fluorosis into four classes: Normal, Stage 1, Stage 2, and Stage 3. The experimental results on 128 blind test images showed that the average pixel accuracy of the segmented binary tooth mask was 92.24% over the four fluorosis classes, and the average pixel accuracy of segmented teeth into white-yellow, opaque, and brown pixels was 79.46%. The proposed method correctly classified four classes of fluorosis in 86 images from a total of 128 blind test images. When compared with a previous work, this result also indicates 10 out of 15 correct classifications on the blind test images, which is equivalent to a 13.33% improvement over the previous work.
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Affiliation(s)
- Ritipong Wongkhuenkaew
- Department of Computer Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand
- Graduate School, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sansanee Auephanwiriyakul
- Department of Computer Engineering, Faculty of Engineering, Excellence Center in Infrastructure Technology and Transportation Engineering, Biomedical Engineering Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nipon Theera-Umpon
- Department of Electrical Engineering, Faculty of Engineering, Biomedical Engineering Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kasemsit Teeyapan
- Department of Computer Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand
- Biomedical Engineering Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Uklid Yeesarapat
- Empress Dental Care Clinic, 224/1 M.12 Klong-Chonlaprathan Road, Nongkwai, Hangdong, Chiang Mai 50230, Thailand
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Zhang R, Cheng L, Zhang T, Xu T, Li M, Yin W, Jiang Q, Yang Y, Hu T. Brick tea consumption is a risk factor for dental caries and dental fluorosis among 12-year-old Tibetan children in Ganzi. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:1405-1417. [PMID: 30483920 DOI: 10.1007/s10653-018-0216-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Brick tea contains high concentration of fluoride. The aim of the present work was to explore whether and how the brick tea is a risk factor for dental caries and dental fluorosis among Tibetan children in Ganzi. A cross-sectional study was conducted with 368 12-year-old Tibetan children in Ganzi. Dental caries was measured by DMFT index, and dental fluorosis severity was measured by Dean's Index. Community Fluorosis Index was used to estimate public health significance of dental fluorosis. Oral health-related behaviors and awareness, dietary habits and socioeconomic status were determined by a questionnaire. Bivariate and multivariate analyses were used to determine risk factors associated with dental caries and dental fluorosis. Dental caries prevalence was 37.50%, mean DMFT was 0.84 ± 1.53, while dental fluorosis prevalence was 62.23%. Community Fluorosis Index was 1.35, indicating a medium prevalent strength of dental fluorosis. Dental fluorosis was associated with mother's regular consumption of brick tea and residence altitude, and dental caries was associated with mother's regular consumption of brick tea. Mother's regular consumption of brick tea was a risk factor for both dental fluorosis and dental caries among children. Reducing mother's brick tea consumption during pregnancy and lactation may improve oral health status of their children.
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Affiliation(s)
- Rui Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Li Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Tao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Ting Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Meng Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Wei Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Qingling Jiang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Yingming Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China.
| | - Tao Hu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, 14#, 3rd section, Renmin South Road, Chengdu, 610041, Sichuan, China.
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Macey R, Tickle M, MacKay L, McGrady M, Pretty IA. A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation. Community Dent Oral Epidemiol 2018; 46:608-614. [PMID: 30178518 DOI: 10.1111/cdoe.12411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is a lack of evidence on the proportion and severity of fluorosis in adult populations exposed and not exposed to fluoridated water over their lifetimes. The aim of this study was to compare the proportion and severity of fluorosis in adults with lifetime exposure to water fluoridation with a nonexposed sample. A secondary aim was to report the gradient of fluorosis severity by age. METHODS A cross-sectional study recruited a sample with lifetime exposure to water fluoridation and a matched, nonexposed group. 580 participants, aged 18-52 years (mean 34.3, SD 9.4) and 64% female, were recruited in general dental practices located in fluoridated (Birmingham and County Durham) and nonfluoridated areas (Manchester). Three digital images were taken of their incisors and an experienced examiner who was blind to exposure status viewed the images remotely and allocated fluorosis scores using the Thylstrup and Fejerskov (TF) scale. RESULTS At TF ≥ 1 (any fluorosis), a significantly higher proportion of participants from the fluoridated area had fluorosis (F 39% NF 21.3%, P < 0.001), at the threshold TF ≥ 3 ("aesthetic concern"), the difference was no longer statistically significant (F 4.1%, NF 2.2%, P = 0.25). There was a gradient by age, whereby fluorosis was highest in the youngest and lowest in the oldest age group. CONCLUSIONS Although fluorosis is more common in adults with lifetime exposure to water fluoridation than those with no exposure, the aesthetic impact of fluorosis seems to diminish with age.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Martin Tickle
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Laura MacKay
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Michael McGrady
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Iain A Pretty
- Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
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5
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Liu Z, Goodwin M, Ellwood RP, Pretty IA, McGrady M. Automatic detection and classification of dental fluorosis in vivo using white light and fluorescence imaging. J Dent 2018; 74 Suppl 1:S34-S41. [PMID: 29929587 DOI: 10.1016/j.jdent.2018.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/24/2018] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES To assess a novel method of automatic fluorosis detection and classification from white light and fluorescent images. METHODS Dental images from 1,729 children living in two fluoridated and two non-fluoridated UK cities were utilised. A novel detection and classification algorithm was applied to each image and TF scores were obtained using thresholding criteria. These were compared to clinical reference standard images. Comparisons between reference and automated assessments were undertaken to record correct and incorrect classifications and the ability of the system to separate the fluoridated and non-fluoridated populations. RESULTS The automated system performed well and was able to differentiate the two populations (P < 0.0001) to the same degree as the reference standard. When using the highest score from the clinical assessment the agreement between automated and clinical assessments was 0.56 (Kappa SE = 0.0160, p < 0.0001). CONCLUSIONS Assessment of dental fluorosis is typically undertaken by clinical examiners in epidemiological studies. The training and calibration of such examiners is complex and time consuming and the assessments are subject to bias - frequently because of the examiner's awareness of the water fluoridation status of subjects. The use of remote scoring using photographs has been advocated but still requires trained examiners. This study has shown that image-processing methodologies applied to white light and fluorescent images could automatically score fluorosis and statistically separate fluoridated and non-fluoridated areas. The system requires further refinement to manage confounding factors such as the presence of non-fluoride opacities and tooth stain.
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Affiliation(s)
- Zhao Liu
- The Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
| | - Michaela Goodwin
- The Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
| | - Roger P Ellwood
- The Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
| | - Iain A Pretty
- The Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK.
| | - Michael McGrady
- The Dental Health Unit, School of Dentistry, The University of Manchester, M15 6SE, UK
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Guo YR, Yang X, Feng XW, Sa Y, Wang M, Li P, Jiang T. New Insights into Effects of Aromatic Amino Acids on Hydroxyapatite. J Dent Res 2017; 97:402-408. [PMID: 29130776 DOI: 10.1177/0022034517741274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Biomimetics inspired by superstructures and extraordinary properties of teeth have resulted in tooth repair and the generation of novel materials. However, little attention has been paid to tooth color, whose origin remains unknown. Based on recent studies, fluorophores-mainly aromatic amino acids (AAAs) in proteins-might be responsible for tooth color. We synthesized carbonated hydroxyapatite (HA; the mineral phase of teeth) in the presence of different amino acids (AAs; the basic units of protein matrix of teeth) as a simplified model of teeth to explore the color source at the AA level. After measuring the fluorescence and color characteristics of HA-AAs before and after bleaching treatment, we found that only HA, synthesized in the presence of AAAs, exhibited remarkable fluorescence and color property. Furthermore, linearly increased fluorescence intensity and deeper color were observed with an increase in AAA content in HA-AAAs. Similarly, significantly decreased absorbance of HA-AAAs between 250 and 300 nm in ultraviolet spectra, declined fluorescence intensity, and decolored performance of HA-AAAs were observed after bleaching treatment. The results showed that AAAs contributed to the fluorescence and color properties of HA and that hydrogen peroxide might whiten HA-AAAs by oxidizing the benzene ring in AAAs. These findings are of great significance in promoting the synthesis of advanced tooth-colored materials and furthering our understanding of the possible mechanisms of hydrogen peroxide. Moreover, our study shed light on the importance of AAAs and might provide new ideas for investigations of biomineralization and biomimetics.
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Affiliation(s)
- Y R Guo
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - X Yang
- 2 Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - X W Feng
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Y Sa
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China.,3 Department of Prosthodontics, Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - M Wang
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - P Li
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - T Jiang
- 1 The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China.,3 Department of Prosthodontics, Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
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Cuevas-Espinosa DM, Martinez-Mier EA, Ando M, Castiblanco GA, Cortes F, Rincon-Bermudez CM, Martignon S. In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth. Caries Res 2017; 51:515-526. [PMID: 28968608 DOI: 10.1159/000479905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
This study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.
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8
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Liu S, Sotomi Y, Eggermont J, Nakazawa G, Torii S, Ijichi T, Onuma Y, Serruys PW, Lelieveldt BPF, Dijkstra J. Tissue characterization with depth-resolved attenuation coefficient and backscatter term in intravascular optical coherence tomography images. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-10. [PMID: 28901053 DOI: 10.1117/1.jbo.22.9.096008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/30/2017] [Indexed: 05/20/2023]
Abstract
An important application of intravascular optical coherence tomography (IVOCT) for atherosclerotic tissue analysis is using it to estimate attenuation and backscatter coefficients. This work aims at exploring the potential of the attenuation coefficient, a proposed backscatter term, and image intensities in distinguishing different atherosclerotic tissue types with a robust implementation of depth-resolved (DR) approach. Therefore, the DR model is introduced to estimate the attenuation coefficient and further extended to estimate the backscatter-related term in IVOCT images, such that values can be estimated per pixel without predefining any delineation for the estimation. In order to exclude noisy regions with a weak signal, an automated algorithm is implemented to determine the cut-off border in IVOCT images. The attenuation coefficient, backscatter term, and the image intensity are further analyzed in regions of interest, which have been delineated referring to their pathology counterparts. Local statistical values were reported and their distributions were further compared with a two-sample t-test to evaluate the potential for distinguishing six types of tissues. Results show that the IVOCT intensity, DR attenuation coefficient, and backscatter term extracted with the reported implementation are complementary to each other on characterizing six tissue types: mixed, calcification, fibrous, lipid-rich, macrophages, and necrotic core.
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Affiliation(s)
- Shengnan Liu
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Yohei Sotomi
- University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeroen Eggermont
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
| | - Gaku Nakazawa
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Sho Torii
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Takeshi Ijichi
- Tokai University School of Medicine, Department of Cardiology, Kanaagawa, Japan
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardialysis, Rotterdam, The Netherlands
| | - Patrick W Serruys
- International Centre for Circulatory Health, the National Heart and Lung Institute, Imperial College, United Kingdom
| | - Boudewijn P F Lelieveldt
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
- Delft University of Technology, Department of Intelligent Systems, Delft, The Netherlands
| | - Jouke Dijkstra
- Leiden University Medical Center, Division of Imaging Processing, Department of Radiology, Leiden, The Netherlands
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9
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Ferreira Zandoná A, Ando M, Gomez GF, Garcia-Corretjer M, Eckert GJ, Santiago E, Katz BP, Zero DT. Longitudinal analyses of early lesions by fluorescence: an observational study. J Dent Res 2013; 92:84S-9S. [PMID: 23690351 DOI: 10.1177/0022034513490167] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Previous caries experience correlates to future caries risk; thus, early identification of lesions has importance for risk assessment and management. In this study, we aimed to determine if Quantitative Light-induced Fluorescence (QLF) parameters--area (A [mm(2)]), fluorescence loss (F [%]), and Q [% × mm(2)]--obtained by image analyses can predict lesion progression. We secured consent from 565 children (from 5-13 years old) and their parents/guardians and examined them at baseline and regular intervals over 48 months according to the International Caries Detection Assessment System (ICDAS), yearly radiographs, and QLF. QLF images from surfaces with ICDAS 0/1/2/3/4 at baseline that progressed (N = 2,191) to cavitation (ICDAS 5/6) or fillings and surfaces that did not progress to cavitation/fillings (N = 4,141) were analyzed independently for A, F, and Q. Linear mixed-effects models were used to compare means and slopes (changes over time) between surfaces that progressed and those that did not. QLF A, F, and Q increased at a faster rate for surfaces that progressed than for surfaces that did not progress (p = .0001), regardless of type of surface or baseline ICDAS score. AUC for ICDAS ranged from 0.65 to 0.80, but adding QLF information improved AUC (0.82-0.87, p < .0005). We concluded that faster changes in QLF variables can indicate lesion progression toward cavitation and be more clinically relevant than actual QLF values.
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Affiliation(s)
- A Ferreira Zandoná
- Department of Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis, Indiana. USA.
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McGrady MG, Ellwood RP, Taylor A, Maguire A, Goodwin M, Boothman N, Pretty IA. Evaluating the use of fluorescent imaging for the quantification of dental fluorosis. BMC Oral Health 2012; 12:47. [PMID: 23116324 PMCID: PMC3549943 DOI: 10.1186/1472-6831-12-47] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 10/25/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The quantification of fluorosis using fluorescence imaging (QLF) hardware and stain analysis software has been demonstrated in selected populations with good correlation between fluorescent image metrics and TF Index scores from photographs. The aim of this study was to evaluate the ability of QLF to quantify fluorosis in a population of subjects (aged 11-13) participating in an epidemiological caries and fluorosis survey in fluoridated and non-fluoridated communities in Northern England. METHODS Fluorescent images of the maxillary incisors were captured together with standardized photographs were scored blind for fluorosis using the TF Index. Subjects were excluded from the analysis if there were restorations or caries on the maxillary central incisors. RESULTS Data were available for 1774 subjects (n=905 Newcastle, n=869 Manchester). The data from the fluorescence method demonstrated a significant correlation with TF Index scores from photographs (Kendall's tau = 0.332 p<0.0001). However, a number of additional confounding factors such as the presence of extrinsic stain or increased enamel translucency on some subjects without fluorosis or at low levels of fluorosis severity had an adverse impact on tooth fluorescence and hence the outcome variable. This in conjunction with an uneven distribution of subjects across the range of fluorosis presentations may have resulted in the lower than anticipated correlations between the fluorescent imaging metrics and the photographic fluorosis scores. Nevertheless, the fluorescence imaging technique was able to discriminate between a fluoridated and non-fluoridated population (p<0.001). CONCLUSIONS Despite confounding factors the fluorescence imaging system may provide a useful objective, blinded system for the assessment of enamel fluorosis when used adjunctively with photographic scoring.
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Affiliation(s)
- Michael G McGrady
- School of Dentistry, University of Manchester, Manchester, England, M13 9PL, UK
| | - Roger P Ellwood
- Colgate Palmolive Dental Health Unit, Williams House, Lloyd Street North, M15 6SE, Manchester, England, UK
| | - Andrew Taylor
- Colgate Palmolive Dental Health Unit, Williams House, Lloyd Street North, M15 6SE, Manchester, England, UK
| | - Anne Maguire
- School of Dental Sciences, University of Newcastle, Newcastle, NE2 4BW, England, UK
| | - Michaela Goodwin
- School of Dentistry, University of Manchester, Manchester, England, M13 9PL, UK
| | - Nicola Boothman
- School of Dentistry, University of Manchester, Manchester, England, M13 9PL, UK
| | - Iain A Pretty
- Colgate Palmolive Dental Health Unit, Williams House, Lloyd Street North, M15 6SE, Manchester, England, UK
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11
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Lyaruu DM, Vermeulen L, Stienen N, Bervoets TJM, Denbesten PK, Bronckers ALJJ. Enamel pits in hamster molars, formed by a single high fluoride dose, are associated with a perturbation of transitional stage ameloblasts. Caries Res 2012; 46:575-80. [PMID: 22947666 DOI: 10.1159/000341802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 06/29/2012] [Indexed: 11/19/2022] Open
Abstract
Excessive intake of fluoride (F) by young children results in the formation of enamel subsurface porosities and pits, called enamel fluorosis. In this study, we used a single high dose of F administered to hamster pups to determine the stage of ameloblasts most affected by F and whether pit formation was related to F-related sub-ameloblastic cyst formation. Hamster pups received a single subcutaneous injection of either 20 mg or 40 mg NaF/kg body weight, were sacrificed 24 h later, and the number of cysts formed in the first molars were counted. Other pups were sacrificed 8 days after F injection, when the first molars had just erupted, to score for enamel defects. All F-injected pups formed enamel defects in the upper half of the cusps in a dose-dependent way. After injection of 20 mg NaF/kg, an average of 2.5 white spots per molar was found but no pits. At 40 mg NaF/kg, almost 4.5 spots per molar were counted as well as 2 pits per molar. The defects in erupted enamel were located in the upper half of the cusps, sites where cysts had formed at the transition stage of ameloblast differentiation. These results suggest that transitional ameloblasts, located between secretory- and maturation-stage ameloblasts, are most sensitive to the effects of a single high dose of F. F-induced cysts formed earlier at the pre-secretory stage were not correlated to either white spots or enamel pits, suggesting that damaged ameloblasts overlying a F-induced cyst regenerate and continue to form enamel.
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Affiliation(s)
- D M Lyaruu
- Department of Oral Cell Biology, ACTA, University of Amsterdam and VU University of Amsterdam, MOVE-Research Institute, Amsterdam, The Netherlands
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12
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McGrady MG, Ellwood RP, Srisilapanan P, Korwanich N, Taylor A, Goodwin M, Pretty IA. Dental fluorosis in populations from Chiang Mai, Thailand with different fluoride exposures - paper 2: the ability of fluorescence imaging to detect differences in fluorosis prevalence and severity for different fluoride intakes from water. BMC Oral Health 2012; 12:33. [PMID: 22908997 PMCID: PMC3478182 DOI: 10.1186/1472-6831-12-33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 07/11/2012] [Indexed: 11/10/2022] Open
Abstract
Background To assess the ability of fluorescence imaging to detect a dose response relationship between fluorosis severity and different levels of fluoride in water supplies compared to remote photographic scoring in selected populations participating in an observational, epidemiological survey in Chiang Mai, Thailand. Methods Subjects were male and female lifetime residents aged 8-13 years. For each child the fluoride content of cooking water samples (CWS) was assessed to create categorical intervals of water fluoride concentration. Fluorescence images were taken of the maxillary central incisors and analyzed for dental fluorosis using two different software techniques. Output metrics for the fluorescence imaging techniques were compared to TF scores from blinded photographic scores obtained from the survey. Results Data from 553 subjects were available. Both software analysis techniques demonstrated significant correlations with the photographic scores. The metrics for area effected by fluorosis and the overall fluorescence loss had the strongest association with the photographic TF score (Spearman’s rho 0.664 and 0.652 respectively). Both software techniques performed well for comparison of repeat fluorescence images with ICC values of 0.95 and 0.85 respectively. Conclusions This study supports the potential use of fluorescence imaging for the objective quantification of dental fluorosis. Fluorescence imaging was able to discriminate between populations with different fluoride exposures on a comparable level to remote photographic scoring with acceptable levels of repeatability.
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13
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Pretty IA, McGrady M, Zakian C, Ellwood RP, Taylor A, Sharif MO, Iafolla T, Martinez-Mier EA, Srisilapanan P, Korwanich N, Goodwin M, Dye BA. Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting. BMC Public Health 2012; 12:366. [PMID: 22607363 PMCID: PMC3490889 DOI: 10.1186/1471-2458-12-366] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/05/2012] [Indexed: 11/15/2022] Open
Abstract
Background To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods. Methods Subjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean’s and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean’s and TF indices by raters and fluorescence images were automatically scored using software. Results Data from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean’s and TF index. Agreement (measured by weighted Kappa’s) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92. Conclusions The study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.
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Affiliation(s)
- Iain A Pretty
- Colgate Palmolive Dental Health Unit, School of Dentistry, University of Manchester, Lloyd Street North, Manchester Science Park, England, M15 6SH, United kingdom.
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14
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Boye U, Walsh T, Pretty IA, Tickle M. Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard. BMC Oral Health 2012; 12:10. [PMID: 22540771 PMCID: PMC3444379 DOI: 10.1186/1472-6831-12-10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 04/27/2012] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to compare diagnostic performance for the detection of caries using photographs with an established visual examination method and histological sections as the reference standard. Methods 50 extracted permanent teeth were assessed for the presence of occlusal caries by 9 examiners using two methods; traditional visual examination developed by BASCD and photographs produced by an intra-oral camera. For both methods, diagnoses were made at “caries into dentine” level. The teeth were histologically sectioned and the diagnostic decisions using visual and photographic assessment were compared to the histological reference standard. Inter- and intra- examiner reliability for the methods was assessed and weighted kappa values were calculated. Results The visual examination method had a median sensitivity value of 65.6% and a median specificity value of 82.4%. The photographic assessments method had a median sensitivity of 81.3% and a median specificity of 82.4%. Conclusions The photographic assessments method had a higher sensitivity for caries detection than the visual examination. The two methods had comparable specificities and good intra- and inter- examiner reliability.
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Affiliation(s)
- Uriana Boye
- The Oral Health Unit, School of Dentistry, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
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15
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Huysmans MCDNJM, Chew HP, Ellwood RP. Clinical studies of dental erosion and erosive wear. Caries Res 2011; 45 Suppl 1:60-8. [PMID: 21625134 DOI: 10.1159/000325947] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We define erosion as a partial demineralisation of enamel or dentine by intrinsic or extrinsic acids and erosive tooth wear as the accelerated loss of dental hard tissue through the combined effect of erosion and mechanical wear (abrasion and attrition) on the tooth surface. Most experts believe that during the last decade there has been a significant increase in the prevalence and severity of erosive tooth wear, particularly in adolescents. Even when erosive wear occurs in its milder forms, this is a matter of concern, as it may compromise the integrity of an otherwise healthy dentition in later life. The erosive wear process is complicated and modified by many chemical, behavioural and associated processes in the mouth. If interventions are to be developed it is therefore important that in vivo methods are developed to assess the outcomes of the erosion and erosive wear processes and the effects of interventions upon them. This paper discusses potential methods of investigating erosion and erosive wear in vivo and the difficulties associated with clinical studies.
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Affiliation(s)
- M C D N J M Huysmans
- College of Dental Science, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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16
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Karlsson L. Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue. Int J Dent 2010; 2010:270729. [PMID: 20454579 PMCID: PMC2864452 DOI: 10.1155/2010/270729] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/04/2010] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Lena Karlsson
- Division of Cariology, Department of Dental Medicine, Karolinska Institutet, Box 4064, 141 04 Huddinge, Sweden
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Taylor AM, Ellwood RP, Pretty IA, Mohan N. Quantitative stain detection in vivo using fluorescent imaging. J Dent 2009; 37:397-405. [PMID: 19250731 DOI: 10.1016/j.jdent.2009.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 01/23/2009] [Accepted: 01/27/2009] [Indexed: 10/21/2022] Open
Abstract
Quantitative Light-induced Fluorescence (QLF) has been used to measure tooth stain in vitro; however the current analysis method cannot be used in vivo, as it requires regions of interest to be surrounded by unstained tissue. In this study, an algorithm was developed to detect stain on QLF images of teeth captured in vivo. It uses convex hulls to reconstruct an image of the tooth, without stain, based on clean areas of the image, and subtracts the captured image from the reconstruction to find areas darkened by stain. A tooth outline (mask) must be provided to guide the reconstruction. Three versions of the algorithm are tested on images taken during a stain development study, using a range of values for the threshold parameter. The stain employed was produced using Chlorhexidine mouth rinse. The software output correlates well with manual scoring (Pearson's>0.7; p<0.001). The algorithm shows promise for examining groups of patients in an objective and reproducible way, conferring many benefits over clinical visual assessments.
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