Applying Technology to the Caries Conundrum

The old method of assessing the presence or absence of caries by visual clinical examination using an explorer and radiography—although it could be effective—in most cases identified late-stage carious lesions, explains Paul J. Vankevich, DMD. The emphasis today is for early-stage diagnosis of disease and/or detection of symptoms.

“If one were to choose the area where we have the greatest difficulty diagnosing, it would be pit-and-fissure caries,” says Howard E. Strassler, DMD. “According to the classical explorer method, the dentist would make diagnoses based upon a physical phenomenon rather than a disease phenomenon. The introduction of digital technologies allows us to get a better sense of the changes to the surface of the enamel, the changes in the translucency of the enamel, and whether the demineralization process is occurring.”

“The important thing about all of these technologies, regardless of what gets developed and makes it into the marketplace, is that they’re going to breed a whole new array of therapeutics to treat the caries lesions,” asserts Joel H. Berg, DDS, MS.

These include—but are not limited to—the following (listed in alphabetical order):

Midwest Caries I.D. (Midwest/DENTSPLY). This light-emitting diode (LED) technology uses light reflection to indicate the presence of healthy enamel versus translucent or demineralized enamel. Sue S. Wong says the Midwest Caries I.D. diagnostic aid can be used by both the hygienist and the dentist and is indicated to detect caries in both pits and fissures on both the occlusal as well as the interproximal area for adult dentitions only. It uses red infrared technology that breaks down the tooth structure and is able to detect demineralization 3 mm deep, within the enamel rods.

“The technology bounces back an audible as well as a digital signal to the clinician,” Wong explains. “So, an absence of the bright red light would indicate that the tooth is a healthy structure. If it was a red light, then it would indicate a stage of decay.”

CariScreen (Oral BioTech). The CariScreen is a simple swab test using the ATP Bioluminescence and a handheld meter to make a broad-spectrum diagnosis of the presence of any acid-producing bacteria that may be at play in a patient’s biofilm. Carri Cady, RDH, explains that a swab of the biofilm from the lingual of the lower anteriors is taken, slid into the meter, and a reading of bacterial level is given within 15 seconds. The ranges include healthy, non-acid producing strains, as well as acid-producing strains that put patients at higher risk for decay, Cady says.

“The CariScreen is used ideally as a screening tool for all patients, whether they’re experiencing decay today or not,” Cady says. “The real strength of the technology is its ability to screen every patient and identify shifts in their bacterial load away from the healthy strains toward the more acid-producing strains so the condition can be treated preventively before the cavitations start to form.”

ATP Bioluminescence is not a new technology and has been used for years in the healthcare and food industries to identify the presence of bacterial load on surfaces. The application of ATP Bioluminescence technology to dentistry, however, allows clinicians to make a real-time assessment of health versus disease state, Cady explains.

DIAGNOdent (KaVO Dental). According to Amod A. Kher, there are numerous technologies used by the dentists today to detect caries. The infrared (IR) laser fluorescence technology is used in the DIAGNOdent caries detection device, he says.

“Fluorescence can be used for caries detection because of the difference in fluorescence observed between sound and de-mineralized enamel, which is greater when the enamel is illuminated by light,” Kher explains. “The DIAGNOdent uses infrared light and has a 655 nanometer wavelength.”

DIAGNOdent, which was introduced in the United States in 2000, is based on the principle that a tooth surface fluoresces when irradiated by a light of a given wavelength. This fluorescence changes according to the optical characteristics of tooth tissue associated with bacteria, Kher says. The value of this change may, therefore, give an indication of the extent of the disease process. ,

DIFOTI (Electro-Optical Sciences). Another adjunctive method is the Digital Imaging Fiber-Optic Trans-illumination (DIFOTI) technique, which enables clinicians essentially to see shadows of teeth that are similar to the manner in which radiography is used to detect shadows. Vankevich says this may be another supplemental new technology that could be used particularly in early-stage diagnosis of lesions.

According to Berg, DIFOTI is an intense transillumination device. In terms of primary teeth, based on his studies, once the technology is perfected, it might, in some instances, be an alternate to bitewing radiography. An intense light could be shined interproximally, perhaps eliminating the need for radiographs. “We’re not there yet, but I think the growth of that technology could get us there at some point,” Berg speculates.

Inspektor Pro System (3M ESPE/OMNI Preventive Care Division). Berg explains that this product is one of several representing an emerging technology and relatively new concept called Quantitative Light-Induced Fluorescence (QLF). These devices use visible light to detect changes in fluorescence that are facilitated with loss of mineral content in the tooth. They are very sensitive in terms of detecting subtle changes far in advance of a cavity actually forming, he says.

“QLF devices can somewhat predict when a cavity might happen,” Berg says. “The problem with many of the very sensitive devices is that we don’t know which lesions will progress and which ones will remineralize on their own by virtue of preventive regimens.”

SPECTRA (Air Techniques). Jon Newman says that by using fluorescence technology, the SPECTRA illuminates the entire occlusal surface of the tooth (including fissures and pits). The reflectiveness of the light coming back to the device is then captured to indicate the presence or absence of potential caries.

The device is connected to a computer, enabling the clinician to use imaging software—similar to digital radiography—a phosphor storage plate scanner, and intraoral camera. Information can be viewed on screen and then saved into a patient’s record for analysis at a later date. This allows tracking of any regression or progression of the caries itself, N