The reader will find the text to be clearly written and informative, with many supporting clinical images. She was a faculty member at Indiana University from untildirecting their graduate residency program in Preventive Dentistry.
She has published and lectured nationally and internationally on prevention and management of dental caries serving on editorial boards and as reviewer for numerous scientific and dental journals. She is the author of 45 peer-reviewed journal articles and several book chapters. In he was accredite Commentaire Helps the clinician to detect early signs of dental caries and to assess caries activity optimally. Caries activity ; Caries lesion stages ; Dental clinical examination ; Hidden Caries ; Tooth surface.
Detection and Assessment of Dental Caries, 1st ed. Résumé This book explains how to optimize clinical conditions for detection of the earliest visible signs of dental caries and how best to assess caries activity as a basis for effective management. Sommaire Introduction. Biographie Dr.
Le diagnostic de la carie occlusale non apparente est toutefois une tâche complexe qui peut être hautement subjective, et les incertitudes inhérentes qui 1 sont associées peuvent donner lieu à des décisions très différentes en matière de traitement.
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Cet article en 2 volets fait une synthèse des connaissances actuelles sur les méthodes classiques et nouvelles de diagnostic de la carie occlusale. La Partie II est consacrée aux techniques nouvelles et émergentes qui sont mises au point pour le diagnostic de la carie occlusale.
Les mesures de conductance électrique et la fluorescence quantitative induite par laser représentent des améliorations appréciables par rapport aux méthodes de diagnostic classiques, en particulier pour les applications in vitro et, surtout, sur le plan de la sensibilité et de la reproductibilité. Les études corroborant son efficacité sont toutefois limitées, mais elles semblent indiquer une bonne sensibilité et une excellente reproductibilité.
Les nouvelles technologies offrent peut-être des renseignements supplémentaires, mais elles ne peuvent pas encore remplacer les méthodes établies pour le diagnostic de la carie occlusale.
Visual Criteria to Diagnose Initial Dental Caries : An Overview
Some of the above-mentioned technologies are suitable only for interproximal or smooth-surface lesions, and others are unsuitable for clinical application. Electrical conductance measurements and laser fluorescence methods including the DIAGNOdent laser fluorescence device [KaVo, Biberach, Germany] are 2 distinct technologies with applications in the diagnosis of occlusal caries. The reported sensitivity and specificity for electrical conductance measurements and laser fluorescence methods are presented in Tables 1 and 2.
Electrical Conductance Measurements EC The electrical conductivity of a tooth changes with demineralization, even when the surface remains apparently intact. Electrical conductance measurements make use of the increased conductivity of carious enamel in pits and fissures.
The entire occlusal surface is first covered with a conducting medium. Conductivity from the occlusal surface to a ground electrode is then measured with a probe. An increase in conductivity is due to the development of microscopic demineralized cavities within enamel, which are filled with saliva. Two early commercial models of devices for measuring electrical conductance are no longer available, but a new instrument, the Electronic Caries Monitor Lode Diagnostic, Groningen, The Netherlandsis currently being evaluated.
No commercial devices are available in Canada. Generally high sensitivity and specificity have been reported for EC techniques. Laser Fluorescence LF The LF method measures the fluorescence of the tooth that is induced after light irradiation to discriminate between carious and sound enamel. It is accepted that the induced fluorescence of enamel is lower in areas of reduced mineral content, and that there is a relation between mineral loss and the radiance of the fluorescence. Several studies in which an argon laser light source nm was used to examine smooth enamel surfaces have shown a strong correlation between a decrease in fluorescence and the degree of enamel demineralization.
Fewer studies have assessed QLF for its ability to detect occlusal pit and fissure caries. The use of air-polishing to remove plaque improved diagnosis by QLF.
QLF was not designed to discriminate between lesions restricted to the enamel and those extending into the dentin. Furthermore, Banerjee and Boyde 17 showed that the fluorescence from dentin was not related to dentin demineralization, so this method is not suitable for measuring dentin demineralization. The unit emits light at nm wavelength from a fibre optic bundle directed onto the occlusal surface of a tooth.
A second fibre optic bundle receives the reflected fluorescent light beam, and changes caused by demineralization are assigned a numeric value, which is displayed on the monitor. The system is calibrated to a provided standard and to reference sound enamel. The instructions for the DIAGNOdent system specify that the occlusal area to be diagnosed be clean, because plaque, tartar and discolouration may give false values. A laser probe is used to scan over the fissure area in a sweeping motion.
The instructions suggest that, in general, numeric data between 5 and 25 indicate initial lesions in the enamel and that values greater than this range indicate early dentinal caries. Advanced dentin caries is said to yield values greater than Surprisingly, the device showed higher diagnostic accuracy in the detection of dentinal caries than enamel caries.
The authors suggested that the DIAGNOdent values were dependent on the volume of the caries rather than on the depth of the lesion. With a cut-off of 18 to 22, the sensitivity for diagnosis of dentinal caries in wet teeth was 0. The investigators concluded that overall correlation between DIAGNOdent and microradiography results was moderate but that the device appeared superior to conventional radiography. They reported that the instrument was very sensitive to the presence of stains, deposits and calculus, all of which led to erroneous readings.
Similarly, any changes in the physical structure of the enamel, including disturbed tooth development or mineralization, produced erroneous readings.
Second repeated sets of DIAGNOdent measurements showed better cor relation with the microradiography standard, which was construed as revealing operator learning and skill development. Reproducibility for the DIAGNOdent device was high in this study, but there was also evidence of different degrees of learning for individual dentists, and for 2 of the clinicians reproducibility was poor.
The investigators used low cut-off values 10 to 18 for diagnosis and recommended caution in extrapolating their results to the clinical situation.