Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth.

We aimed to investigate the performance of fluorescence-based methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

Association between quantitative measures obtained using fluorescence-based methods and activity status of occlusal caries lesions in primary molars.

BACKGROUND: Fluorescence-based methods (FBM) can add objectiveness to diagnosis strategy for caries. Few studies, however, have focused on the evaluation of caries activity. AIM: To evaluate the association between quantitative measures obtained with FBM, clinical parameters acquired from the patients, caries detection, and assessment of activity status in occlusal surfaces of primary molars. DESIGN: Six hundred and six teeth from 113 children (4-14 years) were evaluated. The presence of a biofilm, caries experience, and the number of active lesions were recorded. The teeth were assessed using FBM: DIAGNOdent pen (Lfpen) and Quantitative light-induced fluorescence (QLF). As reference standard, all teeth were evaluated using the ICDAS (International Caries Detection and Assessment System) associated with clinical activity assessments. Multilevel regressions compared the FBM values and evaluated the association between the FBM measures and clinical variables related to the caries activity. RESULTS: The measures from the FBM were higher in cavitated lesions. Only, ∆F values distinguished active and inactive lesions. The LFpen measures were higher in active lesions, at the cavitated threshold (56.95 ± 29.60). Following regression analyses, only the presence of visible biofilm on occlusal surfaces (adjusted prevalence ratio = 1.43) and ∆R values of the teeth (adjusted prevalence ratio = 1.02) were associated with caries activity. CONCLUSION: Some quantitative measures from FBM parameters are associated with caries activity evaluation, which is similar to the clinical evaluation of the presence of visible biofilm.

Clinical performance of fluorescence-based methods for detection of occlusal caries lesions in primary teeth

Abstract We aimed to investigate the performance of fluorescence-based methods (FBMs), compared to visual inspection after histological validation, in detecting and assessing the activity status of occlusal carious lesions in primary teeth. One examiner evaluated 50 primary molars close to exfoliation in 24 children. Teeth were assessed using quantitative light-induced fluorescence (QLF) and pen-type laser fluorescence (LFpen). After exfoliation, histological validation was performed. Teeth were cut and sections were evaluated for lesion depth and activity status (after utilization of a pH indicator) under a stereomicroscope. Parameters related to the performance of the methods in detecting caries lesions at two thresholds (initial and dentin lesions) were calculated. Regarding the activity status, lesions were classified into sound+inactive or active, and the area under the ROC curve and the diagnostic odds ratio values of the methods were calculated and compared. Evaluation of red fluorescence using QLF presented higher sensitivity but lower specificity than visual inspection in detecting dentin caries lesions. However, QLF considering different parameters and LFpen had similar performance to that obtained with visual inspection. Regarding activity assessment, all FBMs and visual inspection also presented similar performance. In conclusion, FBMs did not prove advantageous for the detection and activity assessment of occlusal caries lesions in primary molars when compared to visual inspection.

Clinical Assessment of a New Caries Activity Test Using Dental Plaque Acidogenicity in Children under Three Years of Age.

OBJECTIVES: The aim of this study was to assess the validity of a new caries activity test that uses dental plaque acidogenicity in children with deciduous dentition. STUDY DESIGN: Ninety-two children under the age of three years old underwent clinical examination using the dft index and examinations with two caries activity tests. Plaque samples for the new Cariview(®) test and the saliva sample for the conventional Dentocult SM(®) test were collected, incubated, and scored according to each manufacturers' instruction. The data were analysed using ANOVA and Spearman correlation analyses to evaluate the relationships between the test results and the caries experience. RESULTS: The mean dft index of all of the subjects was 4.73, and 17.4% of the subjects were caries-free. The levels of caries risk based on the new Cariview test score significantly increased with the caries experience (p < 0.01). The test results revealed a stronger correlation with caries indices (dft and dt index) than the conventional SM colony counting method (r = 0.43, r = 0.39, p < 0.01). CONCLUSIONS: The new caries activity test to analyse the acidogenic potential of whole microorganisms from dental plaques can be used to evaluate caries risk in children with deciduous teeth.

Comparison of three diagnostic techniques for detecting occlusal dental caries in primary molars: An in vivo study.

AIM: To compare the accuracy and repeatability of three diagnostic systems; visual inspection, bitewing radiography, and CarieScan PRO for occlusal caries diagnosis in primary molars. MATERIALS AND METHODS: 216 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (visual inspection, bitewing radiography, and CarieScan PRO). Examiners indicated operative intervention (validation method) for 104 teeth which were used for statistical analysis. The validation method was cavity preparation when the two examiners agreed about the presence of dentinal caries. Sensitivity, specificity, likelihood ratio, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each diagnostic technique. Inter- and intra-examiner repeatability was calculated for each diagnostic system using the Cohen's kappa statistics. RESULTS: Visual inspection showed the highest sensitivity (0.93). The highest sensitivity and NPVs were provided by CarieScan PRO (0.97 and 0.95, respectively) however this was offset by a lower specificity (0.82) compared to other techniques. The CarieScan PRO gave the highest values of Cohen's kappa statistics. CONCLUSION: This study showed low sensitivity but substantial specificity with visual inspection. Bitewing radiography performed poorly overall when compared with the other two systems. The CarieScan PRO technique gave the highest overall combination of sensitivity and specificity for detection of occlusal caries.

Modelo experimental de cárie dentária como ferramenta educativa em escolares / Experimental model of tooth decay as an educational tool for school-age children / Modelo experimental de caries dentarias como herramienta educativa en escolares

Objetivo Objetivou-se a constituiu na construção de um modelo educativo sobre o desenvolvimento da Cárie Dentária por meio de uma adaptação do experimento de Miller. Método Em um recipiente de vidro esterilizado e fechado coletou-se a saliva de doadores e acrescentou-se substrato à base de açúcar (sacarose). Somou-se ao conjunto um dente humano extraído pelo tratamento odontológico com a coroa dental hígido. A fase I teve o controle negativo (dente + saliva sem aporte de sacarose) e sendo os demais abertos especificamente após 01, 02, 03 e 04 meses da incubação, e esta serviu de parâmetro para delineamento da etapa seguinte. Na fase II foram necessários dois doadores de saliva. Nesta fase utilizaram-se doadores de saliva com baixos níveis de higiene bucal. A incubação dos dentes (definida pela fase I) foi 02 e 03 meses para cada doador. Resultado O registro do experimento fomenta um trabalho educativo sobre os riscos de desenvolvimento de cárie dentária, etiologia e evolução, de modo que possibilite a construção de uma cartilha explicativa sobre como reproduzir tal modelo experimental a ser trabalhada em escolares do ensino médio. Conclusão A realização desse tipo de trabalho juntos a escolares pode contribuir para diminuir as iniquidades em saúde bucal, especialmente porque há uma aproximação dos discursos, facilitando o processo de disseminação da informação.(AU)

Objective This work consisted of the construction of an educational in vitro model of dental caries that started with an adaptation of Miller's classic experiment. Methods In a sterilized and sealed glass jar, a sample paste of human saliva was collected and a substrate of manufactured sugar (sucrose) was added. In addition, a human tooth with healthy dental crown extracted in dental treatment but otherwise healthy was added. Research phase I had the negative control sample test (tooth + saliva without added) and the others were opened after 1, 2, 3 and 4 months of incubation. This phase was essential for the next experimental time development. In phase II, two saliva donors with poor levels of oral health habits were recruited. The incubation time (defined by phase I) was 2 and 3 months for each donor. Results This research data gives the possibility of building educational materials about the etiology of tooth decay and its clinical evolution. It also makes possible the production of an explanatory sheet about how to reproduce this experimental model to be used by school children in secondary education. Conclusions Doing this kind of work together at school can help reduce inequities in oral health, especially since there is an approximation toward the discourses, facilitating the process of information dissemination.(AU)

Objetivo El objetivo es la construcción de un modelo educativo en el desarrollo de la caries dental por medio de una adaptación del experimento de Miller. Métodos En recipientes de vidrio estériles sellados, se recoge saliva donada y se añade sustrato a base de azúcar (sacarosa). Después, se añade a la gama un diente humano extraído por el tratamiento dental con corona dental por lo demás sanos. La Fase I fue el control negativo (diente + saliva sin ingesta de sacarosa) y los demás se abrieron específicamente después de 01, 02, 03 y 04 meses de incubación. Esto sirvió como parámetro para la siguiente etapa del diseño. En la fase II tomó dos donaciones de saliva. En esta etapa se usan donantes de saliva con bajos niveles de higiene oral. La incubación de los dientes (definido por fase I) fue 2 y 3 meses por donante. Resultado El experimento promueve el trabajo educativo sobre el riesgo de desarrollar caries dental y su etiología y evolución con el fin de hacer posible la construcción de un folleto explicativo sobre cómo un modelo tan experimental para ser trabajado por los estudiantes de secundaria. Conclusión La realización de este tipo de trabajo juntos en la escuela puede ayudar a reducir las desigualdades en la salud bucal, sobre todo porque no es una aproximación de los discursos, lo que facilita el proceso de difusión de la información.(AU)

Impact of different magnification levels on visual caries detection with ICDAS.

OBJECTIVES: The aim of this in vitro study was to examine the effect of different levels of magnification on the accuracy and reliability of visual caries detection using ICDAS criteria. METHODS: Occlusal surfaces of 100 extracted molars were assessed by 14 examiners (3rd and the 4th year dental students and dentists) using no magnification aids, a 2.5× Galilean loupe, a 4.5× Keplerian loupe, or a surgical microscope with 10× magnification. The assessments were repeated on a different day. Sensitivity, specificity, AUC and reliabilities were calculated according to the gold standard of histology. RESULTS: We found that with increasing magnification, the number of surfaces rated as "sound" (ICDAS code 0) decreased, while the number of surfaces with a localized enamel breakdown (ICDAS code 3) increased. While the sensitivities increased, the values of the specificities decreased to an unacceptably low level irrespective of the clinical experience of the examiners. CONCLUSIONS: ICDAS seems to be optimized for natural vision up to 2.0× magnification and not for high magnifications. The use of powerful magnification in visual caries detection involves the risk of unnecessary and premature invasive treatment. CLINICAL SIGNIFICANCE: This paper discusses when it does and does not make sense to use magnification devices for visual caries detection using ICDAS criteria. Strong magnifications should be refrained from for this purpose.

Detection and diagnosis of the early caries lesion.

The purpose of this manuscript is to discuss the current available methods to detect early lesions amenable to prevention. The current evidenced-based caries understanding, based on biological concepts, involves new approaches in caries detection, assessment, and management that should include non-cavitated lesions. Even though the importance of management of non-cavitated (NC) lesions has been recognized since the early 1900 s, dental caries has been traditionally detected at the cavitation stage, and its management has focused strongly on operative treatment. Methods of detection of early carious lesions have received significant research attention over the last 20 years. The most common method of caries detection is visual-tactile. Other non-invasive techniques for detection of early caries have been developed and investigated such as Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Fibre-optic Transillumination (FOTI) and Electrical Conductance (EC). Based on previous systematic reviews, the diagnosis of NCCLs might be more accurately achieved in combination of the visual method and the use of other methods such as electrical methods and QLF for monitoring purposes.

A clinical investigation of the efficacy of a dentifrice containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, on primary root caries.

OBJECTIVE: The purpose of this six-month study was to assess the ability of a new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, to arrest and reverse primary root caries lesions in adults. METHODS: Three test groups used dentifrices which contained either: 1) 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate in a calcium base (experimental); 2) 1450 ppm fluoride as sodium fluoride in a silica base (positive control); or 3) no fluoride in a calcium base (negative control). The study participants were residents of the city of Chengdu, Sichuan Province, China. In order to take part, subjects had to have at least one non-cavitated primary root caries lesion. A total of 412 subjects completed the study. They were aged from 50 to 70 years (mean age 64 +/- 4.1 years) and 53.6% were female. Efficacy for arresting and reversal of primary root caries was assessed by clinical hardness measures and through the use of the Electrical Caries Monitor. RESULTS: After three months of product use, clinical hardness measures showed that 27.7%, 24.6%, and 13.1% of lesions had improved in the experimental, positive, and negative control groups, respectively, and 0.7%, 4.5%, and 16.8% had become worse, respectively. The differences in the distribution of lesion change between the negative control group and both the experimental (p < 0.001) and positive control (p = 0.001) were statistically significant. The Electrical Caries Monitor was also used as an objective measure of lesion severity. The end values increased from baseline to the three-month examinations, but none of the differences between the groups attained statistical significance. After six months, clinical hardness measures showed that only one lesion (0.7%) was worse than at the baseline examination-in the experimental group compared to 9.0% and 18.2% in the positive and negative control groups, respectively. In addition, 61.7%, 56.0%, and 27.0%, respectively, showed improvement for the three groups. The differences in the distribution of lesion change scores between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant, as was the difference between the experimental group and the positive control (p = 0.006). The Electrical Caries Monitor end values for the experimental, positive, and negative control groups at the six-month examination were 7.9, 1.9 mega omega(s), and 387 kilo omegas(s), respectively. The differences between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant. The difference between the experimental and positive control groups was also statistically significant (p = 0.03). CONCLUSION: It is concluded that the new toothpaste containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, provided greater anticaries benefits than a conventional toothpaste containing 1450 ppm fluoride. Both fluoride toothpastes demonstrated greater benefits than non-fluoride toothpaste.

In vitro evaluation of laser fluorescence devices for caries detection through stereomicroscopic imaging.

The aims of this study were to determine the diagnostic accuracy and reproducibility of the laser fluorescence device (LF), and the relationship between laser fluorescence readings taken at the entrance of the fissure, ICDAS visual examination caries detection system and the histological depth of the lesion. Two hundred and forty teeth (122 human third molars and 118 bicuspids) were selected from 62 patients enrolled in the study. Visual and LF examinations (Diagnodent, Kavo, Biberach, Germany) of the occlusal surfaces were performed in vivo. After tooth extraction, histological sections were evaluated by stereomicroscopy in vitro. Statistical analysis was performed using multiple statistical methods (SPSS ver. 17). Intra-examiner reproducibility for the LF measurements was excellent: intra-class-correlation coefficient (ICC) for LF was 0.957. Kappa values for each examiner's reproducibility were 0.74-0.82. The diagnostic performance of the LF device gave a good overall diagnostic accuracy according to ICDAS II codes and histological values as indicated by the area under the ROC curve of 0.707 and 0.709 respectively. The results of the study showed acceptable diagnostic accuracy for the laser fluorescence device. This supports the view that dentists can be site specific in applying fluorescence-based devices to multiple discrete sites within the same surface. In conclusion, these diagnostic methods have different characteristics, indications and limitations for use. In order to detect caries on occlusal surfaces thoroughly, a combination of methods would be the best practice moderated by clinical knowledge and experience.

Use of new minimum intervention dentistry technologies in caries management.

Preservation of natural tooth structure requires early detection of the carious lesion and is associated with comprehensive patient dental care. Processes aiming to detect carious lesions in the initial stage with optimum efficiency employ a variety of technologies such as magnifying loupes, transillumination, light and laser fluorescence (QLF® and DIAGNOdent® ) and autofluorescence (Soprolife® and VistaCam®), electric current/impedance (CarieScan(®) ), tomographic imaging and image processing. Most fluorescent caries detection tools can discriminate between healthy and carious dental tissue, demonstrating different levels of sensitivity and specificity. Based on the fluorescence principle, an LED camera (Soprolife® ) was developed (Sopro-Acteon, La Ciotat, France) which combined magnification, fluorescence, picture acquisition and an innovative therapeutic concept called light-induced fluorescence evaluator for diagnosis and treatment (LIFEDT). This article is rounded off by a Soprolife® illustration about minimally or even non-invasive dental techniques, distinguishing those that preserve or reinforce the enamel and enamel-dentine structures without any preparation (MIT1- minimally invasive therapy 1) from those that require minimum preparation of the dental tissues (MIT2 - minimally invasive therapy 2) using several clinical cases as examples. MIT1 encompasses all the dental techniques aimed at disinfection, remineralizing, reversing and sealing the caries process and MIT2 involves a series of specific tools, including microburs, air abrasion devices, sonic and ultrasonic inserts and photo-activated disinfection to achieve minimal preparation of the tooth. With respect to minimally invasive treatment and prevention, the use of lasers is discussed. Furthermore, while most practices operate under a surgical model, Caries Management by Risk Assessment (CaMBRA) encourages a medical model of disease prevention and management to control the manifestation of the disease, or keep the oral environment in a state of balance between pathological and preventive factors. Early detection and diagnosis and prediction of lesion activity are of great interest and may change traditional operative procedures substantially. Fluorescence tools with high levels of magnification and observational capacity should guide clinicians towards a more preventive and minimally invasive treatment strategy.

[Optimization of initial dental caries diagnostics and treatment in patients infected with herpes virus].

The article presents the results of examination and treatment of patients with initial caries (K02.0), infected with herpes virus. Technologies and methods used by most dentists are not sensitive enough to detect caries at early stages, while the remineralizing therapy can be very effective. The method of laser fluorescence spectroscopy with DIAGNOdent pen device (KaVo) was used for diagnostic of dental caries at early stages. Treatment was carried out with HealOzon device (KaVo), which is used in oral medicine to produce ozone.

Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study.

AIM: This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods. DESIGN: Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics. RESULTS: At D1, visual inspection presented higher sensitivities (0.97-0.99) but lower specificities (0.18-0.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79). CONCLUSIONS: Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Relationship between laser fluorescence values and visual evaluation of fissure caries in schoolchildren - a field study.

BACKGROUND: In our previous study of oral health intervention in children, laser fluorescence (LF) values of occlusal surfaces were reduced after 1 year. AIM: The aim of this study was to explore the relationship between DIAGNOdent pen values and clinical status of the occlusal surfaces. DESIGN: The study conducted in 2007 and 2008 in 700 children aged 13-14 included a clinical examination and LFpen measurement of the occlusal surfaces of first and second molars. Four teams consisting of a dental hygienist and a dental nurse performed the examinations on school premises. The dental hygienist scored the surfaces using the Nyvad criteria for caries assessment; the surfaces were then scanned using a DIAGNOdent pen(®) device. RESULTS: The more severe the visual caries category was, the higher the mean LFpen values were. Correlation coefficients between LF values and NY categories were 0.542 and 0.408 in years 2007 and 2008, respectively (all examiners combined). The LFpen values of active and inactive lesions did not differ significantly. CONCLUSIONS: The correlation between the mean LFpen values and the NY categories was significant. Fissures can be reliably examined with LF and by visual inspection on school premises if certain special arrangements are made.

Intraoral pH measurement of carious lesions with qPCR of cariogenic bacteria to differentiate caries activity.

OBJECTIVES: A low pH environment is created by cariogenic bacteria. This study was aimed to measure pH of carious lesions intraorally using a micro-pH sensor, and assess predominant acid-producing cariogens by qPCR to differentiate caries activities. METHODS: 103 dentine lesions classified as active or arrested caries based on the clinical and radiological examinations were collected from patients after intraoral measurement of the lesion surface pH using a micro-pH sensor. Quantitative detection of genomic DNA copies of target cariogenic bacteria (mutans streptococci and Lactobacillus spp.) in each lesion was performed using real-time PCR. Correlation between the pH ranges and the number of bacterial species was examined by Spearman test. RESULTS: 50 samples were diagnosed as active and 53 as arrested lesions. Statistically significant difference was observed on average surface pH value between active and arrested lesions (p<0.05). Prevalence of Lactobacillus spp. was higher in active lesions than in arrested lesions (76% vs. 58% of samples, respectively). When the carious lesions were categorised into four different pH ranges (up to 5.5, from 5.6 to 5.8, from 5.9 to 6.1 and 6.2 or above), increased prevalence of Lactobacillus spp. was observed with decrease of pH levels. A significant negative relationship was found between pH value and number of Lactobacillus spp. (r=-0.209, p<0.05) but no such correlation was found for mutans streptococci. CONCLUSIONS: Intraoral pH measurement might be clinically useful to determine acidity of the local environment of carious lesions as one aspect of the caries activity assessment. CLINICAL SIGNIFICANCE: The population of certain bacteria may indicate activity of carious lesions. Intraoral pH measurement of the carious lesions using a micro-pH sensor may be a clinically feasible method for assessment of lesion acidity.

Effects of tetracycline hydrochloride on measurements with the laser fluorescence device DIAGNOdent: in vitro and in vivo studies.

Dental materials that fluoresce affect the reading of the laser fluorescence device DIAGNOdent. Tetracycline hydrochloride (TCH) shows fluorescence and is retained in teeth. The aim of this study was to evaluate the effects of TCH on the DIAGNOdent reading. Filter-paper discs that contained various amounts of TCH were prepared (0.16-10 mg per disc). One-day-old newborn rats were subcutaneously injected with TCH for 29 days, and their mandibles were then removed. The DIAGNOdent values (D-V) of the discs and first molars of the rats were measured before and after they were subjected to ultraviolet irradiation (UV). The D-V of discs containing TCH increased depending on the amount of TCH. The D-Vs of discs with lower amounts of TCH (0.16-1.25 mg) were approximately 10-15, and these values increased to 30-40 under UV. In addition, the D-Vs of molars after UV were twofold greater than those before UV. These results suggest that TCH might affect the readings obtained by DIAGNOdent.

A clinical study of a laser fluorescence device for the detection of approximal caries in primary molars.

OBJECTIVE: To evaluate the efficacy of laser fluorescence (LF) device in detecting approximal caries in primary molars. METHODS: Two hundred and sixteen primary molars from 96 children were inspected visually to identify possible caries with contact approximal surfaces. Target molars and their contralateral molars were examined using bitewing radiographs (BR) and LF. Depending on the examination findings, invasive treatments were performed on molars to identify the presence of cavitation. RESULTS: Of 256 surfaces evaluated from 216 primary molars, 128 were intact, 39 had white spots, and 89 had cavities. At the white-spot threshold, sensitivity and specificity, respectively, were 2.56% and 94.87% for visual inspection (VI); 64.10% and 97.43% for BR; and 56.41% and 94.87% for LF. At the cavity threshold, sensitivity and specificity, respectively, were 70.79% and 95.51% for VI; 97.75% and 93.26% for BR; and 92.14% and 97.75% for LF. Significant differences between intact surfaces and white spots, and white spots and cavities were shown through LF readings. CONCLUSIONS: Both LF and BR can detect cavitations on approximal surfaces of primary molars. LF could be an alternative to radiographs in detecting approximal caries in primary molars.

Clinical evaluation of DIAGNOdent in detection of occlusal caries in newly erupted noncavitated first permanent molars in caries-active children.

OBJECTIVE: The aim of this study was to compare the in vivo diagnostic ability of a laser fluorescence system (DIAGNOdent, KaVo, Biberac, Germany) with that of visual inspection in the early detection of occlusal caries in newly erupted noncavitated first permanent molars among caries-active children. MATERIALS AND METHODS: A total of 505 mandibular first permanent molar teeth in 307 children aged 6 to 7 years with decayed, missing, and filled tooth surfaces (DMFS)>8 were examined. Visual examination and DIAGNOdent measurement of caries were compared for teeth with intact occlusal surfaces or varying degrees of fissure discoloration, but with no radiologic evidence of enamel or dentin caries. Teeth were classified according to caries status as sound, enamel caries, or dentin caries using visual examination and DIAGNOdent scoring systems corresponding to histologic definitions of caries depth. Analysis of the results was performed using Cohen's unweighted kappa statistic. RESULTS: Statistical analysis revealed "poor" agreement between the two diagnostic methods (κ=0.231). CONCLUSION: Clinical results suggest that the DIAGNOdent device does not seem to be suitable for accurate diagnosis of early caries lesions in newly erupted first permanent molars.

Correlação entre a avaliação microscópica e a leitura por laser fluorescência de lesões de manchas brancas em dentes bovinos: estudo in vitro / Correlation between the microscopic evaluation and reading by laser fluorescence of enamel decalcification in bovine teeth: in vitro study

Objetivo: avaliar a correlação entre as leituras de descalcificação artificial de esmalte in vitro por meio do DIAGNOdent® e pela microscopia óptica com luz polarizada. Metodologia: foram utilizados 25 dentes bovinos que foram expostos a um meio artificial de cáries por uma hora, duas vezes ao dia, por 35 dias. Em seguida, procedeu-se as leituras das fluorescências utilizando o aparelho laser DIAGNOdent®. Foram registradas as leituras das áreas sem descalcificação (para calibração) e as áreas desmineralizadas artificialmente. Após as leituras da fluorescência, as regiões de leitura por laser foram cortadas em secções de aproximadamente 400μm e avaliadas por meio da microscopia de luz polarizada. Resultados: demonstraram que, embora com algum grau de variação, o sistema DIAGNOdent® foi capaz de detectar as descalcificações semelhantemente àqueles reconhecidos por microscopia de luz polarizada, estabelecendo um padrão razoável de equivalência de leituras. Conclusão: os valores médios encontrados para o DIAGNOdent® demonstraram um coeficiente de correlação de Pearson de 0,63 com relação aos valores das leituras microscópicas.

Aim: evaluate the correlation between the artificial in vitro enamel decalcification through DIAGNOdent® laser and through optic microscopic with polarized light. Methodology: for this research, 25 bovine teeth had been exposed to an artificial decay environment during one hour, two times a day, for 35 days. After wards, DIAGNOdent® laser has been used to read the fluorescence from the enemel areas without decalcification (for calibration) and to evaluate the non-mineralized artificially. After the fluorescence readings regions of laser read were cut into sections of about 400μm and evaluated by polarized light microscopy. Results: the results had demonstrated that, even with some degree of variation, the DIAGNOdent® system was capable of recognizing the decalcification, establishing regular equivalence of standard readings such as light polarized microscopy. Conclusion: the average values found for DIAGNOdent® laser had demonstrated a 0,63 coefficient of correlation of Pearson to the values of microscopically readings.

Detection activity assessment and diagnosis of dental caries lesions.

This article reviews the current methods for detection and assessment of caries lesions focusing on applicability for daily clinical practice. The end point is to arrive at a diagnosis for each caries lesion. Visual inspection aided by a ball-ended probe is essential for caries lesions assessment and the method must be used for all patients. Use of indices, for example, the International Caries Detection and Assessment System (ICDAS), can improve the performance of this method. Using visual inspection, the clinician must decide about the presence, severity and activity of lesions. After this process, additional methods could aid the dentist in reaching a more appropriate treatment decision in some cases. The ICDAS, including the activity assessment system or the Nyvad system, seems to be the best option to reach final diagnoses for managing lesions. The radiographic method is the most recommended additional method available for daily clinical practice.