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

OBJECTIVES: To (1) identify the methods that dentists in The Dental Practice-Based Research Network (DPBRN) use to diagnose dental caries; (2) quantify their frequency of use and (3) test the hypothesis that certain dentist and dental practice characteristics are significantly associated with their use. METHODS: A questionnaire about methods used for caries diagnosis was sent to DPBRN dentists who reported doing some restorative dentistry; 522 dentists participated. Questions included the use of dental radiographs, the dental explorer, laser fluorescence, air-drying and fiber-optic devices and magnification as used when diagnosing primary, secondary/recurrent or non-specific caries lesions. Variations on the frequency of their use were tested using multivariate analysis and Bonferroni tests. RESULTS: Overall, the dental explorer was the instrument most commonly used to detect primary occlusal caries and caries at the margins of existing restorations. In contrast, laser fluorescence was rarely used to help diagnose occlusal primary caries. For proximal caries, radiographs were used to help diagnose 75%­100% of lesions by 96% of the DPBRN dentists. Dentists who use radiographs most often to assess proximal surfaces of posterior teeth were significantly more likely to also report providing a higher percentage of patients with individualized caries prevention (p=.040) and seeing a higher percentage of pediatric patients (p=.001). CONCLUSION: The use of specific diagnostic methods varied substantially. The dental explorer and radiographs are still the most commonly used diagnostic methods..

Detecting Secondary Caries Lesions: A Systematic Review and Meta-analysis.

Secondary caries lesions are the main late complication of dental restorations, limiting their life span and generating costs by repeated reinterventions. Accurate detection of secondary lesions is crucial for estimating the true burden of the disease and allocating appropriate treatments. We aimed to assess the accuracy of detection methods for secondary caries lesions. Clinical or in vitro studies were included that investigated the accuracy of 5 detection methods--visual, tactile, radiography, laser fluorescence, quantitative light-induced fluorescence--of natural or artificially induced secondary lesions, as verified against an established reference test. Sensitivity, specificity, positive and negative likelihood ratios, as well as diagnostic odds ratios were calculated and publication bias assessed. From 1,179 screened studies, 23 were included. Most studies were performed in vitro, on permanent posterior teeth, and had high risk of bias or applicability concerns. Lesions were on proximal (14 studies) or other surfaces and adjacent to amalgam (16 studies) or tooth-colored materials. Visual (n = 11), radiographic (n = 13), and laser fluorescence detection (n = 8) had similar sensitivities (0.50 to 0.59) and specificities (0.78 to 0.83), with visual and laser fluorescence assessment being more accurate on nonproximal surfaces and adjacent to composites, respectively. Tactile assessment (n = 7) had low accuracy. Light-induced fluorescence (n = 3) was sensitive on nonproximal surfaces but had low specificities. Most analyses seemed to suffer from publication bias. Despite being a significant clinical and dental public health problem, detection of secondary caries lesions has been assessed by only a few studies with limited validity and applicability. Visual, radiographic and laser-fluorescence detection might be useful to detect secondary lesions. The validity of tactile assessment and quantitative light-induced fluorescence remains unclear at present.

The real performance of bitewing radiography and fiber-optic transillumination in approximal caries diagnosis.

For both general practitioners and researchers in caries diagnostics, the true validity of available diagnostic techniques is of considerable interest. Yet, for both bitewing radiography and fiber-optic transillumination, this is still not accurately known, nor is it clear which of the two techniques performs best clinically. This study's purpose was to estimate the clinical performance of the two techniques in diagnosing approximal caries lesions in low-caries-prevalence populations. Clinical studies that compare the two techniques were selected from literature. We determined 2 x 2 contingency tables from these studies and calculated one overall contingency table. The cut-off for decay was at dentinal caries. Assuming that erroneous outcomes from both techniques are mutually independent, we expressed diagnostic sensitivity and specificity of the two techniques as functions of the contingency table cell contents, with caries prevalence as the parameter. Because the caries prevalence was unknown, every sensitivity and specificity value was possible. From the conditions that sensitivity, specificity, and caries prevalence are always between one and zero, a limited range of sensitivity and specificity values was obtained. Three situations were examined: Bitewing radiography specificity is 1, fiber-optic transillumination specificity is 1, and both specificities are equal. Under these conditions, the bitewing radiography sensitivity was between 1.00 and 0.71 +/- 0.01, and the fiber-optic transillumination sensitivity was between 0.70 +/- 0.01 and 0.50 +/- 0.02. Both specificities were between 1.00 and 0.99. We concluded that the two techniques have comparable specificities. but that the fiber-optic transillumination sensitivity is significantly lower than that for bitewing radiography.

Statistical issues for combining multiple caries diagnostics for demonstrating caries efficacy.

Caries efficacy in clinical trials has been based primarily on visual examinations supplemented by Fiber Optic Transillumination (FOTI) and radiography, with the assessments combined at the surface level to classify each surface as to its caries status. Newer caries diagnostics techniques measure the caries process in a quantitative manner and so thus yield continuous rather than ordinal results. The objective of this study was to examine various methods for the analysis of multiple outcomes in clinical trials and to compare their usefulness for the analysis of caries trials. Four global tests (rank sum, ordinary least squares, general least squares, and generalized estimating equations) and two caries indices (based on average and maximum values of the methods) were evaluated with the use of one-year follow-up data from 1063 children in a recent caries trial. A new hybrid method was also developed and evaluated. All of the methods performed well when the diagnostic measures showed product differences in caries in the same direction. Ease of use, interpretability, and distributional assumptions must be considered before a consensus method for analysis of multiple diagnostic measures in caries trials can be determined.

Computer simulation of time-gated transillumination and reflection of biological tissues and tissuelike phantoms.

A simulation technique is employed to explore the possibility of locating millimeter-sized objects, immersed in turbid media, from time-gated measurements of the transmitted or reflected light. The simulation results for tissuelike phantoms are compared to experimental transillumination data and excellent agreement is found. Simulations of time-gated reflection experiments show that it is possible to detect objects of 1 mm diameter. This may open new possibilities for medical diagnosis of breast cancer in an early stage.

Approximal caries diagnosis using fiber-optic transillumination: a mathematical adjustment to improve validity.

Several studies were conducted recently to evaluate the use of Fiber-Optic Trans-Illumination (FOTI) in the diagnosis of approximal carious lesions. All these studies utilized radiographic readings to validate the FOTI diagnoses. Other investigations studied the value of radiographic readings using more solid validating techniques, which made it possible to judge the true state of decay, such as histology, cavity preparation and microradiography. In this study, data from both types of studies were used to estimate the validity of FOTI diagnosis of approximal caries relative to the true status of decay through correction for radiographic misclassification. The results indicate that particularly the sensitivity of FOTI diagnosis has yet to be determined.

The use of fibre-optic transillumination in general dental practice.

OBJECTIVE: To assess the use of fibre-optic transillumination (FOTI) as a diagnostic tool in general dental practice. DESIGN: A cross-over quantitative study for the diagnosis of approximal carious lesions by two clinical methods with a qualitative component. SUBJECTS AND METHODS: Seven GDPs were trained to use FOTI as an adjunct to their usual clinical examination to diagnose approximal caries. After 12 weeks of use in their practices four of the GDPs took part in two assessment sessions, set a week apart, using 29 volunteer patients. Each patient was examined on two separate occasions by each GDP using either their standard clinical examination technique alone or supplemented by FOTI examination. The order of the techniques was randomised. Radiographs of each patient were also examined separately. An experienced FOTI user also examined the patients to provide a benchmark. From standard charts the number of enamel and dentinal lesions on approximal surfaces was summed and comparisons made between the techniques. Six GDPs took part in one-to-one interviews. MAIN OUTCOME MEASURES: Mean numbers ofcarious lesions recorded by each clinician using each technique. RESULTS: There was a trend for all GDPs to find more enamel and dentinal lesions using FOTI, than with their standard clinical examination with or without radiographs. All GDPs found the FOTI technique a useful adjunct. They used FOTI in different ways and found a variety of uses for it other than caries diagnosis. CONCLUSIONS: The

Dental survey at school with the purpose to select children with no actual need of dental treatment.

The purpose of this study was to develop an examination method to select children without from children with need of dental treatment. Furthermore the objective was that these examinations could be performed as a survey at school, without utilizing an expensive and fully equipped dental clinic but still maintain the certainty for the individual not to be at increased risk to be declared false caries-free, in comparison with ordinary examination at a dental clinic. The material comprised 88 children 10-13 years old. The children were subject to a survey-examination at school and a few weeks later at a dental clinic by the same examiner. Initially the children were examined at school by two examiners in order to measure the inter-examiner variability. The results showed that 2 of the 88 examined children (2.3%) were judged false healthy at school examination with respect to caries. The inter-examiner variability in diagnosing caries was greater than the intra-examiner variability between survey at school and examination at the dental clinic.

In vitro performance of different methods in detecting occlusal caries lesions.

UNLABELLED: Early caries detection is essential for the implementation of preventive, therapeutic and intervention strategies within general dental practice. OBJECTIVE: The aim of this study was to compare the in vitro performance of the International Caries Detection and Assessment System (ICDAS), digital photographs scored with ICDAS (ICDAS photographs), fibre-optic transillumination (FOTI), optical coherence tomography (OCT), SoproLife(®) camera and two implementations of quantitative light-induced fluorescence a commercial (QLF-Inspektor Research systems) and a custom (QLF-Custom) system, to detect early and intermediate occlusal lesions. METHODS: One hundred and twelve permanent extracted teeth were selected and assessed with each detection method. Histological validation was used as a gold standard. The detection methods were compared by means of sensitivity, specificity, areas under receiver operating characteristic (AUROC) curves for enamel and dentine levels and with the Spearman's rank correlation coefficient against histology. RESULTS: For any enamel or dentine caries detection, the AUROC curves ranged from 0.86 (OCT) to 0.98 (ICDAS and ICDAS photographs, SoproLife(®) camera) and at the dentine level from 0.83 (OCT) to 0.96 for FOTI. The correlations with histology ranged between 0.65 (OCT) and 0.88 (ICDAS and FOTI). Under in vitro conditions, the assessed detection methods showed excellent intra-examiner reproducibility. All the methods were strongly correlated with histology (p<0.01) except OCT which showed a moderate correlation (0.65). CONCLUSION: Even though all methods present similar performance in detecting occlusal caries lesions, visual inspection seems to be sufficient to be used in clinical practice for detection and assessment of lesion depth. Other methods may be useful in monitoring caries lesion behaviour.

Accuracy of a new transmittance-reflectance pulse oximetry sensor in critically ill neonates.

OBJECTIVE: To test the accuracy of a new pulse oximeter sensor based on transmittance and reflectance. This sensor makes transillumination of tissue unnecessary and allows measurements on the hand, forearm, foot, and lower limb. DESIGN: Prospective, open, nonrandomized criterion standard study. SETTING: Neonatal intensive care unit, tertiary care center. PATIENTS: Sequential sample of 54 critically ill neonates (gestational age 27 to 42 wks; postnatal age 1 to 28 days) with arterial catheters in place. MEASUREMENTS AND MAIN RESULTS: A total of 99 comparisons between pulse oximetry and arterial saturation were obtained. Comparison of femoral or umbilical arterial blood with transcutaneous measurements on the lower limb (n = 66) demonstrated an excellent correlation (r2 = .96). The mean difference was +1.44% +/- 3.51 (SD) % (range -11% to +8%). Comparison of the transcutaneous values with the radial artery saturation from the corresponding upper limb (n = 33) revealed a correlation coefficient of 0.94 with a mean error of +0.66% +/- 3.34% (range -6% to +7%). The mean difference between noninvasive and invasive measurements was least with the test sensor on the hand, intermediate on the calf and arm, and greatest on the foot. The mean error and its standard deviation were slightly larger for arterial saturation values < 90% than for values > or = 90%. CONCLUSION: Accurate pulse oximetry saturation can be acquired from the hand, forearm, foot, and calf of critically ill newborns using this new sensor.

[The diagnosis of approximal caries--a comparison of clinical, fiber optic and x-ray diagnostic procedures (the diagnosis of approximal caries)]. / Approximale Kariesdiagnostik--Vergleich klinischer, faseroptischer und röntgenographischer Diagnostikverfahren (Approximalkariesdiagnostik).

A comparison of the efficiency of fibre-optic transillumination with clinical and radiographic diagnosis of proximal caries in posterior teeth was carried out on 186 subjects aged 12 to 17 years. The proportion of diagnosed proximal lesions detected by fibre-optic transillumination was two times more often than by clinical examination while the increase in lesion detection by bitewing radiography was more than threefold. Taking radiographic diagnosis as the validating criteria, the sensitivity of clinical examination was 0.30 and of fibre-optic transillumination 0.68 resp. The specificity was 0.99 for both examinations. In patients with low prevalence of proximal caries and good preventive dental care fibre-optic transillumination should be used as an additional method before using of regular radiographic diagnosing of proximal caries.

Comparison of intrinsic optical signals associated with low Mg2+-and 4-aminopyridine-induced seizure-like events reveals characteristic features in adult rat limbic system.

PURPOSE: To analyze the intrinsic optical signal change associated with seizure-like events in two frequently used in vitro models-the low-Mg2+ and the 4-aminopyridine (4-AP) models-and to monitor regions of onset and spread patterns of these discharges by using imaging of intrinsic optical signals (IOS). METHODS: Combined hippocampal-entorhinal-cortex slices of adult rats were exposed to two different treatments: lowering extracellular Mg2+ concentrations or application of 100 microM 4-AP. The electrographic features of the discharges were monitored using extracellular microelectrodes. Optical imaging was achieved by infrared transillumination of the slice and analysis of changes in light transmission using a subtraction approach. The electrographic features were compared with the optical changes. Regions of onset and spread patterns were analyzed in relevant anatomic regions of the slice. RESULTS: Both lowering extracellular Mg2+ concentrations and application of 4-AP induced seizure-like events. The relative duration of the intrinsic optical signal change associated with seizure-like events in the low-Mg2+ model was significantly longer compared with that seen with those occurring in the 4-AP model, although duration of field potentials did not differ significantly in the two models. Seizure-like events of the low-Mg2+ model originated predominantly in the entorhinal cortex, with subsequent propagation toward the subiculum and neocortical structures. In contrast, no consistent region of onset or spread patterns were seen in the 4-AP model, indicating that the seizure initiation is not confined to a particular region in this model. CONCLUSIONS: We conclude that different forms of spontaneous epileptiform activity are associated with characteristic optical signal changes and that optical imaging represents an excellent method to assess regions of seizure onset and spread patterns.

Técnicas de diagnóstico de la caries dental. Descripción, indicaciones y valoración de su rendimiento / Diagnostic techniques of tooth cavities. Description, indications and assessment of their yield

La caries dental es una de las patologías más prevalentes en los países desarrollados, afectando a más de las dos terceras partes de los niños de 12 años de edad. El diagnóstico de este trastorno durante la fase inicial de desmineralización del diente permite la instauración precoz de medidas preventivas y terapéuticas que, en muchas ocasiones, pueden conseguir que el proceso carioso revierta antes de que estén presentes las lesiones macroscópicas. En el presente trabajo se realiza una revisión sobre el diagnóstico de la caries dental, prestando atención a las distintas técnicas disponibles, tanto a las más habitualmente usadas en la práctica clínica (exploración clínica, exploración radiológica, dispositivo DIAGNOdent(R)) como a otros métodos de utilización menos frecuentes, pero que también pueden contribuir a su detección (transiluminación, detección electrónica, análisis de fluorescencia inducida por luz, etc.). Además, se lleva a cabo una revisión de la literatura para conocer el rendimiento de dichas técnicas mediante la valoración de sus sensibilidad y especificidad. En cualquier caso, el juicio clínico basado en la historia clínica, en la inspección visual y en los hallazgos radiológicos es, todavía, el aspecto más importante para un óptimo cuidado del paciente. Las nuevas tecnologías pueden aportar información suplementaria, pero aún no pueden reemplazar a los métodos convencionales para el diagnóstico de caries

Dental caries is one of the most prevalent pathologies in the developed world; they affect more than two thirds of 12-year-old children. The diagnosis during the initial phase of tooth demineralization allows the implementation of preventive and therapeutic measures that often revert the process before the macroscopic damage appears. This article offers a review of the diagnosis of dental caries with special emphasis on the different techniques available, those more commonly used (clinical exploration, radiological exploration, DIAGNOden(R)) as well as others that, although being less frequent, can still contribute to detection (transillumination, electronic detection, light-induced fluorescence analysis, etc.) Additionally, we review the existing literature in order to determine the efficacy of these different systems by measuring their sensitivity and specificity. In any case, clinical judgment based on clinical history, visual inspection and radiological findings is still the most important factor for high-quality attention. New technologies may bring additional information, but they still cannot replace traditional methods in the diagnosis of caries