Lec.3 Caries Detection Methods Dr.

Sava Bakhtyar
5ThStage

Introduction
Early detection and diagnosis of dental caries reduce:
-Irreversible loss of tooth structure.
-Treatment costs.
-Time needed for restoration of the teeth.
-Conventional examination for caries detection is primarily done using visual
inspection, tactile sensation and radiographs. These methods give satisfactory
results in detection of cavitated lesion,
-They are usually inadequate for the detection of initial lesions. Because of these
deficiencies, new detection methods have been developed to aid better diagnosis.
Conventional Methods Used in Diagnosis of Dental Caries
1.Visual-tactile Examination
Visual changes of the dental structure resulting from the demineralization process
such as an increase in opacity and roughness of the enamel, use of a dental mirror,
a sharp probe and a 3-in-1 syringe and requires good lighting and a clean/dry
tooth surface for tooth examination.
The examination is based primarily on subjective interpretation of surface
characteristics, such as integrity, roughness texture, translucency/opacity,
location and color. Advantage of tactile examination of dental caries is quick,
easy to applied, and not expensive.
Disadvantage of visual tactile examination
-The possibility of transferring cariogenic microorganisms from one site to
another, leading to further spread of the disease in the same oral cavity.
-Use of a sharp explorer with pressure application can cause cavitation or
irreversible damages to the incipient lesions or demineralized tooth structure.
-Explorers have low sensitivity resulting in undetected lesions.
For examination of a suspicious area on the proximal surface, dental floss can be used
for caries detection, the floss will tear when cavity is present but this method may have
confused when calculus present. orthodontic elastic separator can be used for tooth
separation and caries detection, it can be applied for 2-3 days around the contact areas of
proximal surfaces, facilitating the clinical and probing assessments. However, this
method might create some discomfort and requires an extra visit.
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2.Radiographic Techniques (Conventional and Digital).

Radiography is the most common caries lesion detection aid. It is based on the
fact that when the caries progress, the mineral content of enamel and dentin
decreases, resulting in a decrease in the attenuation of the X-ray beam as it passes
through the teeth. Clinically, the detection of carious lesions is based on a
combination of visual-tactile and radiographic examination.
Bitewing radiography has been used for the detection and evaluation of proximal
caries depth, which are invisible or poorly visible for inspection.
Bitewing radiography presents a tendency to make false-results due to:
-Proximal contacts are overlapped.
-The lesion depth may appear to be increased due to angulation and this may lead
to false diagnosis.
-Active and arrested caries can't be distinguished in the radiographs.
-Radiographs may give false positive results due to a phenomenon called "Mach
band effect". In this perceptual phenomenon, the contrast between the dark and
lighter areas has increased, resulting in a dark demarcation band. This effect
causes formation of a radiolucent area in dentin enamel junction.
-Cervical burn out is another optical phenomenon where a wedge shaped
radiolucent area is seen between the bone and the cemento-enamel junction. This
effect is due to tissue density and the low penetration of X-rays at the cervical
region.

Digital radiographic technique offered several advantages over conventional

method include
-Time saving because the image is displayed immediately after exposure and no
processing had to be performed.
-Reductions in radiation dose (between 5% to 50% of the dose needed for
conventional radiography) to obtain quality diagnostic images,
-Digital images facilitate communication and case discussion among dental
professionals as it shown on computer screen.
-Digital manipulation of the image, enhance viewing and avoiding unnecessary
repeated radiographs.
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The primary disadvantages of digital systems include

The rigidity and thickness of the sensors.
The high system cost.
Unknown sensor lifespan.

3. Caries detection dyes

Stain the soft and infected layer of caries which doesn't have the capacity of
remineralization, and decalcified layer that has the ability of remineralization.
Novel Methods for Caries Detection
1.Digital Subtraction Radiography
It is more advanced image analysis tools, this method allows professionals to
distinguish small difference between subsequent radiograph The procedure is
based on the principle that two digital radiographic images obtained in different
time intervals, with the same standardized method and analyzed using specific
software to produce new subtraction image. Digital subtraction radiography has
been used in the assessment of the progression, arrest, or regression of caries
lesions. Subtraction consists of subtracting the pixel values of the baseline image
from the pixel values of the second image. if there is a change in the radiographic
attenuation between the baseline and follow-up examination, regions that had
mineral loss or gain are shown as a darker or brighter area respectively.
2. Fiber Optic Transillumination (FOTI)
This method of caries visual inspection is based on the phenomenon of light
scattering. Sound enamel is comprised of modified hydroxyapatite crystals that
are densely packed, producing an almost transparent structure that allow the light
to pass through it. In the presence of demineralization, the photons of light are
scattered resulting in an optical disruption (dark shadows). FOTI device is for
evaluating the depth of occlusal lesions (if the caries has reached to the dentin or
not) and for the detection of the proximal lesions of anterior teeth.

3.Digital image fiber Optic Transillumination (DIFOTI)

This method is the combination of the FOTI and a digital camera. This system
uses 780 nm wavelength near infrared radiation instead of white light source.
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Advantage of this method:

-Identification of caries and measuring the severity of the lesions
- Non-invasive, doesn't use ionizing radiation,
- More sensitive than X-rays in detecting early demineralizations .
-The images obtained by this method can be saved and viewed later, the properties
of the lesions can be examined by increasing the contrast of the image. This
method is useful in detecting changes like fractures and fluorosis.
4.Electrical Conductivity Measurements (ECM)
Sound enamel is a good electrical insulator because its high mineral content. The
Electronic Caries Monitor (ECM) device employs a single, fixed-frequency
alternating current, which attempts to measure the resistance of tooth tissue to
electric current. A number of physical factors also will affect ECM include the
temperature and thickness of the tissue, the hydration of the material, and the
surface area. A major advantage of ECM is the ability for monitoring lesion
progression, arrest, or remineralization.
5.Ultrasound Caries Detector
Ultrasound can detect lesions easily because the travel time of ultrasonic pulses
differ in sound and demineralized enamel tissues.This method is considered
promising in detecting early enamel lesions because the white spot lesions
confined to enamel produce no detectable or weak echoes whereas deeper lesions
produce substantially higher values.

6.FluorescenceTechniques
a. Quantitative Light-induced Fluorescence QLF
Fluorescence is a phenomenon by which a biological structure is excited by a
particular wavelength of light and emit a fluorescent light. The auto fluorescence
of dental tissue decreases in demineralization of the tissue.
Quantitative light induced fluorescence devices use high-intensity halogen lamp
(blue light 488 nm) to stimulate the tooth to emit the fluorescence in green
spectrum. This reflected light is detected by spectrum and recorded in computer
and demineralization is quantified. QLF offers the opportunity to detect early
caries and measures its progression or regression. It also be able to image plaque,
calculus and determine if a lesion is active or not.
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B. Fluorescence Camera (VistaProof)

Another device based on the light-induced fluorescence phenomenon is the
intraoral camera Vista Proof, which emit a 405-nm light and receive the signal
from the dental surface during fluorescence emission using a sensor and capture
image by the camera which translated to the software on computer screen,
Dental surface that fluoresces in green (sound dental tissue) and in red (carious
dental tissue). The higher bacterial colonization is the higher red fluorescent
signal. The software highlights the lesions and classifies them in a scale from 0
to 5, giving a treatment options in the first evaluation: monitoring,
remineralization or invasive treatment.
C. Laser Fluorescence Devices (DIAGNO dent and DIAGNO dent pen)
Is an instrument designed to facilitate the detection and quantification of dental
caries. DIAGNO dent decay detection is based on principle that when diode laser
with 655nm wavelength is irradiated in dental surface, it is absorbed by
metabolities of bacteria emit red fluorescence.
The emitted light reaches the dental tissues through a flexible tip (tip A for
occlusal surfaces, and tip B for smooth surfaces) the received signals translated
into numeric values, which can vary from 0 to 99. The surface to be examined
must be clean because dental calculus, plaque and discoloration may cause false
results.