Thermography:

A Novel Diagnostic Tool In

Dentistry

B 18
INDEX

 Introduction
 Principle
 Types of Thermography
 Indications of Thermography
 Contraindications of Thermography
 General Clinical Requirements Guidelines By The Japanese
Society Of Thermology
 Advantages
 Disadvantages
 References

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INTRODUCTION

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Being a homeotherm humans are capable of maintaining a constant
temperature of the body, which may be different from surrounding
temperature.

The body of homeotherms can be divided into the inner core and the
outer periphery. The core temperature is preserved within a narrow
limit (Approximately 42–330C).

Regulation of inner core temperature is essential for normal

performance of human body. Change in the core temperature by a few
degrees is considered as a clear indication of probable illness.
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From the ancient past, bodily heat was considered as a major
symbol of health and implementation of temperature
determination along with thermal imaging.

As time advanced an array of devices have been employed such as

thermometers, thermistors, thermocouples and liquid crystal
imaging systems for determining the body temperature.

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PRINCIPLE

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The thermography principle is as the amount of blood
circulation at different layers of the skin varies, the
temperature also changes accordingly. Consequently,
disorders that affect the blood flow too result in abnormalities
in temperature distribution and these when evaluated will
provide valid diagnostic information

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TYPES OF THERMOGRAPHY

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Depending on the method of application, thermography can be
classified into the following types:

1. Semi-quantitative contact method – liquid crystal thermography

2.Quantitative infrared-detecting noncontact methods which are

categorized as follows.
a. Infrared telethermography
b. Dynamic telethermography
c. Facial telethermography.

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Depending upon Determination of Temperature of the Skin-

1. Static Thermography: Temperature measured in a single

instance of time.

2. Dynamic Thermography: Temperature measured in a series of

many consecutive instances.

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LIQUID CRYSTAL THERMOGRAPHY

A liquid crystal thermometer consists of flexible rubber sheets within

which cholesteric crystals are embedded.

These crystals are arranged in several layers and are mounted in a

frame. The sheets also have the provision for inflation, so that the heat
sensitive surface conforms better to the body's contour.

To measure the thermal changes the crystal sheets are placed over the
surfaces to be examined.

After placement, the crystals changes from their neutral colour into
different colour in response to the surface temperature. The resultant
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colour display is then photographed using Polaroid photography which
gives an instant hard copy of the image.
Advantages
• Less expensive
• Portable compared to electronic tele-thermography units.

Disadvantages
• They are technique sensitive
• Requires timed skin contact to record a reproducible temperature
distribution
• Moreover, the temperatures recorded are not accurate due to the
contact of the crystal sheet with the body surface which can cause
compensatory warming/cooling of the contact area.
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INFRARED TELETHERMOGRAPHY

ITT also referred to as telethermometry, telethermography, digital

infrared telethermographic imaging or electronic thermography is
a non-contact method of determination of temperature, where the
detector is placed at a single spot.

It comprises of an amplifier-digitizer, an infrared detector, a

microcomputer along with a video clip.

The infrared detectors which are used are of various types and
include linear array infrared detectors, single element infrared
detector and two-dimensional array detectors.
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The single detector infrared radiation thermography functions in a
manner such that as the infrared radiation emitted by the face
entered the germanium lens, it passed via the mirrors placed
perpendicular. The electric signals are converted to digital values
by an amplifier. These signals are reconstructed into a digitised
thermal image.

Advantages
They have higher speed (allowing to obtain >100 images/s),
reliability, and maintenance-free performance since they require
no moving parts.
Disadvantages
They have limited spatial resolution 14
DYNAMIC AREA TELETHERMOMETRY

DAT is a recent promising branch of infrared imaging which is

directed at the quantitative measurement of the time dependence
of skin temperature, assessing the modulation of temperature that
has direct bearing on the thermoregulation of skin.

Temporal behaviour of surface temperature is studied using a

series of thermal images along with quantitatively assessing the
temporal thermal behaviour of each subarea as a function of time.
The temperature values pertaining to a subarea unit is obtained
from each of a sequence of thermal images, comprises a time
sequence of temperatures, the dynamics of which can be analysed
quantitatively 15
FACIAL TELETHERMOGRAPHY

Heat emissions from the human face have been shown to be

physiologic indicators of the underlying health or disease.

Heat emission is directly related to cutaneous vascular activity,

yielding enhanced heat output on vasodilatation and reduced heat
output on vasoconstriction.

Infrared telethermography of the face may serve, therefore, as an

utterly harmless, noninvasive diagnostic technique that can help to
differentiate selected clinical problems.
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INDICATIONS OF THERMOGRAPHY

 Chronic oro-facial pain

 Temporomandibular joint disorders

 Quantification of thermal insult to pulp

 Assessing inferior alveolar nerve deficit

 Detection of herpes labialis in prodromal phase

 Evaluation of craniomandibular disorders

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 Detection of carotid occlusal disease

 Quantification of the effects of postsurgical inflammation, analgesics,

anti-inflammatory drugs, etc.

 In the diagnosis of myofascial symptoms

 In the diagnosis of nerve and bone disorders, joint pains,

osteoarthritis, rheumatoid arthritis hyper- or hypo-tonic muscular
pain reactions

 Endodontic treatments can monitored

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To assess the reaction of tissue to a new dental material

 Diagnosis of any kind of orofacial inflammation

Acute and chronic periodontitis

 Sinusitis

 Cancers in orofacial region

 Myofacial pain dysfunction syndrome

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Thermographic image in orofacial pain (myofacial pain Thermographic image for temporomandibular joint
dysfunction syndrome) disorders

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Thermographic image of an inflamed pulp Thermograph of herpes labialis infection
CONTRAINDICATIONS
Contraindications for Dental/ Systemic Health Thermal Imaging
include-

Presence of casts, bandages or other technical factors that preclude

the ability to expose skin to a temperature equilibration environment.

 Patients with fever and with sunburn are not eligible for accurate
thermal image analysis, in such cases, it is advisable to defer
telethermographic facial studies until the acute phase subsides

 Similarly, facial scars can appear as pathological hypothermic lesions

 An uncooperative patient. 21
General Clinical Requirements Guidelines by the Japanese Society of
Thermology-

1. Keep the testing room free of wind. Turn off air conditioners.

2. Sources which emit infrared are to be kept away from the subject.
Place a screen between any heater and the subject.

3. Keep controlled room temperature at over 25ºC. Record room

temperature and humidity when taking each thermal image.

4. Stabilise the environment for at least 20 minutes before examination in

the winter.

5. Subjects undergoing thermographic examination are to abstain from22

smoking at least 4 hours prior to the investigation and must be

6. Note the following items as subject-related information in the
medical record including name, sex, age, chief complaint, history of
tobacco use, history of alcohol consumption, handedness, painful
position, abnormal position, region of cold sensitivity, past medical
history, present clinical history, presence of medical treatment and
detail of medical treatment, diagnostic entity, body temperature, time
when the thermal image is taken, room temperature, room humidity
and wall temperature.

7.Check the first thermal image again at the end of the sequence to
confirm the reproducibility of images and changes over time.

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Advantages
• Non invasive technique

• Easy seating examination

• Minimal examination time (2–3 min)

• Its real-time application enables very fast scanning of stationary

targets and capturing fast-changing thermal patterns

• To store thermograms, we can use many methods:

a. Printing on paper, Xerox paper, or coated with a material that
changes color on heating; this is the thermal printing
b. Magnetic devices (compact disc [CD] or computer database 24
archive).
Disadvantages
• Quality cameras often have a high price range

• Images are difficult to interpret accurately when based on certain

objects, specifically objects with erratic temperatures

• Most cameras have ±2% accuracy or worse in measurement

• Unable to detect the inside temperature if the medium is separated

by glass/polythene material, etc. Only able to detect surface
temperatures

• Sensitivity and resolution reduce with distance and angle of view

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• Training and staying proficient is time-consuming.

CONCLUSION

Thermography aids in the assessment and staging of various

dysfunctions of the head and neck region. The unique
significance of thermography is both qualitative and
quantitative assessment which helps in estimation of
progression of the disease in a systematic manner. With the
innovation of novel equipments and the state of the art facility,
thermography in the near future will certainly re-emerge as a
unique research tool in dentistry.

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REFERANCES

• Sikdar SD, Khandelwal A, Ghom S, Diwan R, Debta FM. Thermography:A new diagnostic
tool in dentistry. JIAOMR 2010;22(4):206-10.

• Sudhakar S, Kayshap B, Reddy SP. Thermography in dentistry - revisited. Int J Biol Med
Res 2011;2(1): 461-5.

• ChandraMouli PE, Kumar SM, Senthil B, et al. Application of thermography in dentistry - a

review. Journal of Dental and Medical Sciences 2012;1(1):3943.

• Bouzida N, Bendada A, Maldague XP. Visualization of body thermoregulation by infrared

imaging. Journal of Thermal Biology 2009;34(3):120-6

• Komoriyama M, Nomoto R, Tanaka R, Hosoya N, Gomi K, Iino F, et al.Application of

thermography in dentistry – Visualization of temperature distribution on oral tissues.
Dent Mater J 2003;22:436-43.
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