Establishing quantitative light-induced fluorescence cut-offs for the detection of occlusal dentine lesions

The aims of this in vitro study were, first, to define suitable cut-off values for the detection of occlusal dentine lesions by means of quantitative light-induced fluorescence (QLF), and, second, to compare the validity of light microscopy (LM) and microradiography (MR) as reference standards. Fifty-four third molar occlusal fissures with sound sites or non-cavitated lesions were examined. Standard QLF equipment was used to capture, display, store, and analyze fluorescence images. Each tooth was cut into sections in the bucco-lingual direction using a microtome saw, and the caries levels were subsequently assessed with the two reference methods. The histological examination with LM indicated that 46% of the specimens had carious lesions progressing into the dentine compared with 41% measured using MR (D3-4 level). Using optimal cut-off levels for the detection of dentine lesions, the sensitivity and specificity values were > 80%. The area under the receiver operating characteristic curve was slightly higher for MR (0.91-0.93) than for LM (0.88-0.89). The results of this study give a good idea of suitable cut-off points for the detection of occlusal dentine lesions using QLF. Owing to the small number of specimens in this study, further studies should be carried out before establishing definite cut-offs.     

Caries in fissures of permanent first molars as a predictor for caries increment

A group of 268 children were checked for caries experience at the age of 7.2 yr later at the age of 9 and 4 yr later at the age of 11 yr. Caries experience of fissures in permanent first molars at the age of 7 yr served as a screening criterion for caries increment between the ages of 7 and 11 yr. This screening resulted in a sensitivity of 0.62, a specificity of 0.82, and a diagnostic power of 0.83 for total caries increment in the permanent dentition and in a sensitivity of 0.68, a specificity of 0.80, and a diagnostic power of 0.78 for caries increment in fissures of permanent first molars. It was concluded that this screening offered the best method available for identifying children at risk from fissure caries in their permanent first molars. Cost effectiveness of preventive treatment directed towards individuals, for instance the application of fissure sealants, can be improved by using this screening method.     

Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars

The aim of the study was to describe the 3-yr results of a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 children 6-8 yr old with their permanent right first molars in different stages of eruption. The results were compared with record data from 58 children of the same age who had received a traditional caries treatment program including fissure sealing (control group). After 1 yr a significant reduction of occlusal surfaces with visible plaque was noted in the study group as well as an increased proportion of arrested lesions. These results were maintained after 2 and 3 yr. Ten (9%) teeth were sealed and one filled during the study period. Examination of record data in the control group over a 3-yr period revealed that 76 (65%) first molars were sealed and 7 (6%) were filled. During the first year 1/3 of the children in the study group needed 5-6 recall visits, whereas in the following period all children were only seen 1-4 times. In contrast, 50% of the children in the control group needed 5-6 recalls in the 3rd yr. Our data indicate that professional care for erupting teeth on an individual basis has a long-term effect on occlusal surfaces as well. The alternative technique required less clinical time than the traditional application of sealants.     

Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars

The aim of this study was to evaluate a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 6-8-yr-old children with their permanent right first molars in different stages of eruption. Data from the program were compared with previous data recorded in a similar sample of children. After 1 yr the majority of children in the study group had their permanent right first molars in full occlusion. A significant decrease of surfaces with easily detectable plaque and an increase of surfaces without plaque was observed. The proportion of arrested lesions increased and active enamel lesions decreased. Fissure sealing was only needed in two teeth in contrast to more than 2/3 of molars in a comparable sample of children. The program proved to be an efficient alternative to fissure sealing in preventing occlusal caries in erupting teeth.     

激光荧光法诊断早期龋的研究进展及评价

早期龋的探测及诊断是龋病防治的重要方面.激光荧光法是新型龋诊断方法之一,它是利用龋坏部位激发的荧光强度远高于正常牙齿硬组织,定量分析牙体脱矿程度.激光荧光法灵敏度高、准确度高、可靠性好及无创性,可作为诊断早期龋的有效辅助手段.本文就激光荧光法诊断早期龋的原理、诊断价值、临床应用以及影响因素等研究进展作一综述.     

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

Objectives

To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D₀–D_1–4; D_0–2–D_3,4) in permanent molars.

Methods

In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention (n = 86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention (n = 34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann–Whitney test, Spearman’s rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested.

Results

Sound sites (n = 13) had significantly minor fluorescence values than carious sites (n = 107) (P < 0.0001) as had sites with no/enamel caries (n = 63) compared to dentinal caries (n = 57). The AUCs for the same discriminations were 0.92 and 0.78 (P < 0.001). For the D₀–D_1–4 threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D_0–2–D_3,4 threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho = +0.57, P = 0.01).

Conclusion

Within this study, the device’s discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.     

部分去龋法治疗恒磨牙深龋的疗效观察

目的:探讨部分去龋治疗恒磨牙深龋的临床疗效.方法:对102颗恒牙深龋进行部分去龋法结合树脂严密充填,随访6个月以上,评价其牙髓存留率及治疗主观感受.结果:随访到的97颗患牙中,90颗充填物完好,牙髓活力正常,治疗成功率为92.8％;79.9％的患者治疗感受为轻度不适或无反应.结论:部分去龋法治疗恒牙深龋,可以减少牙髓暴露的风险,减轻患者治疗时的不适,获得较好的充填治疗效果,值得临床推广.     

In vitro study of caries detection through sound dentin using a laser fluorescence device,DIAGNOdent

The objective of this study was to investigate the feasibility of proximal surface caries detection using a laser fluorescence device, DIAGNOdent, through the sound dentin surrounding the cavity wall after removal of occlusal caries. Extracted sound human molars were ground to prepare horizontal and vertical dentin plates 1.4 mm thick. Extracted carious human molars were reduced in thickness horizontally from the occlusal surfaces until exposure of the dentin caries. The dentin plate was placed on the carious tooth. Before and after gradual thinning of the dentin plate from approximately 1.4 mm to 0.2 mm thick, the dentin caries was measured 10 times through the plate by the laser fluorescence device with a cone-shaped tip or a broad tip. When the dentin plate was reduced to less than 0.3 mm thick (using a combination of a horizontal plate and cone-shaped tip) or 0.2 mm thick (using the other combinations), the values measured with the laser fluorescence device were significantly larger than the values before reducing the thickness of the dentin. Based on these results, the device offers potential use as one of the screening tests for proximal surface caries detection through sound dentin when the sound dentin between tip and caries is thin.     

Control of occlusal caries in the first permanent molars by oral hygiene

Abstract Caries of the pits and fissures of permanent teeth continues to be a problem for children, newly erupted permanent molars being particularly at risk. Oral hygiene measures have been shown to be able to reduce the incidence of caries. The aim of this study was to compare the caries-preventive effects on newly erupted first permanent molars of a professional tooth cleaning and oral health education program (test) with a standard preventive program (control), comprising selective fissure sealing and application of topical fluorides. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to four test or four control clinics. Schoolchildren, mean age 6.3±0.3 (s) years with sound, newly erupted first permanent molars were included in the study (207 test, 197 control). After 12 months, 186 test and 163 control children were examined by an examiner who was ‘blind’ to the test or control status of the children. Caries of the first permanent molars developed in 34 test and 35 control children; the estimated risk ratio was 0.86 (95% CI 0.56, 1.30). Children in the test group had an average DFT score of 0.26±0.62 compared with 0.29±0.64 DFT in the control group (t-test, P=0.67). The 12-month results suggest that there was no statistically significant difference between the caries-preventive effects of a professional tooth cleaning and oral health education program and a program based on selective fissure sealing and application of topical fluorides.     

Reproducibility of DIAGNOdent 2095 and DIAGNOdent Pen measurements: results from an in vitro study on occlusal sites

The aim of this in vitro study was to investigate the intra- and interdevice reproducibility of the DIAGNOdent 2095 (DD2095) and the new DIAGNOdent Pen (DDPen) on non-cavitated occlusal caries sites. Altogether, 241 sites on 90 molars were inspected twice with both devices and by four examiners. The intra/interdevice reproducibilities were assessed by means of the intraclass correlation coefficient (ICC) as well as by the range of the 95% limits of agreement of Bland & Altman. Additionally, a linear mixed-effects model was fitted with fixed effects for the visual scores and the devices used and random effects for occlusal sites and examiners within each measurement site. In result, the following values were determined for the intradevice reproducibility: DD2095: ICC 0.89, range 42.3; and DDPen: ICC 0.88, range 49.3. The interdevice reproducibility was found to be in the same order of magnitude (ICC 0.82, range 53.7). The comparison between both devices indicated significantly lower mean values for the DDPen. The estimates of the linear model show that there is a high variation between the sites that cannot be explained by the fixed effects. In conclusion, both devices showed an imperfect reproducibility, which indicate the usage as adjunct tool only in clinical practice.     

Comparison of the severity of caries attack in permanent first molars in Iraqi and Sudanese schoolchildren

Severity of caries attack of the permanent first molars was investigated on two population groups of Arabian origin, namely 1617 Iraqi and 725 Sudanese primary schoolchildren ranging in age from 6 to 12 years. The results showed a higher DMF rate in the Iraqis in all the age groups studied, reaching a maximum of 83% at age 11, whereas the maximum level was 60% in Sudanese children at age 10.     

颌骨牙源性囊肿袋形术/减压术引流装置的设计与临床应用

 颌骨牙源性囊肿是一组来源于与牙发生相关组织的病变，上皮衬里的囊腔包含液体或半流体。由于囊腔内的压力、骨吸收因子释放及上皮增生引起囊肿不断增大，导致颌骨膨隆、牙松动移位，面部畸形及咬合功能障碍。牙源性囊肿的袋形术/减压术是一种简单易行而有效的保守性治疗方法。成功的治疗需要术后采用不同引流装置保持囊肿引流。较大的囊肿常在术后配戴囊肿塞或阻塞器，而较小的病变则通过减压管保守引流。大多数病例是在袋形术/减压术后囊肿缩小时二期行囊肿刮除术，可减少邻近结构的损伤或手术并发症，仅少数病例中袋形术作为惟一的治疗方式。文章简要介绍了袋形术/减压术的相关治疗机制以及多种引流装置的设计与临床应用。     

Influence of the condition of the adjacent tooth surface on fluorescence measurements for the detection of approximal caries

The aim of this study was to test whether the status of the adjacent tooth surface has an influence on the signal of a new laser fluorescence (LF) device for the detection of approximal caries. Seventy-eight teeth were selected from a pool of extracted permanent human molars, frozen at -20 degrees C until use. Before being measured the teeth were defrosted, cleaned, and any calculus removed. As a control, a defined approximal surface of each tooth was measured with the LF device holding the tip with the detecting- and the reverse-side on it, but without a neighboring tooth contacting the surface. The proximal site under examination was then placed adjacent to a tooth, which had deep dentinal caries, a composite restoration, a provisional ZnO-Eugenol restoration, or a ceramic restoration. The adjacent tooth with the ZnO-Eugenol restoration, the composite restoration, and the dentinal caries all demonstrated a statistically significant increase of LF readings on sound tooth surfaces. Teeth with enamel or dentinal caries were only slightly (and not statistically significantly) influenced by the different types of neighboring surfaces compared with the control LF readings. It can be concluded that caries detection of approximal tooth surfaces with the new LF system might be influenced by the condition of the adjacent tooth surface.     

Localization of carious lesions in occlusal pits and fissures of human premolars

Abstract – The position of carious lesions in fissures of 50 maxillary premolars was studied in serial ground sections in polarized light using air and various aqueous media for imbibition. The particular section in which the greatest pore volume was demonstrated, was selected for morphometric measurements of the fissure, i.e. depth, width, and angle. The localization of the carious lesion was registered in relation to four areas around the fissures, i.e. above the entrance, the top and bottom part of the wall, and below the base of the fissure. Most frequently the carious lesion was localized in the lower part of fissures (61%). Multiple foci both in the upper and lower part were found in 36% of the fissures. Only 13% had carious lesions positioned above the entrance. No relationship was found between fissure morphology and site of the carious lesions. However, this study has confirmed that fissured areas are highly susceptible to caries in premolars.     

Validity of a laser fluorescence system (DIAGNOdent) for detection of occlusal caries in third molars: an in vitro study

The aim of this study was to compare the validity of the measurements of the laser fluorescence device, KaVo DIAGNOdent, with the result of polarized light microscopy in the detection of occlusal fissure caries in extracted third molars. Ten impacted, surgically removed, and 25 extracted third molars with macroscopically intact occlusal surfaces were selected. The DIAGNOdent measurements of the occlusal test site were recorded by two observers at intervals of 2 days. The teeth were then sectioned at the specified test sites for histological examinations. Prepared specimens were evaluated under the polarized light microscopy and all images were scored with the caries classification of D1 (sound and fissure lesion in the half of the outer enamel), D2 (enamel decay) and D3 (dentin decay) level (gold standard). The kappa value for the inter-observer repeatability was calculated and the value 0.83 for the first measurements and 0.67 for the second measurement were obtained,respectively. Inter-observer correct classification percentages were 88.5 and 77.1 for the first and second measurements, respectively. The kappa value for intra-observer repeatability was 0.79 for the first observer and 0.75 for the second observer. Intra-observer correct classification percentage values were 85.7 and 82.8 for the first and second observer, respectively. Value of specificity for the detection of enamel caries at D1 level was 0.74 and sensitivity values at D2 and D3 levels were 0.66 and 1.00, respectively. The present study indicates that the DIAGNOdent provides not only almost perfect agreement but also sufficient repeatability at D1, D2, D3 levels and better specificity at D1 level as well as lower sensitivity at D2 level and excellent sensitivity at D3 level.     

大连开发区儿童第一恒磨牙窝沟形态及龋病患病状况调查

目的 了解大连开发区7~9岁儿童第一恒磨牙窝沟形态和龋病患病状况,探索第一恒磨牙窝沟形态与非成洞龋的关系。方法 采用多阶段、分层、整群抽样方法调查大连开发区7~9岁儿童第一恒磨牙的窝沟形态和龋病患病状况。窝沟形态包括深度和着色情况,龋病的检查参考ICDAS标准分为成洞龋和非成洞龋。结果 总调查样本量1 160人,第一恒磨牙成洞龋患病率为19.1%,龋均为0.31,城乡、男女、不同年龄组患龋率和龋均间的差异均无统计学意义。非成洞龋患病率42.1%,龋均0.86,农村儿童龋均显著高于城市儿童,女生龋均显著高于男生,不同年龄组之间龋均无统计学差异。44.7%的人第一恒磨牙有深窝沟,非成洞龋的患病率随着窝沟深度的增加而增加。结论 大连开发区7~9岁儿童第一恒磨牙的非成洞龋患病率和深窝沟率均较高,窝沟深度与非成洞龋之间存在相关性。     

Caries prevalence in primary teeth as a predictor of early fissure caries in permanent first molars

The study aimed to examine the validity of employing the caries experience of the primary dentition for predicting early caries in the permanent first molar fissures. Subjects consisted of 192 children who were followed for 2 yr, 91 of whom were pursued for a further year, all receiving semiannual check-ups. The caries prevalence in the primary dentition (dmft), excluding incisors, was recorded at baseline, which was the year the children became 6. Fissure caries in the permanent first molars was recorded as being confined to enamel or dentin, based on findings during cavity preparation. The correlation between dmft and the number of intact permanent first molars was -0.368 and -0.337 after 2 and 3 yr observation respectively. When the children were grouped according to their dmft, a statistically significant relationship was found between the dmft and the number of intact molars in each individual. The positive and negative predictive values as well as the sensitivity and specificity of different dmft values were calculated, and the relationship between them illustrated by the use of ROC curves. Even if there are no specific dmft values which seem obviously favorable for the purpose, these data give information relevant in planning for large scale use of fissure sealing in preventing early fissure caries in permanent first molars.     

Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: an in vivo study

The aim of this in vivo study was to validate the DIAGNOdent laser fluorescence method and the International Caries Detection and Assessment System (ICDAS) for caries classification against the gold standard, histological examination, for detecting occlusal caries on permanent molars; the thresholds used were the outer enamel (D1), the inner enamel and outer third of the dentine (D2), and the inner two‐thirds of the dentine (D3). Patients with non‐impacted third molars (n = 43) were recruited from a university clinic. A trained examiner performed the examinations. After the teeth were extracted, the histological criterion was used to determine the severity of the lesions. Intra‐examiner agreement (weighted kappa) for ICDAS was 0.60 and reliability (intraclass correlation coefficient) for DIAGNOdent was 0.968. The correlations with the histological reference were weak for DIAGNOdent (r_s = 0.369) and moderate for ICDAS (r_s = 0.515). The areas under the receiver–operating characteristics (ROC) curve at D1, D2, and D3 were 0.60, 0.69, and 0.91, respectively, for ICDAS and 0.55, 0.65, and 0.92, respectively, for DIAGNOdent. ICDAS and DIAGNOdent proved to be reproducible methods with similar performance in the detection of occlusal carious lesions in dentine. The ability of DIAGNOdent to detect initial enamel lesions was higher than that of ICDAS, but with low specificity. The usefulness of DIAGNOdent as an adjunct method for assessment of initial occlusal caries in permanent molars is questionable.     

A longitudinal study of caries experience and extraction of permanent first molars in English children

One hundred and twenty eight children in Leeds, England, initially aged 11 years, were examined annually for 6 years. The site of dental caries on 441 permanent first molars was recorded at the first examination. Twelve per cent of the teeth were caries free, 83 % had between one and three DF sites each, and 6 % had four or more DF sites. After 6 years 8 % of the originally caries free teeth had been extracted, compared with 19 % of those that initially had had up to three DF sites and 58 % of those with four or more DF sites at the first examination. With the exception of the distal surface site a consistent pattern of the prevalence of caries was seen in each of the sites in the permanent first molar teeth that were not extracted during the study. In the distal site dental caries became relatively more prevalent as the children grew older. The accumulation of similar information from other populations should provide a useful guide for the prognosis of dental caries in the permanent first molar teeth.