Incipient and hidden caries.
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Dental Caries↗
Biomedical subjects
Daniel W Boston
Publications and source records attributed to Daniel W Boston.
Evaluation of laser fluorescence for differentiating caries dye-stainable versus caries dye-unstainable dentin in carious lesions.
PURPOSE: To assess the performance of laser fluorescence (DIAGNOdent, "DD") for differentiating carious versus non-carious dentin during caries excavation using caries dye as the gold standard. METHODS: The superficial carious dentin surfaces of lesions in 25 teeth were exposed, and the surface evaluated by DD. Next, caries dye was applied and the surface was observed for dye staining. The lesion was then excavated approximately 0.5 mm with a round bur. The resulting surface was evaluated by DD, and the above sequence was repeated until three non-stained surfaces were evaluated by DD. Using "caries dye staining" as the gold standard, correct classification proportion was calculated at each DD cutpoint in the dataset. Using the optimal cutpoint, sensitivity, specificity and likelihood ratios were calculated. Non-parametric ROC analysis was performed and AUC calculated. RESULTS: With an optimal cutpoint of 11 or 12, DD was highly accurate in discriminating between dye-stainable and dye-unstainable surfaces, producing a correct classification proportion of over 98% and an AUC of 0.999 for all 176 surfaces. These results support further refinement of DD for use in caries excavation and further research relating DD to other caries excavation endpoints.
Dental Caries↗
Initial in vitro evaluation of DIAGNOdent for detecting secondary carious lesions associated with resin composite restorations.
OBJECTIVE: To assess the potential of DIAGNOdent (DD) readings for detecting secondary enamel and dentin carious lesions associated with resin composite restorations in a set of preserved extracted adult teeth. METHOD AND MATERIALS: Thirty test sites adjacent to resin composite restorations in 15 extracted teeth were evaluated visually and with DD readings for enamel and dentin caries. The results were compared to gold standard diagnosis determined by sectioning through each site and subsequent microscopic observation. Sensitivity, specificity, accuracy, and likelihood ratios at optimum threshold values for enamel and dentin caries were determined. Receiver operator characteristic (ROC) analysis was performed to compare visual and DD diagnostic methods. RESULTS: Histologic incidence of enamel caries was 20% and dentin caries was 36.67%. All composite restorations in the sample teeth fluoresced (range 5 to 22). For enamel caries detection with DD, the optimum threshold of > or = 26 produced a sensitivity of .67 and a specificity of .79. For dentin caries detection with DD, the optimum threshold of > or = 22 produced a sensitivity of .73 and a specificity of .84. ROC analysis showed that the DD readings do contain diagnostic information. DD readings for dentin caries diagnosis produced better diagnostic results compared to visual readings for the 30 test sites in the study, but these results were not significantly different. CONCLUSION: DIAGNOdent readings may have potential for resin composite secondary enamel and dentin carious lesion detection. DIAGNOdent instrument design factors and technique should be optimized to improve performance prior to clinical trial for this application.
Adult↗
Clinical curriculum for the twenty-first century.
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Competency-Based Education↗
Predoctoral clinical curriculum models at U.S. and Canadian dental schools.
In fall 2002, the ADEA Section on Comprehensive Care and General Dentistry conducted a survey of the predoctoral clinical curriculum models at sixty-four North American dental schools. Fifty-eight percent of the schools reported that most patient care is provided in a comprehensive care clinic setting, 22 percent reported that most patient care is provided in discipline-specific settings, and 20 percent reported a hybrid of comprehensive care and discipline-specific settings. While ten Primarily Discipline-Based (PD) schools have instituted new Primarily Comprehensive Care (PCC) or Hybrid clinical curricula since 1997, one PCC school has converted to a Hybrid model, and one PCC school has converted to a PD model. PCC curriculum models were frequently associated with the following institutional factors: more densely populated metropolitan areas; private institutional sponsorship; location within a university medical center; larger class size; and more students enrolled in advanced training at the school. Curriculum factors frequently associated with PCC models included the following: increased use of simulation technology: higher proportion of clinical/teaching track faculty; higher proportion of part-time faculty; higher proportion of generalist faculty; same faculty supervising both treatment planning and patient treatment; and use of competency exams as the main requirement for completion of the curriculum.
Canada↗
New device for selective dentin caries removal.
OBJECTIVES: To develop prototype rotary selective dentin caries excavators and to demonstrate their ability to remove only carious dentin in extracted teeth. METHOD AND MATERIALS: Milled polymer prototype and formed wire loop prototype burs were made. They were tested on normal dentin with standardized force application and compared to carbide burs for ability to cut by weighing three extracted teeth at pre- and postcutting for each prototype version. They were tested on carious dentin of three teeth for each prototype version. The resulting excavated surfaces were analyzed with dentin caries dye, the teeth were decalcified and examined histologically, and the used prototypes were examined in light and scanning electron microscopes. RESULTS: For both prototypes, noncarious teeth did not lose weight from prototype instrumentation, but each lost 9 or 10 mg after instrumentation with the control carbide bur. Both prototypes quickly removed carious dentin in each of the carious teeth until a definitive cutting endpoint was reached. The excavated surfaces from the milled polymer prototypes did not stain with caries dye, but those from the wire loop prototypes stained lightly in some areas. In the light microscope, all sections of excavated carious teeth were bacteria-free. Light and scanning electron microscope images of the prototypes revealed scratch patterns on the wire loop prototypes and deformation of blades on the polymer prototypes. CONCLUSION: Both prototypes removed carious dentin but did not remove normal dentin in the extracted teeth used in this study. Further development is indicated.
Dental Caries↗
Staining of non-carious human coronal dentin by caries dyes.
This study tested the hypothesis that commercially available caries dyes stain non-carious human coronal dentin in freshly extracted teeth. Multiple sections were cut from 10 non-carious and two control carious teeth using a water-cooled saw. Each section was stained with one of five caries dyes. The location of staining, if any, was noted and the staining intensity was scored on a four-point scale. One of the sections from each tooth was subsequently decalcified and processed for observation under a light microscope using four histologic staining techniques to evaluate morphology, collagen distribution and bacterial content. The association between the stain intensity scores on the undecalcified sections and the five dyes was evaluated using the Kruskal-Wallis One-Way ANOVA by Ranks test. Outer carious dentin in the control specimens stained intensely with each of the five dyes. In the undecalcified, non-carious sections, all had at least one area of staining. However, this staining could be differentiated from the intensity of dye staining in the carious controls, except in two instances. The association between stain intensity scores and the five dyes was not statistically significant. In the histologic sections, numerous bacteria were seen within the dentinal tubules of carious lesions of the two control specimens; however, no bacteria were found in any of the sections from non-carious specimens. Histologically, no differences were observed in the morphology or staining pattern within mantle or circumpulpal dentin in areas stained with caries dye, and in only one unique instance within the main body of the dentin. These results suggest that the five dyes evaluated in this study can stain non-carious dentin, however, this stain can be differentiated from the staining of outer carious dentin in vitro.
Analysis of Variance↗