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PubMedDate not supplied

Performance of conventional and new methods for the detection of occlusal caries in deciduous teeth.

The aim of this study was to compare, in vitro, the performance of different conventional diagnostic techniques with the laser-based device, DIAGNOdent, for diagnosis of occlusal caries in deciduous teeth. 95 deciduous teeth with macroscopically intact occlusal surfaces were selected. All teeth were assessed by the following techniques: visual inspection (VI), visual inspection with magnification (VIM), visual inspection combined with light pressure probing (VIP), bitewing radiography (BW) and the DIAGNOdent (DD). Caries extension was assessed by histology. DIAGNOdent showed, in comparison with the conventional clinical methods, a significantly improved ability (p < 0.05) to detect dentinal lesions (D(3) or D(4)) in deciduous teeth and an overall performance similar to that obtained in previous studies on permanent teeth. There was no statistically significant difference between VIM and DD in detecting caries confined to enamel (D(2)). DD performed better at D(2) level than the other methods. The intraexaminer kappa scores for DIAGNOdent were 0.76-0.86 (D(2)) and 0.77-0.85 (D(3)), respectively. It was concluded that DIAGNOdent could be used as an additional tool in the detection of occlusal caries in deciduous teeth and its good reproducibility should enable the laser device to monitor the caries process over time.

Child, Preschool↗
PubMed2006

Detection of approximal caries with a new laser fluorescence device.

The laser device DIAGNOdent developed for the detection of occlusal caries has limited value on approximal surfaces. The aim of this study was to develop and to test a new laser fluorescence (LF) device for the detection of approximal caries. Light with a wavelength of 655 nm was transported to the approximal surface using two different sapphire fibre tips. Seventy-five teeth were selected from a pool of extracted permanent human molars, frozen at -20 degrees C until use. Before being measured, they were defrosted, cleaned and calculus was removed with a scaler. The molars were set in blocks simulating the contact area of adults. Bitewing radiographs were obtained using Kodak Insight films. After two independent assessments with the new LF device, the teeth were histologically prepared, and assessed for caries extension. Using the laser, specificity values for D1 threshold (outer half of enamel), D2 threshold (inner half of enamel), D3 threshold (dentine) ranged between 0.81 and 0.93, sensitivity between 0.84 and 0.92 with no difference between the two tips. Bitewing radiography showed an inferior performance compared to LF (p<0.05). Intraex aminer reproducibility was high (kappa>.74). The new LF system might be a useful additional tool in detecting approximal caries. Because of its good reproducibility, it could be used to monitor caries regression or progression on approximal surfaces.

Adult↗
PubMed2002

An abbreviated caries clinical trial design validated over 24 months.

Conventional caries trials last from 24 to 36 months. This study evaluated whether the previously established difference in efficacy between 1000- and 2500-ppm-fluoride dentifrices could be detected after 12 months. Caries was assessed by clinical visual assessment (CVA-simplified version of Dundee Selectable Threshold Method - DSTM), bitewing radiography, and Fiber Optic Transillumination (FOTI). Changes in status for individual surfaces were classified by means of pre-prepared matrices as 0 (unchanged), +1 (initiation or progression), or -1 (regression) and summed for each subject to yield an event score. Mean group event scores were calculated for each product. DSTM at the D(1) [enamel and dentin] threshold showed significant inter-group differences in mean event scores (p < 0.003) and D(1)MFS increment (< 0.007) at 12 months; these were confirmed at 24 months by traditional increment analysis (CVA & FOTI at the D(3) (dentin only) threshold + radiography, p < 0.03). This study confirms the validity of an abbreviated trial protocol.

Adolescent↗
PubMed1994

[Diagnosis of primary caries. Current techniques and their consequences for treatment].

The decline in caries prevalence in The Netherlands has incited dentists to focus their attention to the detection of small carious lesions rather than large cavities. The diagnosis of primary caries is, however, still predominantly being accomplished by the traditional diagnostic methods, used in the high caries prevalence era. Today's appearance and behaviour of caries lesions have led to the situation that incipient enamel lesions, dentinal caries and cavities are frequently missed during routine recall examinations. There is increasing concern with the occurrence of large caries lesions underneath visually intact enamel. These problems have induced diagnostic research aimed at developing and evaluating new caries diagnostic methods and some of them are already used in general practice. Visual inspection and bitewing radiography, however, still constitute the most important methods in the diagnosis of primary caries. The results from these examinations are used to classify an individual's caries risk, to monitor the progression of existing caries lesions, and to aid preventive or restorative treatment decision making.

Dental Caries↗
PubMedDate not supplied

Occlusal caries detection: a comparison of a laser fluorescence system and conventional methods.

PURPOSE: The purpose of this study was to compare the effectiveness of a laser fluorescence (LF) device (DIAGNOdent) with a visual and radiographic scoring system for in vitro detection of occlusal caries and to evaluate the effect of 1% NaOCl immersion on the LF readings. METHODS: A total of 54 extracted third molars with macroscopically intact occlusal surfaces were selected. Three examiners assessed 105 sites by visual inspection (VI), bitewing radiography (BWR), and LF. Ten days after the first measurement, all teeth were reevaluated using the same methods. Then, teeth were immersed in 1% NaOCl solution for 24 hours, and LF readings were taken again. Caries extension was assessed by histology (x40). The diagnosis methods were compared by means of sensitivity, specificity, intra- and interexaminer reproducibility, and area under receiver operating characteristic (ROC) curve. The mean values of the first, second, and third LF readings from the 3 examiners were compared by one-way analysis of variance and Student-Newman-Keuls test. RESULTS: No difference was found among the areas under ROC curve. Regarding sensitivity, however, both VI and LF performed similarly (P>.05) and superiorly to BWR (P<.05). All methods showed a similar performance regarding specificity. The intra- and interexaminer reproducibility was good for all methods. A significant reduction of the LF reading was found after immersion in 1% of NaOCl. CONCLUSIONS: It was concluded that visual inspection is as valid an evaluation method as the laser fluorescence device, which should be considered a better adjunct for occlusal caries diagnosis than BWR.

Dental Caries↗
PubMed1991

[The diagnosis of approximal caries--a comparison of clinical, fiber optic and x-ray diagnostic procedures (the diagnosis of approximal caries)].

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.

Adolescent↗
PubMed1996

An assessment of capitation in the new General Dental Service contract.

A 2-year study has been completed to examine the dental health and patterns of treatment of samples of children registered under capitation in three areas of England. The opportunity was taken to compare some of these results with those reported in the same areas in 1989 when the dentists were remunerated under fee-for-service. In addition, the validity of the dental health information supplied by general dental practitioners on the FP17C form was assessed. The dental health of 14-15-year-old patients registered for more than a year was compared with that of similar patients in the same areas in 1989. There was a large reduction in the caries experience (mean DMFT) in these patients in all areas between 1989 and 1994 mainly due to a significant fall in the mean numbers of teeth filled. The mean number of teeth extracted for caries remained low in all areas. There was a small increase in the mean number of decayed, untreated teeth in all areas. There was a large increase in the proportion of patients with one or more fissure sealants present. The dental health of 7-8-year-old patients registered for more than a year was examined but, as this age group were not examined in 1989, no comparative data were available. Regularly attending child patients had, on average, one untreated decayed deciduous tooth, but few had more than two. Caries experience in first permanent molars was low in all areas. Data were collected from a sample of general dental practitioners in three areas on the treatment provided over a 12-month period for random samples of patients in two age groups: 6-12 and 13-15 years. There was an increase in two of the three areas in the provision of oral hygiene instruction and dietary advice. The level of fissure sealant use was maintained or increased. There was a reduction in the numbers of both deciduous and permanent teeth filled. Fewer children had teeth extracted. The proportions of patients having bitewing radiography reduced. The mean number of both visits and check-up examinations reduced. There validation of the dental health information on the FP17C was carried out by comparing the data collected for 7-8 and 14-15 year old patients during the dental health examinations with that submitted by general dental practitioners on FP17C forms to the Dental Practice Board for the same children. For the permanent dentition, agreement was good for missing and filled teeth but poor for decayed, untreated teeth. For deciduous teeth, levels of agreement were generally poor except for filled teeth where it was fair.

Adolescent↗
PubMed2004

[Digital radiography in young children. Considerations based on experiences in practice].

In dentistry, digital radiology techniques, such as a charge-coupled device and a storage phosphor plate, are gaining popularity. It was the objective of this study to assess the importance of the advantages and disadvantages of digital radiology techniques for bitewing radiography in young children, when compared to conventional film. A group of dentists received a questionnaire regarding their experiences with digital radiology techniques or conventional films among young children. Using the Simple Multi-Attributive Rating Technique (SMART) a final weighted score was calculated for the charge-coupled device, the phosphor plate, and conventional film. The scores were 7.40, 7.38, and 6.98 respectively. The differences were not statistically significant (p > 0.47). It could be concluded that, on the basis of experiences in practice, there are no statistically significant preferences for the use of digital radioogy techniques for bitewing radiography in young children.

Adolescent↗
PubMed1989

Evaluation of simple periodontal screening technique currently used in the UK armed forces.

The need to prioritise resources for periodontal care within the UK Armed Forces has led to the development and introduction of a simple periodontal screening technique, the Periodontal Index for Treatment (PIT), based upon the clinical assessment of six teeth (all first molars and the maxillary right and mandibular left central incisors) with a specially designed periodontal probe (the PIT probe) and the use of bitewing radiography. This paper describes the evaluation of the technique. This was carried out by examining 406 subjects aged from 16 to 64 yr in four groups. All subjects received a full mouth periodontal assessment, performed by one of two periodontists with standardised bitewing radiography of their premolar and first and second molars. They were then categorised as periodontally healthy (PIT 0), with gingivitis but no pocketing exceeding 4 mm (PIT 1), with pocketing 4-5 mm (PIT 2), or with 6 mm + pocketing (PIT 3). The subjects were then examined and categorised by one of 32 General Dental Practitioners using the PIT technique upon the six test teeth and subsequently viewing the bitewing radiographs. The results of the two types of examination, with and without bitewing radiographic evidence, were tested for sensitivity and specificity to detect pocketing in excess of 4 mm and/or bone loss. The results showed that, when used without bitewings as an adjunct, the PIT technique showed a specificity of 95-100% but a low sensitivity in three groups (36%, 52% and 59%) and of 94% in the fourth group who had in fact been referred for periodontal treatment. When bitewing radiographs were used as an adjunct to periodontal probing, the PIT technique showed a specificity of 100% in each group and a sensitivity of 89-100% when screening for pockets and/or bone loss. It was concluded that, in the subjects studied, the PIT technique when used in conjunction with bitewing radiography provided simple, rapid and reliable periodontal screening.

Adolescent↗
PubMed1991

Panoramic radiography in the assessment of the marginal bone level.

The radiation dosage for the Orthopantomograph model OP5 was measured using two different sizes of collimators. The concordance between and accuracy of panoramic radiography and periapical and bitewing radiography was examined regarding assessment of the marginal bone level. The measurability of panoramic and periapical and bitewing radiographs was compared, as was the image quality of panoramic radiographs from one selected sample and two random samples. The energy imparted was 0.4-0.8 mJ for one panoramic radiograph. The use of the narrow collimator reduced the dosage by about one-third. The concordance between panoramic and intraoral radiography was high. In some anatomical regions, the concordance was as high as the intraobserver agreement for one and the same technique. The concordance was lower in sites with severe bone loss, however. Sounding was very accurate for the measurement of the marginal bone loss. Of the radiographic techniques, periapical radiography was most accurate. The observer performance for linear measurements of bone loss varied substantially and systematically among five observers. The measurability in the upper arch was the same in panoramic and periapical radiography. In the lower arch, the measurability of periapical radiography was better. The image quality of panoramic radiography influenced the measurability. The image quality of panoramic radiographs from random samples was inferior to that of the selected sample. It was concluded that, for the assessment of the marginal bone level, the panoramic radiograph should be the radiographic examination of choice, if increased image quality is achieved.

Adult↗
PubMed1993

Alignment errors in bitewing radiographs using uncoupled positioning devices.

Errors in X-ray beam alignment account for many of the exposure errors in bitewing radiography. A new method for measuring these alignment errors is described. The alignment accuracy of two different models of inexpensive plastic positioning devices, used for bitewing radiography, were quantified and compared. The technique involves documenting the alignment of an 'ideal' reference radiograph and successive exposures. It permits calculation of X-ray beam-film alignment errors in all subsequent radiographs using the 'ideal' reference. Bitewing radiographs were taken on 61 patients and 19 of these were re-radiographed at 6-month intervals over a 2-year period, providing a total of 156 radiographs for the study. Horizontal and vertical angular deviations were measured and total alignment errors calculated for each radiograph. The average angular alignment error was less than 2 degrees total angular error (1.3-2.4 degrees, 95% confidence intervals). It is concluded that these devices can be used when X-ray beam-film alignment error below 2.5 degrees is acceptable.

Humans↗
PubMed2003

[Routine dental examination as evaluation tool in clinical cariology].

As a result of the caries prevalence of the Dutch population the character of the routine dental examination is changing. Caries screening remains relevant for high caries risk individuals but the interpretation of early caries lesions deserves more attention, especially the assessment of progression of caries lesions in time. Diagnosis of caries by dental practitioners in the Netherlands mainly consists of visual inspection in combination with bitewing radiography and both methods play an important role in the timing of bitewing radiographs and forthcoming recall visits for oral health examination. The content and frequency of the routine dental examination are discussed in relation to the individual risk prediction as relevant aspects of quality of dental care in the Netherlands.

Dental Care↗
PubMedDate not supplied

Clinical effectiveness of laser fluorescence, visual inspection and radiography in the detection of occlusal caries.

The aim of this in vivo study was to compare a laser fluorescence (LF) device with Ekstrand's visual scoring system and radiographic assessment for detection of occlusal caries. Thirty-eight adults aged 19-35 years participated in the study; a total of 57 third molars with macroscopically intact occlusal surfaces were selected. Two examiners assessed 110 sites by visual inspection (VI), bitewing radiography (BW) and LF. Teeth were then extracted and caries extent assessed by histology. The detection methods were compared by means of sensitivity, specificity, inter-examiner reproducibility (kappa statistics) and area under the ROC curve. VI and LF had similar (p > 0.05) and superior sensitivities than BW (p < 0.05). VI and BW showed similar specificities, which was superior to LF. The inter-examiner reproducibility was good for VI and BW and moderate for LF. The area under ROC curves showed that VI was better than LF. It was concluded that Ekstrand's visual scoring system is the most valid method for caries diagnosis. LF should be considered an adjunct to caries diagnosis.

Adult↗
PubMedDate not supplied

Detection of approximal caries in 5-year-old Swedish children.

The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. Two hundred and sixty-seven consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs (decayed, missing and filled surfaces) value (canines and molars), the number of occlusal dmfs, the frequency of intake of between-meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs value without bitewing examination was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33% at least one enamel lesion that were detected from bitewing examination only. The gain from adding bitewing examination to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist's overall judgement with an average precision of 73%; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33% of the 5-year-olds, representing a low caries prevalence population, benefited from bitewing examination. The ability to identify these children from the predictors was, however, limited.

Child, Preschool↗
PubMed2004

Comparison of diagnostic yields of clinical and radiographic caries examinations in children of different age.

AIM: This was to investigate if the pattern of distribution of caries lesions detected by clinical and radiographic examinations at different diagnostic thresholds changed over a 3-year period during the course of eruption of the permanent dentition. It has been hypothesized that the contribution of bitewing radiography to caries detection in posterior teeth may increase when approximal contacts are established during maturation of the dentition. METHODS: Clinical and radiographic caries recordings were made using the non- cavitated/enamel and cavity/dentine thresholds for caries detection among a group of 12-year-old Lithuanian children with a high caries experience. Examinations were repeated in the same children after 3 years. The bitewing radiographs from both examination sessions were coded to ensure unbiased recordings and were read by a single examiner. RESULTS: The diagnostic yields of the clinical and radiographic examination methods did not change after the permanent teeth had fully erupted. At both examination sessions the clinical examination resulted in the detection of significantly more lesions than did the radiographic method at the non-cavitated level (43- 47% lesions detected by clinical means only and 2-26% by radiographic means only). Only for approximal surfaces at the cavity/dentine diagnostic threshold did radiographs contribute to more lesions (15-16% lesions detected by clinical means only and 38-41% by radiographic means only). Establishment of approximal contacts in the permanent dentition did not increase the relative diagnostic yields of bite-wing radiography in this study group. CONCLUSION: The contribution of the two methods to caries diagnosis depends more on the diagnostic threshold selected than on the stage of maturation of the dentition.

Child↗
PubMed1987

The current status of panoramic radiography.

The current status of dental panoramic tomography (rotational panoramic radiography) is reviewed. This technique is based on a combination of tomography and slit-beam radiography to provide an image of both jaws on a single film. There is a greater degree of image degradation when compared with conventional radiographic techniques due to tomographic blurring, magnification and distortion, secondary images and burn-out. Meticulous patient position is essential to accommodate their jaws to the image layer determined by the manufacturers. The absorbed doses from panoramic radiography are of a similar order to that from bitewing radiography and lower than those from a full-mouth periapical series. The individual risk of 1.3 X 10(-6) is compared with that from other radiographic examinations and smoking. The collective risk, 1.04 deaths in the UK in 1981, is relatively insignificant as is the genetic dose. The risk to the dentist and his staff is also low compared to other risks. The methods of dose limitation currently available are reviewed. The clinical indications are considered in relation to the guidelines of the American Dental Association and the Dental Estimates Board in the UK. The problems associated with attempts to measure diagnostic yield are considered. In view of the world-wide public concern at the potential dangers of ionising radiation, dentists are urged to maximize the diagnostic yield from their panoramic radiography by taking such radiographs only when clinically necessary, ensuring meticulous positioning and processing, followed by scrupulous assessment of the radiography for any sign of pathological change.

Humans↗