PURPOSE: This paper will review the literature and key strategies for caries management and early detection. Two relatively new detection technologies, the DIAGNODENTand DIFOTI, will be reviewed.
MATERIALS & METHODS:
DIAGNODENT is a lightweight, battery operated diagnostic device which incorporates a Diode laser to detect and measure fluorescence created by bacterial by-products in subsurface lesions. Bacterial metabolites of the caries process cause a fluorescence to occur which is enhanced by the DIAGNODENT laser light. The unit gives both an adjustable audible sound and a digital numeric readout (0-99). This can be used to help the clinician decide whether a tooth should be opened. Interpretation of the readings are as follows: 0-15, no active care is advised; 16-30, preventative or operative care depending on caries risk; 31-99, preventative or operative care is advised.
DIFOTI: developed as a diagnostic instrument for early and reliable detection of caries without the need for ionizing radiation. It received FDA approval in 1999 and can be used to inspect the integrity of the tooth for fractures, decalcification and wear of amalgams, composites, sealants and so forth. It has the potential to detect early lesions but also to monitor the progress of chemical tx. as necessary without fear of harmful radiation because it uses harmless visible light
RESULTS: It was concluded that the DIAGNODENT method was superior to that of radiography in detecting early occlusal lesions. This seemed to be the most useful with early noncavitated occlusal lesions. However, it does not work on composite, sealants or amalgams and is limited to only nonrestored areas of the occlusal.
The best minimal intervention may include the use of DIFOTI and chemical remineralization instead of surgical restoration. However, DIFOTI is not of great assistance in detecting early root demineralization.
DIFOTI does not measure lesion depth, so there is a greater possibility of overdiagnosis. In fact, DIFOTI does not detect caries, rather it detects surface changes to visible light. It is up to the clinician to interpret these images.
DISCUSSION: Authors need to carefully define and explain the clinical relevance in terms they use as well as readers must be aware of the circumstances in which they are being used. By nature, human caries trials may not always be clinically practical, making in vitro studies, where histological analysis may be performed, a logical compromise. Clinical studies are needed to determine if fissure widening would improve clinical detection or if preparation before sealant placement and improved sealant material will translate to better clinical outcomes. Further investigations are needed to determine whether DIAGNODENTor DIFOTI may assist in the conventional detection of root surface caries. Although chemical remineralization is a choice for the clinician, the consequences of failure must be weighed against the risk of restorative failure and undetected recurrent caries. Clearly, the best choice is prevention.
SUMMARY/COMMENTS: Clinical decisions should be based on scientific knowledge, which requires practitioners to read and understand the appropriate literature. Without clearly defined terms, many clinicians may conclude erroneously that they need to be more aggressive in restoring approximal lesions detected on radiographic examination. The fact is that the decision between chemical remineralization and restorative tx. of lesions should be based on the extent of surface cavitation. Users often propose the use of DOFOTI to enhance the discovery of suspect occlusal areas followed by use of the DIAGNODENT to help confirm the need for surgical intervention. Until then, the debate of supervised neglect (watching early lesions get bigger) versus overtreatment will not be settled definitively.
Young, Douglas A. ; General Dentistry; July-August; 320-331; 2002.