The incidence of caries remains a central oral health problem in the United States. Many in the dental community believe that prevention is the best medicine in the fight against caries, with early caries detection as a close second.
Recent statistics show that approximately 18.6% of children age 5 to 19, and 31.6% of adults age 20 to 44 have untreated dental caries. 1Centers for Disease Control and Prevention. Oral and Dental Health. Available at: https://www.cdc.gov/nchs/fastats/dental.htm. Accessed September 14, 2018. In fact, the National Institute of Dental and Craniofacial Research identifies dental caries as the most prevalent chronic disease for all age ranges. 2National Institute of Dental and Craniofacial Research. Dental Caries (Tooth Decay). Available at: https://www.nidcr.nih.gov/research/data-statistics/dental-caries. Accessed September 14, 2018.
Risk Assessment Tools
The American Dental Association (ADA) advocates the use of risk assessment tools such as Caries Management Risk Assessment (CAMBRA), in conjunction with radiography and visual and tactile exams. 3American Dental Association. Oral Health Topics: Caries Risk Assessment Management. Available at: https://www.ada.org/en/member-center/oral-health-topics/caries-risk-assessment-and-management. Accessed September 14, 2018. CAMBRA is an age-specific assessment tool designed to gather and analyze risk factors for developing caries. Armed with this information, a clinician can then recommend preventive measures or treatments.4Macri D. Implementing a Multifaceted Approach to Caries Prevention. Dimensions of Dental Hygiene. 2018;16(5):21–22,24–25.
Other tools, some that dovetail CAMBRA, include the International Caries Detection and Assessment System (ICDAS), which, based on appearance, grades lesions on how far they have spread into tooth structure using a seven-point scale. 5Pitts N, Ekstrand KR. International Caries Detection and Assessment System (ICDAS) and its International Caries Classification and Management System (ICCMS) – methods for staging of the caries process and enabling dentists to manage caries. Epidemiology. 2013;14:541–e51.
The ADA’s Caries Classification System (CCS) incorporates ICDAS and other classification systems to identify both cavitated and noncavitated lesions, linking them to radiographic findings.6American Dental Association. Oral Health Topics: Caries Risk Assessment Management. Available at: https://www.ada.org/en/member-center/oral-health-topics/caries-risk-assessment-and-management. Accessed September 14, 2018.
Caries Detection Strategies
For traditional hands-on detection, the first step typically involves a visual/tactile diagnostic exam and radiography. However, concerns have been raised about the use of explorers, which may inflict iatrogenic damage to tooth structure during exams. 7American Dental Association. Oral Health Topics: Caries Risk Assessment Management. Available at: https://www.ada.org/en/member-center/oral-health-topics/caries-risk-assessment-and-management. Accessed September 14, 2018.
Likewise, efforts have begun in recent years to limit exposure to ionizing radiation exposure from radiography as much as possible. While the ADA still recommends the use of X-rays, such as bitewings, especially in detecting interproximal lesions, there is a general consensus that X-rays should be taken judiciously, following the “as low as reasonably achievable” or (ALARA) principle. 8American Dental Association. Oral Health Topics: Caries Risk Assessment Management. Available at: https://www.ada.org/en/member-center/oral-health-topics/caries-risk-assessment-and-management. Accessed September 14, 2018.
Caries Detection Technology
Caries detection devices do not emit ionizing radiation. They are designed to help clinicians locate carious lesions in their earliest stages, when they can be addressed through minimally invasive means. These technologies may use light-induced fluorescence, infrared fluorescence, infrared fluorescence combined with photothermal radiometry, transillumination or alternating current impedance spectroscopy. 9Marsh L. Advance in Caries Detection. Dimensions of Dental Hygiene. 2014;12(5):42,44.
Many of these devices are laser- or light emitting diode (LED)-based, and will cause healthy tooth structure to appear differently than carious structure. For instance, those using fluorescence might cause healthy structure to fluoresce green, while demineralized structure fluoresces red. Devices using transillumination will direct light through tooth structure, revealing inner anomalies such as caries or cracks. 10Stone R. Light-Bulb Moments. Mentor. 2017;8(3):28-32. Another technology, alternating current impedance spectroscopy, measures electrical resistance variations in tooth structure.
Some newer detection devices are integrated with other technologies to optimize clinical diagnostics. For example, they may combine intraoral camera capabilities with caries detection technology. Such devices are winning new fans.
One thing that many classification and caries detection strategies have in common is the need for clean, dry teeth. Fortunately, with the use of isolation systems, such as Isolite, clinicians have an ally in maintaining a dry field to get the most reliable results possible. That’s a winning strategy for everyone.
There is no doubt that caries prevention and early caries detection are ground zero for minimally invasive dentistry. And by using any appropriate aids available to this end, dentists are ensuring the best care for their patients.