A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages. 1. Introduction Dental caries is one of the most prevalent chronic diseases of humans worldwide. When different stages of the disease are taken into account, from the initial to the clinically manifest lesion, very few individuals are truly unaffected. In most industrialised countries 60%–90% of school-aged children are affected. The prevalence among adults is even higher and in most countries the disease affects nearly 100% of the population [1]. During the last thirty years, however, major changes have occurred in the pattern of the disease. Progression of enamel caries is now slower [2], allowing time for preventive intervention before irreversible destruction of tooth substance occurs. During the early stages of the disease the process is reversible and can be arrested: noninvasive intervention can convert a lesion from an active to an inactive state [3, 4]. Appropriate diagnostic techniques are necessary to support such decisions about management of the individual lesion. The clinician needs to be able to monitor the outcome of noninvasive measures and in cases where there is evidence of lesion progression, make a timely decision to intervene, using minimally invasive techniques and restoring damaged tooth structure without weakening the tooth. Applying strategies to control, arrest, or reverse the disease process can reduce the economic burden, pain, and suffering of placing and replacing restorations [5]. This modern, conservative approach to clinical management of dental caries, which has been evolving during the past twenty years, has necessitated a
References
[1]
P. E. Petersen, D. Bourgeois, H. Ogawa, S. Estupinan-Day, and C. Ndiaye, “The global burden of oral diseases and risks to oral health,” Bulletin of the World Health Organization, vol. 83, no. 9, pp. 661–669, 2005.
[2]
I. Mejare, H. Stenlund, and C. Zelezny-Holmlund, “Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden,” Caries Research, vol. 38, no. 2, pp. 130–141, 2004.
[3]
J. D. B. Featherstone, “Dental caries: a dynamic disease process,” Australian Dental Journal, vol. 53, no. 3, pp. 286–291, 2008.
[4]
O. Fejerskov and E. Kidd, Dental Caries: The Disease and Its Clinical Management, chapter 4, Blackwell Munksgaard, Copenhagen, Denmark, 2nd edition, 2008.
[5]
L.-P. Choo-Smith, C. C. S. Dong, B. Cleghorn, and M. Hewko, “Shedding new light on early caries detection,” Journal of the Canadian Dental Association, vol. 74, no. 10, pp. 913–918, 2008.
[6]
B. Angmar-Mansson, “How to measure the effects of fluoride treatments in clinical trials? Assessment: modern versus traditional methods,” Caries Research, vol. 35, no. 1, supplement 1, pp. 30–33, 2001.
[7]
I. A. Pretty, “Caries detection and diagnosis: novel technologies,” Journal of Dentistry, vol. 34, no. 10, pp. 727–739, 2006.
[8]
R. H. Selwitz, A. I. Ismail, and N. B. Pitts, “Dental caries,” The Lancet, vol. 369, no. 9555, pp. 51–59, 2007.
[9]
J. D. Bader, D. A. Shugars, and A. J. Bonito, “A systematic review of the performance of methods for identifying carious lesions,” Journal of Public Health Dentistry, vol. 62, no. 4, pp. 201–213, 2002.
[10]
M. S. Hopcraft and M. V. Morgan, “Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population,” Community Dentistry and Oral Epidemiology, vol. 33, no. 3, pp. 212–218, 2005.
[11]
K. Ridell, H. Olsson, and I. Mejare, “Unrestored dentin caries and deep dentin restorations in Swedish adolescents,” Caries Research, vol. 42, no. 3, pp. 164–170, 2008.
[12]
The Swedish Council on Technology Assessment in Health Care, “Caries—diagnosis, risk assessment and non-invasive treatment,” Tech. Rep. 510-39, 2008.
[13]
J. Yang and V. Dutra, “Utility of radiology, laser fluorescence, and transillumination,” Dental Clinics of North America, vol. 49, no. 4, pp. 739–752, 2005.
[14]
D. G. Altman and J. M. Bland, “Diagnostic tests 1: sensitivity and specificity,” British Medical Journal, vol. 308, no. 6943, p. 1552, 1994.
[15]
The Swedish Council on Technology Assessment in Health Care, “Karies—diagnostik, riskbed？mning och icke-invasiv behandling,” no. 188:84, 2007.
[16]
J. D. Bader, D. A. Shugars, and A. J. Bonito, “Systematic reviews of selected dental caries diagnostic and management methods,” Journal of Dental Education, vol. 65, no. 10, pp. 960–968, 2001.
[17]
I. A. Pretty and G. Maupome, “A closer look at diagnosis in clinical dental practice: part 5. Emerging technologies for caries detection and diagnosis,” Journal of the Canadian Dental Association, vol. 70, no. 8, pp. 540a–540i, 2004.
[18]
G. K. Stookey and C. Gonzalez-Cabezas, “Emerging methods of caries diagnosis,” Journal of Dental Education, vol. 65, no. 10, pp. 1001–1006, 2001.
[19]
G. Stookey, Proceedings of the First Annual Indiana Conference: Early Detection of Dental Caries, Indiana University School of Dentistry, Indiana, Ind, USA, 1996.
[20]
G. Stookey, Proceedings of the Second Annual Indiana Conference: Early Detection of Dental Caries, Indiana University School of Dentistry, Indianapolis, Ind, USA, 2000.
[21]
G. Stookey, Proceedings of the Third Annual Indiana Conference: Early Detection of Dental Caries, Indiana University School of Dentistry, Indianapolis, Ind, USA, 2004.
[22]
B. Angmar-Mansson, S. Al-Khateeb, and S. Tranaeus, “Monitoring the caries process. Optical methods for clinical diagnosis and quantification of enamel caries,” European Journal of Oral Sciences, vol. 104, no. 4, part 2, pp. 480–485, 1996.
[23]
B. Angmar-Mansson and J. J. ten Bosch, “Advances in methods for diagnosing coronal caries—a review,” Advances in Dental Research, vol. 7, no. 2, pp. 70–79, 1993.
[24]
J. D. Bader and D. A. Shugars, “A systematic review of the performance of a laser fluorescence device for detecting caries,” Journal of the American Dental Association, vol. 135, no. 10, pp. 1413–1426, 2004.
[25]
J. D. Bader and D. A. Shugars, “The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries,” Journal of Evidence-Based Dental Practice, vol. 6, no. 1, pp. 91–100, 2006.
[26]
A. Hall and J. M. Girkin, “A review of potential new diagnostic modalities for caries lesions,” Journal of Dental Research, vol. 83, supplement 1, pp. C89–C94, 2004.
[27]
L. Karlsson and S. Tran？us, “Supplementary methods for detection and quantification of dental caries,” Journal Laser Dentistry, vol. 16, no. 1, pp. 8–16, 2008.
[28]
A. Lussi, R. Hibst, and R. Paulus, “DIAGNOdent: an optical method for caries detection,” Journal of Dental Research, vol. 83, supplement 1, pp. C80–C83, 2004.
[29]
K. W. Neuhaus, C. Longbottom, R. Ellwood, and A. Lussi, “Novel lesion detection aids,” Monographs in Oral Science, vol. 21, pp. 52–62, 2009.
[30]
A. C. Pereira, H. Eggertsson, E. A. Martinez-Mier, F. L. Mialhe, G. J. Eckert, and D. T. Zero, “Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries-detection methods,” European Journal of Oral Sciences, vol. 117, no. 1, pp. 51–57, 2009.
[31]
G. K. Stookey, “Optical methods—quantitative light fluorescence,” Journal of Dental Research, vol. 83, supplement 1, pp. C84–C88, 2004.
[32]
S. Tranaeus, X.-Q. Shi, and B. Angmar-Mansson, “Caries risk assessment: methods available to clinicians for caries detection,” Community Dentistry and Oral Epidemiology, vol. 33, no. 4, pp. 265–273, 2005.
[33]
D. A. Young, “New caries detection technologies and modern caries management: merging the strategies,” General Dentistry, vol. 50, no. 4, pp. 320–331, 2002.
[34]
A. F. Zandona and D. T. Zero, “Diagnostic tools for early caries detection,” Journal of the American Dental Association, vol. 137, no. 12, pp. 1675–1684, 2006.
[35]
J. R. Zijp, “Optical properties of dental hard tissue,” in Introduction, chapter 1, Groningen Rijksuniversiteit, Groningen, The Netherlands, 2001.
[36]
H. C. Benedict, “A note on the fluorescence of teeth in ultra-violet rays,” Science, vol. 67, no. 1739, p. 442, 1928.
[37]
E. Borisova, T. Uzunov, and L. Avramov, “Laser-induced autofluorescence study of caries model in vitro,” Lasers in Medical Science, vol. 21, no. 1, pp. 34–41, 2006.
[38]
H. Bjelkhagen, F. Sundstr？m, B. Angmar-M？nsson, and H. Rydén, “Early detection of enamel caries by the luminescence excited by visible laser light,” Swedish Dental Journal, vol. 6, no. 1, pp. 1–7, 1982.
[39]
F. Sundstr？m, K. Fredriksson, S. Montan, U. Hafstrom-Bjorkman , and J. Str？m, “Laser-induced fluorescence from sound and carious tooth substance: spectroscopic studies,” Swedish Dental Journal, vol. 9, no. 2, pp. 71–80, 1985.
[40]
E. de Josselin de Jong, F. Sundstr？m, H. Westerling, S. Tranaeus, J. J. ten Bosch, and B. Angmar-Mansson, “A new method for in vivo quantification of changes in initial enamel caries with laser fluorescence,” Caries Research, vol. 29, no. 1, pp. 2–7, 1995.
[41]
B. Angmar-Mansson and J. J. ten Bosch, “Quantitative light-induced fluorescence (QLF): a method for assessment of incipient caries lesions,” Dentomaxillofacial Radiology, vol. 30, no. 6, pp. 298–307, 2001.
[42]
S. Tranaeus, S. Al-Khateeb, S. Bjorkman, S. Twetman, and B. Angmar-Mansson, “Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A comparative study of remineralisation by fluoride varnish and professional cleaning,” European Journal of Oral Sciences, vol. 109, no. 2, pp. 71–75, 2001.
[43]
M. H. van der Veen and E. de Josselin de Jong, “Application of quantitative light-induced fluorescence for assessing early caries lesions,” Monographs in Oral Science, vol. 17, pp. 144–162, 2000.
[44]
S. Al-Khateeb, J. M. ten Cate, B. Angmar-Mansson, et al., “Quantification of formation and remineralization of artificial enamel lesions with a new portable fluorescence device,” Advances in Dental Research, vol. 11, no. 4, pp. 502–506, 1997.
[45]
R. Gmur, E. Giertsen, M. H. van der Veen, E. de Josselin de Jong, J. M. ten Cate, and B. Guggenheim, “In vitro quantitative light-induced fluorescence to measure changes in enamel mineralization,” Clinical Oral Investigations, vol. 10, no. 3, pp. 187–195, 2006.
[46]
R. Heinrich-Weltzien, J. Kuhnisch, M. Van der veen, E. de Josselin de Jong, and L. Stosser, “Quantitative light-induced fluorescence (QLF)—a potential method for the dental practitioner,” Quintessence International, vol. 34, no. 3, pp. 181–188, 2003.
[47]
N. B. Pitts and J. W. Stamm, “International consensus workshop on caries clinical trials (ICW-CCT)—final consensus statements: agreeing where the evidence leads,” Journal of Dental Research, vol. 83, supplement 1, pp. C125–C128, 2004.
[48]
Y. Feng, W. Yin, D. Hu, Y. P. Zhang, R. P. Ellwood, and I. A. Pretty, “Assessment of autofluorescence to detect the remineralization capabilities of sodium fluoride, monofluorophosphate and non-fluoride dentifrices: a single-blind cluster randomized trial,” Caries Research, vol. 41, no. 5, pp. 358–364, 2007.
[49]
L. Karlsson, L.-E. Lindgren, K. Trollsas, B. Angmar-Mansson, and S. Tranaeus, “Effect of supplementary amine fluoride gel in caries-active adolescents. a clinical QLF study,” Acta Odontologica Scandinavica, vol. 65, no. 5, pp. 284–291, 2007.
[50]
O. Kronenberg, A. Lussi, and S. Ruf, “Preventive effect of ozone on the development of white spot lesions during multibracket appliance therapy,” Angle Orthodontist, vol. 79, no. 1, pp. 64–69, 2009.
[51]
I. A. Pretty, J. A. Tavener, D. Browne, D. S. Brettle, H. Whelton, and R. P. Ellwood, “Quantification of dental fluorosis using fluorescence imaging,” Caries Research, vol. 40, no. 5, pp. 426–434, 2006.
[52]
M. A. Ablal, J. S. Kaur, L. Cooper, et al., “The erosive potential of some alcopops using bovine enamel: an in vitro study,” Journal of Dentistry, vol. 37, no. 11, pp. 835–839, 2009.
[53]
V. Elton, L. Cooper, S. M. Higham, and N. Pender, “Validation of enamel erosion in vitro,” Journal of Dentistry, vol. 37, no. 5, pp. 336–341, 2009.
[54]
A. A. Adeyemi, N. Pender, and S. M. Higham, “The susceptibility of bleached enamel to staining as measured by Quantitative Light-induced Fluorescence (QLF),” International Dental Journal, vol. 58, no. 4, pp. 208–212, 2008.
[55]
A. A. Adeyemi, F. D. Jarad, E. de Josselin de Jong, N. Pender, and S. M. Higham, “The evaluation of a novel method comparing quantitative light-induced fluorescence (QLF) with spectrophotometry to assess staining and bleaching of teeth,” Clinical Oral Investigations, vol. 14, no. 1, pp. 19–25, 2010.
[56]
A. M. Taylor, R. P. Ellwood, I. A. Pretty, and N. Mohan, “Quantitative stain detection in vivo using fluorescent imaging,” Journal of Dentistry, vol. 37, no. 5, pp. 397–405, 2009.
[57]
M. H. van der Veen, R. Z. Thomas, M. C. Huysmans, and J. J. de Soet, “Red autofluorescence of dental plaque bacteria,” Caries Research, vol. 40, no. 6, pp. 542–545, 2006.
[58]
R. Hibst and R. Gall, “Development of a diode laser-based fluorescence caries detector,” Caries Research, vol. 32, no. 4, article 294, 1998.
[59]
H. V. Gostanian, Z. Shey, C. Kasinathan, J. Caceda, and M. N. Janal, “An in vitro evaluation of the effect of sealant characteristics on laser fluorescence for caries detection,” Pediatric Dentistry, vol. 28, no. 5, pp. 445–450, 2006.
[60]
C. Abalos, M. Herrera, A. Jimenez-Planas, and R. Llamas, “Performance of laser fluorescence for detection of occlusal dentinal caries lesions in permanent molars: an in vivo study with total validation of the sample,” Caries Research, vol. 43, no. 2, pp. 137–141, 2009.
[61]
S. Akarsu and H. Koprulu, “In vivo comparison of the efficacy of DIAGNOdent by visual inspection and radiographic diagnostic techniques in the diagnosis of occlusal caries,” Journal of Clinical Dentistry, vol. 17, no. 3, pp. 53–58, 2006.
[62]
V. Angnes, G. Angnes, M. Batisttella, R. H. M. Grande, A. D. Loguercio, and A. Reis, “Clinical effectiveness of laser fluorescence, visual inspection and radiography in the detection of occlusal caries,” Caries Research, vol. 39, no. 6, pp. 490–495, 2005.
[63]
V. Anttonen, L. Seppa, and H. Hausen, “A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children,” Community Dentistry and Oral Epidemiology, vol. 32, no. 4, pp. 312–318, 2004.
[64]
A. Astvaldsdottir, W. P. Holbrook, and S. Tranaeus, “Consistency of DIAGNOdent instruments for clinical assessment of fissure caries,” Acta Odontologica Scandinavica, vol. 62, no. 4, pp. 193–198, 2004.
[65]
M. Bamzahim, A. Aljehani, and X.-Q. Shi, “Clinical performance of DIAGNOdent in the detection of secondary carious lesions,” Acta Odontologica Scandinavica, vol. 63, no. 1, pp. 26–30, 2005.
[66]
C. H. Chu, E. C. M. Lo, and D. S. H. You, “Clinical diagnosis of fissure caries with conventional and laser-induced fluorescence techniques,” Lasers in Medical Science, pp. 1–8, 2009.
[67]
M. A. Khalife, J. R. Boynton, J. B. Dennison, P. Yaman, and J. C. Hamilton, “In vivo evaluation of DIAGNOdent for the occlusal dental caries,” Operative Dentistry, vol. 34, no. 2, pp. 136–141, 2009.
[68]
A. Reis, F. M. Mendes, V. Angnes, G. Angnes, R. H. M. Grande, and A. D. Loguercio, “Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions,” Journal of Dentistry, vol. 34, no. 2, pp. 89–96, 2006.
[69]
R. O. Rocha, T. M. Ardenghi, L. B. Oliveira, C. R. M. D. Rodrigues, and A. L. Ciamponi, “In vivo effectiveness of laser fluorescence compared to visual Inspection and radiography for the detection of occlusal caries in primary teeth,” Caries Research, vol. 37, no. 6, pp. 437–441, 2003.
[70]
S. Tranaeus, L.-E. Lindgren, L. Karlsson, and B. Angmar-Mansson, “In vivo validity and reliability of IR fluorescence measurements for caries detection and quantification,” Swedish Dental Journal, vol. 28, no. 4, pp. 173–182, 2004.
[71]
A. Lussi and E. Hellwig, “Performance of a new laser fluorescence device for the detection of occlusal caries in vitro,” Journal of Dentistry, vol. 34, no. 7, pp. 467–471, 2006.
[72]
K. C. Huth, K. W. Neuhaus, M. Gygax, et al., “Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars,” Journal of Dentistry, vol. 36, no. 12, pp. 1033–1040, 2008.
[73]
A. Aljehani, M. Bamzahim, M. A. Yousif, and X. Q. Shi, “In vivo reliability of an infrared fluorescence method for quantification of carious lesions in orthodontic patients,” Oral Health & Preventive Dentistry, vol. 4, no. 2, pp. 145–150, 2006.
[74]
A. Andersson, K. Skold-Larsson, A. Hallgren, L. G. Petersson, and S. Twetman, “Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence,” Oral Health & Preventive Dentistry, vol. 5, no. 3, pp. 229–233, 2007.
[75]
K. Skold-Larsson, A.-C. Fornell, A. Lussi, and S. Twetman, “Effect of topical applications of a chlorhexidine/thymol-containing varnish on fissure caries assessed by laser fluorescence,” Acta Odontologica Scandinavica, vol. 62, no. 6, pp. 339–342, 2004.
[76]
L. Karlsson, E. Johansson, and S. Tranaeus, “Validity and reliability of laser-induced fluorescence measurements on carious root surfaces in vitro,” Caries Research, vol. 43, no. 5, pp. 397–404, 2009.
[77]
M. J. Wicht, R. Haak, H. Stutzer, D. Strohe, and M. J. Noack, “Intra- and interexaminer variability and validity of laser fluorescence and electrical resistance readings on root surface lesions,” Caries Research, vol. 36, no. 4, pp. 241–248, 2002.
[78]
W. Zhang, C. McGrath, and E. C. M. Lo, “A comparison of root caries diagnosis based on visual-tactile criteria and DIAGNOdent in vivo,” Journal of Dentistry, vol. 37, no. 7, pp. 509–513, 2009.
[79]
C. L. Darling and D. Fried, “Real-time near IR (1310？nm) imaging of CO2 laser ablation of enamel,” Optics Express, vol. 16, no. 4, pp. 2685–2693, 2008.
[80]
A. Schneiderman, M. Elbaum, T. Shultz, S. Keem, M. Greenebaum, and J. Driller, “Assessment of dental caries with digital imaging fiber-optic translllumination ( ): in vitro Study,” Caries Research, vol. 31, no. 2, pp. 103–110, 1997.
[81]
C. M. Buhler, P. Ngaotheppitak, and D. Fried, “Imaging of occlusal dental caries (decay) with near-IR light at 1310-nm,” Optics Express, vol. 13, no. 2, pp. 573–582, 2005.
[82]
C. L. Darling and D. Fried, “Optical roperties of natural caries lesions in dental enamel at 1310-nm,” in Lasers in Dentistry XI, P. Rechmann and D. Fried, Eds., vol. 5687 of Proceeding of SPIE, pp. 102–110, San Jose, Calif, USA, January 2005.
[83]
C. L. Darling, G. D. Huynh, and D. Fried, “Light scattering properties of natural and artificially demineralized dental enamel at 1310？nm,” Journal of Biomedical Optics, vol. 11, no. 3, Article ID 034023, 2006.
[84]
D. Fried, R. E. Glena, J. D. B. Featherstone, and W. Seka, “Nature of light scattering in dental enamel and dentin at visible and near-infrared wavelengths,” Applied Optics, vol. 34, no. 7, pp. 1278–1285, 1995.
[85]
R. S. Jones, G. D. Huynh, G. C. Jones, and D. Fried, “Near-infrared transillumination at 1310-nm for the imaging of early dental decay,” Optics Express, vol. 11, no. 18, pp. 2259–2265, 2003.
[86]
J. Wu and D. Fried, “High contrast near-infrared polarized reflectance images of demineralization on tooth buccal and occlusal surfaces at -nm,” Lasers in Surgery and Medicine, vol. 41, no. 3, pp. 208–213, 2009.
