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LASER FLUORESCENCE DEVICE (DIAGNODENT) IN COMPARISON TO VISUAL EXAMINATION IN DETECTION OF OCCLUSAL CARIES IN PERMANENT MOLARS AND PREMOLARS.

Byline: Kauser Parveen, Shazia Mushtaq and Naveed Khawaja

Abstract

The objective of this study was to evaluate and compare laser fluorescence (LF), using DIAGNOdent tool and visual examination (VE) methods for diagnosis of early occlusal caries in permanent molars and premolars. Two hundred occlusal surfaces were randomly selected in permanent molars and premolars of 54 female patients (17-25 years old), visited Dental Hygiene Clinics of College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Clinical examination for dental caries using LF and VE methods was conducted by two examiners. The agreement between the two examiners was almost perfect (Kappa .87 and 1.0) using LF and VE for diagnosis of the occlusal caries. There was no significant difference in sensitivity and specificity value of the two methods. It is also concluded that the laser fluorescence can be used as an adjunct tool in the diagnosis of occlusal dental caries in permanent molars and premolars.

Key Words: Occlusal caries, permanent molars and premolars, laser fluorescence (DIAGNOdent)

INTRODUCTION

Dental caries is highly prevalent among Saudis, and the prevalence is expected to increase further in primary and permanent teeth.1 Early detection of this disease would enable dentists to execute non/minimally invasive treatment that could be less expensive for the patient and also provide considerable improvement in the tooth's life span.

Occlusal surfaces are difficult to detect on clinical examination, due to occlusal anatomy (pits and fissures) especially in premolars and molars that cannot be easily cleansed from deposit and debris. Similarly, it is not easy to detect depth or progress of initial and recurrent caries by conventional visual and tactile methods of caries detection. Bitewing radiographs used for proximal caries detection may not be useful for detection of occlusal caries due to overlapping structures. As stated in evidence-based literature, sharp dental explorer is an inappropriate tool for assessing dental lesions because they can irreversibly damage enamel.2,8 Pit and fissures dental caries usually spread in inverted "V" pattern with broad surface towards dentino-enamel junction (DEJ). Smooth surface caries spread is Vshaped with the apex towards DEJ.

Therefore, occlusal caries has greater tendency reaching pulp if not detected at an early stage. Visual examination is basically a direct, and there is difficulty in assessing the severity of occlusal caries.9,10

Many studies have documented false-positive and false-negative findings frequently encountered during detection of occlusal caries with VE.11,13

With advancement in technology, caries detection devices that help in identifying early carious lesions are now available. The Laser fluorescence (LF) device (DIAGNOdent) was introduced in market in 1998, as a tool to help in diagnosis of early occlusal caries as an adjunct to visual examination. The device is based on the principle that when an infrared laser with 655 nm wavelength is irradiated on dental surface, light is absorbed by tooth tissues as well as by metabolites from oral bacterial porphyrins 14, and in this way, decalcified areas in the enamel and dentin structure stimulate fluorescent light of a different wavelength, and resulting fluorescence is evaluated by the appropriate electronic system in the DIAGNOdent unit. The information is scarce on comparing the performance of DIAGNOdent LF device with visual examination (VE) in detection of occlusal caries in the Saudi population.

The aim of this study therefore, was to compare efficacy of LF and VE methods for detection of occlusal caries in permanent molars and premolars.

MATERIALS AND METHODS

Two hundred occlusal surfaces were randomly selected in permanent molars and premolars of 54 female patients (age 17-25 years) attending Dental Hygiene Clinics of College of Dentistry, King Saud University, Riyadh, Saudi Arabia. All the patients had unremarkable medical history. All restored, extensively carious, and structurally defective teeth were excluded. The inclusion criteria were; sound, initial visual changes, distinct visual changes, opacity or discoloration or enamel caries on the occlusal surfaces.

After taking consent from the selected patients, the procedure was explained to the patients. Visual clinical examination was carried out by two experienced examiners (KP and SM) with dental light, air/water spray and mouth mirror. Loose debris were removed by water sprays and surfaces dried with air without using any probe. The visual clinical examination followed criteria provided by Ekstrand et al. (1998)4 [Table 1]. The LF examination using DIAGNOdent (KaVo, Germany, Pen 2190) was carried out by same two examiners using criteria (0-100) provided by Lussi et al (1991)8 [Table 2]. The measurements were taken by using a fiber-optic conical tip (Tip A) specifically designed for occlusal surfaces according to the manufacturer's instructions. The highest reading shown on the device was recorded. All readings were recorded on a form especially designed for the study.

The data were entered into a computer and analyzed using Statistical Package for Social Sciences (SPSS) version #17. Intraand inter-examiner agreements for both VE and LF methods were assessed using kappa statistics. Chi-square test was used to compare all categorical data.

RESULTS

Distribution of 200 selected occlusal surfaces in molars and premolars is given in Table 3; with almost even distribution in terms of tooth type (Table 3). The results of VE for occlusal caries by the two examiners are detailed in Table 4. There was almost perfect agreement (Kappa value.87) found between two examiners in diagnosing occlusal caries by VE. The results of examination for occlusal caries using LF by the two examiners are describe in Table 5. There was a perfect agreement (Kappa value 1) found between the two examiners using LF in detection of occlusal caries in permanent molars and premolars.

The diagnosis of occlusal surface caries by the VE and LF methods was significantly (p=.003) similar (Figure 1). The sensitivity for both the methods (VE=.87 and LF.9) was much higher than specificity (VE=.5 and LF=.5) [Table 6]. The specificity scores were same for both visual and LF methods, while sensitivity score was slightly high for LF method than VE method (Table 6).

DISCUSSION

The occlusal surface of tooth is more susceptible to dental caries and reliable detection of occlusal caries is a challenging task. Early caries detection improves the chances of successful prevention strategies. The results of this study showed that LF (DIAGNOdent 2190) is a sensitive method in early detection of occlusal caries, and LF method could be used as an adjunct tool followed by VE method. Zaidi et al (2016)18 conducted an in-vivo study on deciduous and permanent teeth, their results were in agreement with this study.

They concluded that the DIAGNOdent was the most accurate and valid system tested for the detection of occlusal caries. They found a higher value of sensitivity for DIAGNOdent (0.91) than for visual examination. They observed that DIAGNOdent has the advantage of quantifying the mineral content of the teeth and visual examination alone is not adequate.

TABLE 1: VISUAL CLINICAL EXAMINATION (VE) CRITERIA BY EKSTRAND ET AL.15

Score###Criteria

0###No or slight change in enamel translucency

###after prolonged air-drying

1###Opacity or discoloration hardly visible with-

###out drying, but visible after air-drying

2###Opacity or discoloration visible even without

###air-drying

3###Localized enamel breakdown in opaque or

###discolored enamel and / or grayish discolor-

###ation from underlying dentin

4###Cavitation in plaque or discolored enamel

###exposing to dentin

TABLE 2: CRITERIA USED IN EXAMINATION WITH DIAGNODENT BY LUSSI ET AL.16

Score###Criteria

0-14###No caries

15-20###Enamel caries

21-99###Dentinal caries

TABLE 3: DISTRIBUTION OF EXAMINED OCCLUSAL SURFACES

Total###Teeth###No of###Percentage

surfaces###surfaces###%

200###Premolars###101###50.5

###Molars###99###49.5

###Total###200###100

TABLE 4: VISUAL EXAMINATION BY THE TWO EXAMINERS FOR OCCLUSAL CARIES

Stage of decay###Ex 1###Percentage###Ex 2###Percentage###Kappa Value

No caries###25###12.5%###21###10.5%###0.872

Opacity after air-drying###75###37.5%###79###39.5%

Opacity visible without air-drying###44###22%###44###22%

Localized enamel breakdown###46###23%###41###20.5%

Cavity###10###5%###15###7.5%

Total###200###100###200###100

TABLE 5: EXAMINATION BY THE TWO EXAMINERS FOR OCCLUSAL CARIES USING LF METHOD

Stage of decay###Ex 1###Percentage###Ex 2###Percentage###Kappa

0-14 (no caries)###21###10.5%###21###11.5%###1.000

15-20 (enamel)###43###21.5%###43###21%

21-99 (dentinal###136###68%###136###67.5%

caries)

Total###200###100%###200###100%

TABLE 6: SPECIFICITY AND SENSITIVITY

Methods###No Caries###Caries###Caries status###Specificity###Sensitivity

###Caries free###Caries

Visual###25###175###12.5%###87.5%###0.50###0.875

DD###20###180###10%###90%###0.50###0.900

Kouchaji (2012)19 showed a strong relationship between examination with the DIAGNOdent and VE. DIAGNOdent sensitivity and specificity were.97 and.52, respectively. He concluded that DIAGNOdent may be very helpful in conjunction with visual examination in the detection of occlusal caries in permanent molars of children. In 2005, Melo et al 20 conducted a prospective study in Spain compared traditional visual and tactile method, DIAGNOdent, Vista Proof and Caries Scan for diagnosis of occlusal caries.

DIAGNOdent was seen to be the most effective technique followed by Caries Scan and Vista Proof. Attrill and Ashley (2001) 17 compared VE and LF methods; and found higher sensitivity for DIAGNOdent (0.77 and 0.80) among two examiners. They concluded that DIAGNOdent was the most accurate system tested for detection of occlusal caries in primary molars.

They also mentioned that the performance of LF system was not statistically better than the visual examination of non-cavitated teeth. In 2005 Angnes et al 21 compared the performance of LF with the visual-ranked assessment method and bitewing radiographs for occlusal caries detection. They found that VE and LF had similar results. According to their assessment Ekstrand's visual scoring system15 was the most valid method for caries diagnosis. They commented that LF should be considered an adjunct to caries diagnosis because of its relatively high cost compared to VE. In suspicious cases, radiography and DIAGNOdent can be used as adjunct procedures.

CONCLUSION

It can be concluded that the laser fluorescence can be successfully used as an adjunct tool in the diagnosis of occlusal dental caries.

ACKNOWLEDGMENT

We are thankful to Prof. AbualAziz AlKhuraif (Head of the Research Chair, Dental Health Department) for his kind support and encouragement in the success of this research project. We would like to appreciate Prof. Amjad H. Wyne (Professor of Pediatric Dentistry in College of Dentistry, King Saud University) for his continuous guidance in this research project.

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Publication:Pakistan Oral and Dental Journal
Date:Jun 30, 2018
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