Dr.Gousalya V 1st year post graduate student Department of Public Health Dentistry Early dental caries diagnosis is an important step for the overall management of dental patients..Here are the recent advances in dental caries diagnosis.

1. Recent advances in
dental caries diagnosis
Dr. Gousalya,
1st year post graduate student,
Department of Public Health Dentistry,
SRMDC,
31/5/2021

2. DENTAL CARIES ?
• Dental caries is one of the most common preventable childhood diseases;
people are susceptible to the disease throughout their lifetime.

3. DEFINITION
• Dental caries is a complex disease, defined as a progressive, irreversible,
microbial disease affecting the hard parts of the tooth exposed to the oral
environment, characterized by demineralization of inorganic constituents
and destruction of the organic constituents thereby leading to a cavity
formation.
Srilatha A, Doshi D, Kulkarni S, Reddy MP, Bharathi V. Advanced diagnostic aids in dental caries – A Review. J Global Oral Health
2019;2(2):118-27.

4. DIAGNOSIS
Diagnosis has been defined as “the art or act of identifying a
disease from its signs and symptoms” and caries detection is the
signs and symptoms identified.
Nyvad B. Diagnosis versus detection of caries. Caries research. 2004;38(3):192-8.

5. GENERAL CRITERIA FOR IDEAL CARIES DETECTION
METHOD

7. METHODS FOR DENTAL CARIES DIAGNOSIS
• CONVENTIONAL METHODS
• Visual inspection
• Tactile sensation
• Radiography
• Caries detecting dyes

8. • NOVEL METHODS FOR CARIES DETECTION
• RADIOGRAPHIC TECHNIQUES
Xeroradiography
Digital imaging
Subtraction radiography
• ENHANCED VISUAL TECHNIQUES
Fiber optic transillumination
Digital fiber optic transillumination
• FLUORESCENT TECHNIQUES
Quantitative light induced fluorescene
• LASER-INDUCED FLUORESCENCE
DIAGNOdent
Fluorescence camera (VistaProof)
LED technology (Midwest Caries I.D.):
• DETECTION SYSTEMS BASED ON
ELECTRICAL CURRENT
MEASUREMENT:
Vangaurd electronic caries detector
Caries meter L.
• ELECTRONIC CARIES MONITOR
(ECM)
• ULTRASOUND TECHNIQUES
The Ultrasonic System
• Micro Air Abrasion

9. • Cone Beam Computed Tomography
• Multiphoton Imaging
• Optic Coherence Tomography
• Terahertz Imaging
• Infrared Thermography
• Infrared Fluorescence
• Tuned Aperture Computed Tomography

10. Visual inspection
Visual examination has been shown to
have high specificity but low
sensitivity and reproducibility.
Bader JD, Shugars DA, Bonito AJ. Systematic reviews of selected dental caries diagnostic and management methods. J Dent
Educ. 2001;65:960-8.
Deery C, Fyffe HE, Nugent Z, Nuttall NM, Pitts NB. The effect of placing a clear pit and fissure sealant on the validity and reproducibility of
occlusal caries diagnosis. Caries Res. 1995;29:377-81.
many decayed teeth will be left untreated,
underestimation of caries prevalence
over-treatment with fissure sealants.

11. Tactile sensation
 Shredding of dental
floss indicates a
proximal cavity.
INTEGRITY
TEXTURE
LOCATION
COLOR
Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of
three methods for assessment of demineralization depth of the occlusal
surface: An in vitro examination. Caries Res. 1997;31:224-31.
> 100 years

12. Conventional Radiography
Bitewing radiographs show high sensitivity (50–70%) to detect caries
lesions in the dentin.
detecting the initial dentinal lesions and occlusal enamel lesions due to
the superimposition of buccal and lingual enamel.
In vitro bitewing radiography alone results in a sensitivity of 58%,
higher than that of visual inspection and a specificity of 87% according
to histological validation
Zandoná AF, Zero DT. Diagnostic tools for early caries
detection. J Am Dent Assoc. 2006;137:1675-84.
Meta-analyses have observed that visual and radiographic examination
for detection of early approximal caries has noticeably high specificity
(Sp) but low sensitivity (Sn).
Schwendicke F, Tzschoppe M, Paris S. Radiographic caries detection:
A systematic review and meta-analysis. J Dent. 2015;43:924-33.
Wenzel A. Current trends in radiographic caries imaging. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 1995;80:527-39.
BITEWING

13. CARIES DETECTING DYES
detecting early enamel caries
assessing the depth of dentine caries
more “scientific.”
Srilatha A, Doshi D, Kulkarni S, Reddy MP, Bharathi V. Advanced diagnostic aids in dental caries – A Review. J Global Oral Health
2019;2(2):118-27.
The lack of specificity of caries-detector dyes was
confirmed by Yip et al. where they observed that sound
circumpulpal dentin and sound dentin at the dentinoenamel
junction took up the stain because of the higher proportion
of organic matrix.

14. NOVEL METHODS FOR CARIES
DETECTION

15. RADIOGRAPHIC TECHNIQUES

16. • XERORADIOGRAPHY
Xeroradiography which is a method of imaging uses the xeroradiographic
copying process to record images produced by diagnostic x-rays.
 Physicist Chester F. Carlson, in 1937.
Xeroradiography – Review Article. European Journal of Molecular & Clinical Medicine, 2020; 7(5): 1393-1402.

17. ADVANTAGES:
DISADVANTAGES:

18. DIGITAL IMAGING
image composed of a series of sensors
and pixels distributed orderly.
ADVANTAGES
Yılmaz H, Keleş S. Recent methods for diagnosis of dental caries in dentistry. Meandros Medical and Dental Journal. 2018 Apr
1;19(1):1.

19. DISADVANTAGES
Sensitivities and specificities of digital radiographs being significantly lower than those of regular
radiographs when assessing small proximal lesions.
Mital P, Mehta N, Saini A, Raisingani D, Sharma M. Recent advances in detection and diagnosis of dental caries. Journal of
Evolution of Medical and Dental Sciences. 2014 Jan 6;3(1):177-92.

21. DIGITAL SUBTRACTION RADIOGRAPHY
used in the assessment of the progression, arrest, or regression of caries
lesions
Mital P, Mehta N, Saini A, Raisingani D, Sharma M. Recent advances in detection and diagnosis of dental caries. Journal of
Evolution of Medical and Dental Sciences. 2014 Jan 6;3(1):177-92.
Subtraction images
therefore emphasise
this change and the
sensitivity is
increased

22. ENHANCED VISUAL
TECHNIQUES

23. FIBER OPTIC TRANSILLUMINATION
 Carious tooth structure has a lower index of light transmission than sound
tooth structure, an area of decay shows up as a darkened shadow that
follows the spread of decay along the path of dentinal tubules.

24. • The research around FOTI is somewhat polarised, with a recent review
finding a mean sensitivity of only 14 and a specificity of 95 when
considering occlusal dentine lesions.
NON
INVASIVE
Mital P, Mehta N, Saini A, Raisingani D, Sharma M. Recent advances in detection and diagnosis of dental caries. Journal of
Evolution of Medical and Dental Sciences. 2014 Jan 6;3(1):177-92.

26. DIGITAL IMAGING FIBER OPTIC
TRANSILLUMINATION
 Developed by Schneidermann et al, Department of
Oral Pathology, Radiology and Diagnostic Sciences,
New Jersy Dental School, University of Medicine and
Dentistry of NewJersey
 DIFOTI presents higher
sensitivity in detection
early lesions when
compared to the
radiographic examination
and has potential for
quantitative monitoring of
selected lesions over a
period of time.
 With the greater sensitivity and somewhat lower
specificity there is real possibility of over diagnosis.

27. USES
Incipient.
 frank and secondary caries lesions on occlusal, approximal and smooth
surfaces.
used to detect other changes in coronal tooth anatomy, such as tooth
fractures and fluorosis.

28. FLUORESCENT TECHNIQUES

29. Quantitative light induced fluorescene
 visible light system
 visible light has a wavelength (l) of 370 nm

31. LASER-INDUCED FLUORESCENCE

32. DIAGNOdent
This system has a range of 0 to 99.
The value 0 indicates the healthiest state of the tooth.
It is an effective method in detecting initial lesions without cavitation.
 It’s also useful for measuring different decalcification values in different
surfaces of the tooth.
The fiber optic probe directed onto the occlusal surface of the tooth emits a
light of wavelength 655 nm.
The changes caused by demineralization are converted into numeric values and
displayed on the screen.

33. Tam LE, McComb D. Diagnosis of occlusal caries: Part II. Recent diagnostic
technologies. Journal of the Canadian Dental Association. 2001 Sep 1;67(8):459-64.
READINGS
5-12: INITIAL LESIONS
25-35: EARLY DENTINAL CARIES
>35: ADVANCED DENTINAL CARIES

34. Costa AM, Paula LM, Bezerra AC. Use of DIAGNOdent for diagnosis of non-cavitated occlusal dentin caries. J Appl Oral Sci
2008; 16: 18-23. 22.
Toraman Alkurt M, Peker I, Deniz Arisu H, Bala O, Altunkaynak B. In vivo comparison of laser fluorescence measurements with
conventional methods for occlusal caries detection. Lasers Med Sci 2008; 23: 307-12.
According to studies carried on permanent teeth it is indicated that
DIAGNOdent has high sensitivity and low specifity.
Having a high sensitivity means that the tool is suitable for caries detection
but having low specifity means a higher rate of false positive results are
obtained. Therefore, it is recommended to use DIAGNOdent in combination
with other techniques.

37. Fluorescence camera (VistaProof)
Lightinduced fluorescence phenomenon emitting a 405-nm light.
Green (sound dental tissue) and in red (carious dental tissue).
 DBSWIN software is used to analyze the images and translate into
values the intensity ratio of the red and green fluorescence.

38. LED technology (Midwest Caries I.D.)
Mini-D
(DENTSPLY Professional, York, PA, USA) is developed for caries
detection.
This device is based on the fiber optic principle,
it is easy to use and requires no calibration.
LED and fiber optic technologies to detect occlusal and proximal
caries lesions

39.  This device emits 635-880 nm wavelength LED
light, analyzes the light reflected from the surface of
the tooth and converts it to electrical signals.
 The presence of caries is identified by two signals;
sound and light (green light turns to red). It is also
effective in wet environment but the plaque must be
removed before the examination
MID was not reliable in determining sound dental
structure based low specificity value, resulting in
overdiagnosis (false-positive result), corroborating
the report of Patel et al.
Diniz, M.B., Campos, P.H., Wilde, S. et al. Performance of light-emitting diode device in detecting
occlusal caries in the primary molars. Lasers Med Sci 34, 1235–1241 (2019).

40. INTERPRETATION
0, green light/no beeping noise (no demineralization);
1, red light, slow beeping noise (demineralization at the enamel);
2, red light, moderate beeping noise (demineralization at the
amelodentinal junction);
3, red light, fast beeping noise (demineralization at the dentin)

41. DETECTION SYSTEMS BASED ON
ELECTRICAL CURRENT
MEASUREMENT- MAGITOT

42. VANGAURD ELECTRONIC CARIES
DETECTOR
Manufactured by massachusetts manufacturing corp., Cambridge,
mass, USA.
Electrical conductivity is expressed numerically on a scale from 0 to
9.
The machine displayed a frowning face that indicated extensive
demineralization or the smiling face that indicated a sound site.
This device is no longer available commercially

43. Caries meter L.
• Caries meter L. manufactured by two companies-GC international corp,
leven, belgium and Onuki dental corp, ltd, japan.
• Each measurement site is moistened with saliva to ensure proper contact
between the electrode and the tooth.
• The Caries Meter L uses colored lights to indicate caries extent.

44. • Green-sound (>600K)
• Yellow-enamel caries (250-600K)
• Orange-dentinal caries (15-250K)
• Red-caries reaching the pulp (<15K)

45. ELECTRONIC CARIES MONITOR
(ECM)
Employs a single, fixed-frequency
alternating current which attempts to
measure the ‘bulk resistance’ of tooth
tissue.
During the 5 s measurement cycle,
compressed air is expressed from the tip of
the probe and this results in a collection of
data over the measurement period.
Increase in porosity associated with caries
is responsible for the mechanism of action
for ECM.

46. • Factors affecting the results
Temperature of the tooth,
The thickness of the tissue,
 the hydration of the material (i.E. One should not dry the teeth prior
to use) and the surface area.
The ecm readings may range between -0.70 and 13.20 indicating
increased conductance.

47. • Interpretation of values of ECM
1.00 to 3.00=sound enamel or incipient stage of caries
3.01 to 6.00=caries upto the DEJ (enamel caries)
6.01 to 8.00=dentinal caries
 8.01 to 13.00=extending half of dentine thickness

48. ULTRASOUND TECHNIQUES

49. The Ultrasonic System
Ultrasonic system is composed of a transducer (probe) & an ultrasonic
precision thickness gauge.
right angle type with a 1.5mm tip contact diameter, 11MHz nominal
center frequency with a removable plexiglass delay tip.
 The useful range is from 0.010 to 0.25 inches approximately.

50. • The UCD exhibited a higher sensitivity than the radiographs but a lower
specificity.
Matalon S, Feuerstein O, Calderon S, Mittleman A, Kaffe I. Detection of cavitated carious lesions in
approximal tooth surfaces by ultrasonic caries detector. Oral Surgery, Oral Medicine, Oral Pathology,
Oral Radiology, and Endodontology. 2007 Jan 1;103(1):109-13.

51. Micro Air Abrasion
suspicious area.