Visual inspection alone has low sensitivity in detecting early caries lesions. This study assessed the effect of magnification and air drying on detecting occlusal caries in 44 extracted teeth using naked eye, magnifying loupes, and stereomicroscope, both before and after air drying. The results showed that visual examination before and after air drying had the highest specificity but lowest sensitivity, while magnifying loupes after air drying had the highest sensitivity but lowest specificity compared to other diagnostic techniques. In conclusion, magnification and air drying can improve the detection of early occlusal caries compared to visual examination alone.

1. JC ON CARIES DIAGNOSTICTOOLS
By,
Dr Vinodini J
1st year pg

2. What is diagnosis?
Diagnosis is an art and science that results from the
synthesis of scientific knowledge, clinical experience,
intuition & common sense
Caries diagnosis implies deciding whether a lesion is active,
progressing rapidly or slowly or whether is already arrested.

3. Various assessment tools
• Visual & tactile
• ICDAS
• Dye detection test
• Visible light
• Quantitative light induced fluorescence
• Laser fluorescence
• Electronic conductance measurement

4. • Alternating current impedance spectroscopy
(ACIS)
• INTRAORAL TELEVISION CAMERA
• D-Carie mini
• SPECIES SPECIFIC MONOCLONAL ANTIBODIES
• Polarization-sensitive optical coherent
tomography (OCT)
• Frequency-domain laser-induced infrared
photothermal radiometry & modulated
luminescence (PTR/LUM)

5. VISUAL-TACTILE METHODS
Visual methods:
 Detection of white spot, discoloration / frank cavitations
Magnification loupes- Head worn prism loupes (X 4.5) or
surgical microscopes(X 16) may be used
comfort, relatively inexpensive, available in various
magnification

6. Tactile methods:
 Explorers are widely used for the detection of carious tooth
structure
 Dental floss

7. Caries Classifications
• The standard American Dental Association (ADA)
caries classification system designated dental
caries as initial, moderate, and severe.
• As the result of the International Consensus
Workshop on Caries Clinical Trials (ICW-CCT) held
in 2002, the work on the International Caries
Detection and Assessment System (ICDAS) was
begun in earnest; and, today it has emerged as
the leading international system for caries
diagnosis

8. • The ICDAS for caries diagnosis offers a six-
stage, visual based system for detection and
assessment of coronal caries. It has been
thoroughly tested and has been found to be
both clinically reliable and predictable.
• The ICDAS is gaining acceptance as the new
and evolving standard for caries diagnosis
internationally and here in the U.S..

10. DYES FOR CARIES DETECTION
• They selectively complex with carious tooth structure which
is later disclosed with the help of fluorescence
• Aids in both quantitative & qualitative analysis of the lesion
DYES FOR ENAMEL CARIES:
Procion: N2 & (OH) groups irreversibly complex
with caries
Acts as a fixative
Calcein: complexes with calcium & remains bound
to the tooth
Zyglo ZL-22: fluorescent tracer dye, not used in vivo
Brilliant blue: 10% aqueous Brilliant Blue

11. DYES FOR DENTIN CARIES:
 1% acid red in propylene glycol complexes specifically with
denatured collagen, hence used to differentiate infected and
affected dentin
 Iodine penetration method (Pot iodide) for evaluating
enamel permeability
DISADVANTAGES
• Dye staining and bacterial penetration are independent
phenomena, hence no actual quantification
• They also stain food debris, enamel pellicle, other organic
matter
• Dye aided carious removal- laborious
• Stains DEJ

12. Advanced dye detection techniques
• Confocal laser scanning microscopy (CLSM)
• Dye-enhanced laser fluorescence (DELF)

13. VISIBLE LIGHT
• The next level along this continuum is the advanced
use of visible light—fiber optic transillumination (FOTI)
and digital imaging fiber optic transillumination
(DIFOTI).
• The differential transmission of light through healthy
tooth structure as compared to carious tooth structure
can be detected.
• When using fiber optic light the operator is able to use
a more focused and higher intensity light beam instead
of an operatory light, thereby increasing the potential
to detect smaller carious lesions.

14. • Images of the teeth are obtained
through visible light fibreoptic
transillumination and digital CCD
camera.
• These images are sent to
computer for analysis with
specific algorithms . These
algorithms are developed to
facilitatte the location and
diagnosis of the carious lesion
• Advantage is that it can indicate
the presence of incepient and
recurrent caries even when
radiological images fail to show
their presence.
Price JB. A Review of Dental Caries Detection Technologies.

15. • The difference between these two technologies is
that the DIFOTI system has a built-in CCD camera
to allow for image capture of the tooth for
documentation purposes.
• This can then be compared to a future image
after fluoride therapy or in patient education
efforts.
• The DIFOTI system has had mixed reviews in the
literature and currently does not appear to be
actively marketed in the U.S

16. Quantitative Light-Induced
Fluorescence (QLF)
• QLF technology measures the refractive
differences between healthy enamel and
demineralized, porous enamel. Areas of caries
and demineralization show less fluorescence.

17. • With the use of a fluorescent dye which can
be applied to dentin, the QLF system can also
be used to detect dentinal lesions in addition
to enamel lesions.
• A major advantage of the QLF system is that
these changes in tooth mineralization levels
can be tracked over time using the
documented measurements of fluorescence
and the images from the camera.

18. • In addition, the QLF system has demonstrated
accurate results between examiners. It has
also demonstrated a reliable ability to detect
caries and avoid false negatives.
Price JB. A Review of Dental Caries Detection Technologies.

19. LASER FLUORESCENCE
• Laser fluorescence detection techniques such as
the DIAGNOdent®, (KaVo USA) rely on the
differential refraction of light as it passes through
sound tooth structure versus carious tooth
structure.
• Using a small laser the system produces
excitation wavelength of 655nm which produces
a red light .This is carried using intraoral tips –
one designed for pit & fissures and other for
smooth surfaces.

20. • Tip emits the light and collects the resultant
fluorescence .this is then displayed as a
numerical value on two LED displays .
• The signal comes out as a number on
instrument on a scale of a 0 to 99. Higher the
number more is caries.
Price JB. A Review of Dental Caries Detection Technologies.

22. ADVANTAGE
• early detection of lesion
• Quantification of caries and improved
diagnostic accuracy

23. ELECTRICAL CONDUCTANCE
MEASUREMENT
• It was proposed by MAGITOT.
• Principle : Sound tooth surfaces possess
limited conductivity where as demineralized
or carious enamel act as conductive pathway.
• Saliva soaks into the pores of the
demineralized enamel and increases the
electrical conductivity of the tooth.
• Eg- Vanguard electronic caries detector
- caries meter
Price JB. A Review of Dental Caries Detection Technologies.

24. Procedure
• Teeth are dried and isolated before starting
treatment.
• Tooth fissure is moistened with a drop of saliva to
ensure good electrical conductance .
• Resistance measurement is made btw probe tip
and clip attached to oral electrode and coloured
lights reflect the status of tooth.
green –no caries yellow – enamel caries
orange – dentin caries red –pulp involvement

25. Alternating current impedance
spectroscopy (ACIS)
• ACIS uses multiple electrical frequencies to detect
and diagnose occlusal and smooth surface
caries.Eg CarieScan
• It has disposable tufted sensors (single use), test
sensor(to check if the device is operating or not)
• Tufted sensors is placed over the teeth to be
examined , a soft tissue contact , which is
disposable metal clip that’s placed over the lip in
the corner of patient’s mouth, connects to device
via soft tissue cable to complete the circuit.

26. Green : sound tooth tissue
Red : deep caries
Yellow : only preventive care
A systematic review comparing carieScan with visual , bitewing , DIAGNOdent
reported CarieScan to have superior sensitivity and specificity over other
methods . (JD Bader,DA Shrogars ,AJ Bonito)
The diagnostic reliability of this device is more accurate and reliable than the
ECM; and, according to the literature, stains and discolorations do not interfere
with the proper use of the device. It appears to have good potential as a caries
detection technology
Price JB. A Review of Dental Caries Detection Technologies.

27. INTRAORAL TELEVISION CAMERA
• Can see magnified images , which are better
than direct vision.
• Useful in educating the patients.
• Disadvantage : loss of specificity.

28. D-Carie Mini
• Introduced by Neks technology in oct 2006 at
ADA.
• This is a pen-sized , light weight , cord
less,fully sterlizable unit that uses laser
fluorescence to detect occlusal lesions.
• It has been shown to detect more than 92% of
occlusal caries and over 80% of interproximal
caries

29. Advanced Radiographic Techniques
• Eg MRMI – magnetic resonance microimaging
• Photo stimulable phosphor radiography
• Tuned aperture computed tomography(TACT)

30. SPECIES SPECIFIC MONOCLONAL
ANTIBODIES
• It was given by SHI.et.al in 1998 , who
identified SMA that recognize the surface of
cariogenic bacteria .
• Probes are tagged with fluorescent molecules
that measure quantitatively with
spectrometer.
• Can be used chair side & provides instant
results.
Shi, W., A. Jewett, and W. R. Hume. "Rapid and quantitative detection of Streptococcus
mutans with species-specific monoclonal antibodies." Hybridoma 17.4 (1998): 365-371.

31. Polarization-sensitive optical coherent
tomography (OCT)
• OCT uses near infrared light to image teeth with
confocal microscopy and low coherence interferometry
resulting in very high resolution images at ~10—20
microns.
• The accuracy of OCT is so detailed that early mineral
changes in teeth can be detected in vivo after exposure
to low pHacidic solutions in as little as 24 hours by
using differences in reflectivity of the near infrared
light.
• In addition, tooth staining and the presence of dental
plaque and calculus do not appear to affect the
accuracy of OCT.

32. deep dentinal caries or crown
preparation or when judging the
marginal integrity of a
restoration, OCT is the technique
of choice
Veen MH. Detecting short-term
changes in the activity of caries lesions
with the aid of new technologies.
Current oral health reports. 2015 Jun
1;2(2):102-9.

33. Frequency-domain laser-induced infrared
photothermal radiometry & modulated
luminescence (PTR/LUM)
• This technology relies on the absorption of infrared
laser light by the tooth with measurement of the
subsequent temperature change, which is in the 1° C or
less range.(Canary system)
• Highly accurate information regarding tissue densities
at greater depths than visual only techniques.
• Early laboratory testing shows better sensitivity for
caries detection for this technology than for
radiography, visual or for laser fluorescence
technology.

34. • PTR–LUM offers features beyond what is
currently available in traditional dental
detection methods. These features include the
ability to perform depth profilometry and very
early caries detection and monitoring on
various tooth surfaces.
• Its portable and a safe way to identify the
carious and non-carious lesion.
Garcia JA, Mandelis A, Abrams SH, Matvienko A. Photothermal radiometry and
modulated luminescence: applications for dental caries detection. Handbook of
biophotonics. 2011.

35. Effectiveness of Air Drying and
Magnification Methods for Detecting
Initial Caries on Occlusal Surfaces
Using Three Different Diagnostic Aids
Deepti Goel Meera Sandhu Pulkit Jhingan Vinod
Sachdev
The Journal of Clinical Pediatric Dentistry 2016

36. • The aim of this study was to assess the effect
of magnification and air-drying on detection
of carious lesion

37. METHODS
• Forty-four freshly extracted intact, visually caries free
human premolars, indicated for extraction for
orthodontic purposes were selected for the present
study.
• All samples were assessed for caries using three
diagnostic methods using
 naked eye
 magnifying loupes
 stereomicroscope
Inter-examiner blinding using three different trained
examiners.

39. Technique 1: The occlusal surfaces of
all the samples assessed before air
drying
Technique 1(a):
The occlusal
surfaces of all the
samples assessed
before air drying
with Naked eye.
Technique 1(b): The
occlusal surfaces of all
the samples assessed
before air drying with
Magnifying loupes
Technique 1(c): The occlusal
surfaces of all the samples
assessed before air drying under
stereomicroscope (10x
magnification) (Zoom
Stereomicroscope, Olympus
Optical Co., Japan)

40. Technique 2: The occlusal surfaces of all
the samples assessed after air drying
Technique 2(a): The
occlusal surfaces of all the
samples assessed after air
drying with Naked eye.
Technique 2(b): The occlusal
surfaces of all the samples
assessed after air drying with
Magnifying loupes (4.2x
magnification, Amtec, India)
Technique 2(c): The occlusal
surfaces of all the samples
assessed after air drying under
stereomicroscope (10x
magnification) (Zoom
Stereomicroscope, Olympus
Optical Co., Japan)

41. Scoring
All the samples were assessed according to the
above mentioned techniques and the scores
were recorded according to:
• Score 0- Absence of discoloration or cavitation
• Score 1- Presence of discoloration or
cavitation

42. • After examining all samples with above
mentioned techniques, samples were subjected
to histological examination to confirm the
presence or absence of a carious lesion.
• Each sample was hemi-sectioned in a bucco-
lingual direction using a diamond disc mounted
on a slow speed handpiece and each section was
viewed under a stereomicroscope .
• Sections of each tooth were scored according to
the scoring criteria mentioned above by the
fourth examiner.

43. Results
• On Statistical analysis, visual examination
before and after air drying had highest
specificity but lowest sensitivity compared to
different diagnostic techniques.
• Magnifying loupes after air-drying had highest
sensitivity and lowest specificity compared to
other diagnostic techniques.

44. Discussion
• Various methods for dental caries diagnosis
have been used in the last few decades, but
visual inspection still claims to be the most
commonly used diagnostic method in
populations with low caries prevalence.
• But it is ineffective in correctly diagnosing
early carious lesion because of low sensitivity
of visual inspection alone

45. Visual inspection of caries is carried out by using a probe in clean
dry conditions.
This can cause transmission of cariogenic flora from one infected
site to another, which may also lead to traumatic defects in
potentially remineralizable enamel.
Magnification is a common aid for diagnosis which overcomes the
various drawbacks of unaided visual examination.
It increases the number of correctly identified lesions which allows for
various preventive measures to be used effectively for incipient lesion.
Currently used magnifying aids such as magnification eyeglasses,
stereomicroscope and also digital imaging with magnification have
been proved to be effective in proximal caries detection.

46. The most important aspect of diagnosis of early caries is that
the surface must be dry because saliva can mask differences in
the reflection of light between carious and healthy tooth
structure, hindering the observation of changes in colour and
brightness on the enamel surface
White spots are more visible when teeth are dry because of
the difference in the refractive indices of enamel, water and
air.
Shi et al reported a systematic difference between data from
the same registration under wet and dry conditions on occlusal
surfaces.

47. Braga et al (2010) stated that there are 29 different visual criteria
for detecting caries lesion but only about half of the technologies
recommend teeth to be cleaned and/or dried before the
examination process, which if not included increases the risk of
missing lesions which are not seen under naked eye examination.
Studies have shown that visual inspection is as accurate as FOTI
in detecting occlusal caries and provides high sensitivity
compared to radiographic method and Diagnodent
Angnes et al and Reis et al found magnification and laser
fluorescence did not significantly alter the specificity of diagnosis
compared to unaided vision as the maintenance of high levels of
specificity will prevent overtreatment.

48. Visual examination alone does not provide enough details
on examination but the use of low-powered magnification
significantly improves the accuracy of examination. Use of
magnification devices is easy, less technique sensitive and
less time consuming Therefore magnification can be
integrated into clinical practice without much alteration to
scheduling procedure.

49. Conclusion
• Early diagnosis of initial caries in children using the
above mentioned magnification and air drying
techniques would help prevent their progression and
development of new carious lesions thus creating a
healthy oral environment instilling a positive attitude
in children as well as parents towards dental treatment.
• Air drying combined with magnifying aids are cost-
effective, reliable method for detection of early carious
lesion.
• If used in pediatric clinical practice, any undesirable
pain and discomfort to the patient due to invasive
procedures and helps in employing preventive
measures.

50. Evaluation of different Diagnostic Modalities
for Diagnosis of Dental Caries: An in vivo study
Iram Zaidi, Rani Somani, Shipra Jaidka, Muhamad Nishad, Shikha
Singh, Divya Tomar
International Journal of Clinical Pediatric
Dentistry 2016

51. Aim : To compare and evaluate the efficacy of
different diagnostic aids for diagnosis of dental
caries and to compare the validity in terms of
sensitivity and specificity of all four diagnostic
modalities for diagnosis of caries.

52. Methodology
• Occlusal surfaces of 100 primary and permanent
molars were examined using the four diagnostic
systems
i. visual
ii. intraoral camera
iii. DIAGNOdent
iv. DIAGNOdent with dye
• Results were compared with operative intervention
gold standard.
• Sensitivity and specificity were calculated for each
diagnostic system for both enamel and dentin caries.
Interrater agreement was calculated for each
diagnostic system using kappa statistics.

53. • Visual examination was first done on wet
surface. The carious surface was examined
with mouth mirror under standard dental
operating light.
• The presence or absence of occlusal pit and
fissure caries was recorded using the criteria
described by Ekstrand12 (Table 1).

54. Table 1: Criteria used in visual examination
(Ekstrand et al)
Score Criteria
V0 No or slight change in enamel translucency after prolonged air
drying (≥5 sec)
V1 Opacity hardly visible on the wet surface, but distinctly
visible after drying.
V2 Opacity distinctly visible without air drying
V3 Localized enamel breakdown in opaque or discolored enamel
and/or gray discoloration from the underlying dentin
V4 Cavitation in opaque or discolored enamel exposing the dentin

55. DIAGNOdent
• After reisolation, the teeth were quantitatively
examined by a portable laser fluorescence
system(diagnodent) .
• The probe tip was placed perpendicularly on the
carious surface and was slowly rocked in a
pendulous motion to examine the adjacent
periphery of the carious surface at various angles,
and the maximum value (peak value) was
recorded. This peak value was then compared
with the DIAGNOdent value based on criteria
given by Lussi et al12

56. SCORE CRITERIA
0-14 No Caries
15-20 Enamel caries
21-99 Dentinal caries
Criteria used in examination with DIADNOdent(Lussi et al)

57. DIAGNOdent with dye
• After reisolation, the dye was applied to the
occlusal surface using a small applicator. Dye
was then removed after 10 seconds, and then
tooth was examined using DIAGNOdent
according to the manufacturer’s instructions.
• The readings of peak value were then
recorded according to the criteria given by
Lussi et al.

59. Results
• For both enamel and dentin caries, the highest
sensitivity values were provided by DIAGNOdent
(0.91 and 0.72) and lowest for visual examination
on wet surface (0.60 and 0.50).
• For both enamel and dentin caries, the specificity
was found to be highest for intraoral camera on
dry surface and lowest for visual examination.
• The DIAGNOdent gave the highest value of
interrater agreement (kappa), i.e., 0.816 as
compared with 0.03 for visual examination.

60. DISCUSSION
• Caries lesions occur on a continuous scale of
tissue damage, from subclinical surface changes
to macroscopic cavities reaching the pulp, and if
detected at an early stage, they can be reversed
or remineralized.
• The importance of early detection of caries
activity is emphasized by the fact that an incipient
lesion, which is amenable to remineralization, can
be arrested, reversed, or restored with minimal
invasion

61. • In this study, among all diagnostic methods,
higher value of sensitivity was found to be for
DIAGNOdent, i.e., 0.91, and lowest for visual
examination (wet) i.e 0.60.
• DIAGNOdent quantifies the mineral loss as it
picks up fluorescence from the slopes of the
fissure walls, where the caries process is
believed to start and thus lead to early
detection of caries.

62. • The possible explanation for less efficacy and validity of
visual examination is because many lesions are left
undetected due to the macroscopically intact surface
(hidden caries) or wrongly diagnosed as enamel caries,
thus allowing the dentinal lesions to progress
unchecked.
• In addition, dental caries is a dynamic process in which
early lesions undergo demineralization before being
expressed clinically, thus being missed visually.

63. • It was also observed that, in the present study,
the use of dye with DIAGNOdent did not
improve the result as the sensitivity and
specificity in this method were found to be
inferior than DIAGNOdent alone.

64. Conclusion
• DIAGNOdent is a valid method as it has the advantage
of quantifying the mineral content, helping to improve
the diagnostic efficacy.
• The results of the study and inferences drawn show
that DIAGNOdent is superior to the currently available
methods for detection of initial caries and there is no
additional advantage of using dye with DIAGNOdent.
• Thus, it is conceivable that fluorescence assisted
diagnosis may improve caries diagnosis in future.

65. Clinical performance of ICDAS II,
radiovisiography, and alternating current
impedance spectroscopy device for the
detection and assessment of occlusal caries in
primary molars
Rohit Singh1, Shobha Tandon2, Monika Rathore2, Nitesh Tewari2, Neha
Singh3, Abhinav Pradeep Shitoot1
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND
PREVENTIVE DENTISTRY -2016

66. AIM : To investigate the clinical performance of
International Caries Detection and Assessment
System II (ICDAS II) (a ranked visual scale),
radiovisiography (RVG) (a digital radiography
device), and an alternating current impedance
spectroscopy (ACIS) device for the detection
and assessment of occlusal caries in primary
teeth.

67. METHODOLOGY
• The present study was conducted in two phases:
• In vivo phase: The 25 teeth were examined by
ICDAS II, RVG, and ACIS device for caries
detection in primary molars.
• In vitro phase: The 25 examined teeth were
extracted and retested in vitro, and validity of
caries detection assessment was determined by
histological evaluation. 20 teeth out of the sample
were retested after 1 week for intra-examiner
reliability.

68. CARIES ASSESSMENT IN-VIVO
• ICDAS II assessment was carried out first. The
tooth was initially viewed wet to determine
whether caries was visible, then air-dried for 5
s to desiccate the tooth surface before visual
assessment.
• For the RVG, the images were obtained with a
charge-coupled device sensor (Dixi 3;
Planmeca, Helsinki, Finland), using an
exposure time of 0.2 s.

69. Detection of occlusal caries
with alternating current
impedance spectroscopy
device
For the ACIS device (Cariescan
Pro, Caries Scan Ltd., Dundee,
Scotland), the tooth was
rehydrated with water from a
syringe for 5 s to enable
electrical conductance of the
device. The tooth was dried
for 3 s, and the activated
device was placed directly on
the area to be tested

70. RVG
For the RVG, the
images were
obtained with a
charge-coupled
device sensor (Dixi
3; Planmeca,
Helsinki, Finland),
using an exposure
time of 0.2 s.

71. Caries assessment In-Vitro
• They were then extracted and also assessed
by examiners in vitro.

72. Histological validation
The teeth were mounted in sticky
wax holders before hemi-section
from the mesial to distal surface of
each tooth, using a 0.1-mm-thick
band saw under running tap water.
Wet sections were viewed at ×15
magnification (Olympus SZ-PT,
Olympus Optical Co., Japan) for the
presence or absence of caries in
enamel or dentine.
The results were classified using
Downer's criteria, which allowed
for comparison with previous work.
One week later, 20 teeth were
selected randomly, and their
sections were re-examined to
determine the repeatability of the
histological assessment

73. Results
• ICDAS II system showed the highest validity
and repeatability for assessing occlusal caries
in the primary molars.
• RVG was less accurate than the ICDAS II for
detecting caries lesions confined to enamel.
However, when dentine was involved, RVG
was found to be as effective as ICDAS II.

74. Discussion
The present study design utilized both an in vivo and in vitro
component by using three different systems along with their
gold standard histological validation, allowing for a direct
comparison and analysis of their caries assessment
capabilities.
Both in vivo and in vitro data showed that ICDAS II had the
highest validity and repeatability for caries assessment among
three systems, which was in general agreement with other
studies conducted on primary teeth.
They had higher sensitivities than specificities and these
findings were similar to the results from a recent in vitro
study by Neuhaus et al.

75. In the present study, ICDAS II with sensitivity of 77.78% and
specificity of 75% was more accurate than the radiographic
methods with sensitivity of 66.67% and specificity of 75% for
enamel occlusal carious lesions in primary molars. For dentine
caries lesions, digital radiography specificity (83.33%) had a
similar performance to ICDAS II specificity (83.33%)
In the present study, ACIS device demonstrated high value of
sensitivity and and lower value of specificity In a previous study
by Pitts et al., permanent teeth and a micro computerized
tomography technique for histology were used, and better
sensitivity (0.92) and specificity (0.92) values were recorded. This
difference can be explained with the anatomical variations on the
occlusal surfaces of permanent and primary teeth and perhaps
the difference for the histology technique.

76. There was a lack of agreement
between in vivo and in vitro results of ACIS device.
Despite its potential, the performance for ACIS device on
primary teeth was low. Since the previous study conducted by
Hall et al. showed promising results for ACIS device, a possible
reason for this low performance would be the variation in the
conductance of electrical impulses due to enamel thickness of
primary teeth.
Thus, at this juncture, any in vitro research conducted with the
ACIS device in primary teeth should not be extrapolated to the
clinical situation. Because primary and permanent teeth are
still physiologically similar, care should also be taken when
interpreting in vitro results obtained on permanent teeth, as
they also may not necessarily correlate to in vivo findings with
a degree of predictability

77. Conclusion
• ICDAS II system demonstrated the highest validity and repeatability
for assessing occlusal caries in the primary molars.
• The digital radiographic method (RVG) was less accurate than the
ICDAS II for detecting caries lesions confined to enamel. However,
when dentine was involved, RVG was found to be effective for
assessing occlusal caries in primary molars.
• The ACIS device was less accurate among the three systems for
caries assessment due to the variation in the conductance of
electrical impulses.

78. Performance of fluorescence-based methods
for detecting and quantifying smooth-surface
caries lesions in primary teeth: an in vitro study
TATIANE FERNANDES NOVAES1,2, CAROLINE MORAES MORIYAMA1, MONIQUE
SAVERIANO DE BENEDETTO
International Journal of Paediatric Dentistry 2015

79. Aim: To evaluate the in vitro performance of
laser fluorescence devices, namely DIAGNOdent
(LF) and DIAGNOdent pen (LFpen), and a
fluorescence camera (VistaProof; FC) in the
detection and quantification of smooth-surface
caries in primary teeth.

81. Methodology
• Two examiners evaluated 99 smooth surfaces of
65 extracted primary molars using FC, LF, and
LFpen. As a reference standard, the actual and
relative lesion depths were determined using
stereomicroscopy and polarized light microscopy.
Reproducibilities were assessed, and correlation
analyses were performed.
• The sensitivities, specificities, and accuracies of
the methods were calculated and compared.

82. Results
• There was a significant correlation between the
values obtained using the fluorescence-based
devices and the actual and relative lesion depths,
although the correlation coefficient values were
not higher than 0.7 (LF, 0.673; LFpen, 0.646; FC,
0.663).
• The sensitivities of the devices were similar for
the detection of enamel caries, although LFpen
was superior in detecting dentin lesions.
• The reliabilities of all methods were moderate to
low, with similar accuracies at all depths.

83. Discussion
According to the ICC values, fluorescence based devices showed
moderate to high reproducibility. These data corroborate with the
findings of other studies and can be explained by the quantitative
properties of the methods, their correct application, and experience and
practical training of the examiners.
With regard to enamel lesions, these fluorescence-based methods do
not adequately measure small changes in mineralization. With regard to
the dentin threshold, the fluorescence emitted by carious tissue is
probably provoked by its organic material. Therefore, more advanced
and infected lesions can be more easily and repeatedly detected,
regardless of the time of evaluation.
This was not observed in their study, however, probably because of its in
vitro nature and the fact that freezing the teeth may have influenced this
property; the organic content of the carious lesions could have been
altered between the series of evaluations.

84. In in vitro studies, dehydration of the sample can influence
the absorption coefficient of water present in the lesion and
consequently, the scattering of fluorescent light.
Differences in reproducibility were observed between the
different tips of LFpen. This can be due to the shape of the
probe tips. It can also be attributed to difficulty in positioning
the cylindrical tip on the smooth surface with no adjacent
tooth for stabilization.
FC is a device that derives results from a single static
measurement,where lesions that are not perpendicular to the
light font cannot be detected, producing discrepancies in
results

85. LF and LFpen use a red light with a wavelength of 655 nm,
whereas FC works with a blue light at 405 nm.
The use of blue light as a detecting tool seems to be more
effective than red light in detecting porphyrin activity in initial
lesions. On the other hand, red light seems to be more efficient
in detecting dentin caries

86. Conclusion
• Although the fluorescence-based devices
showed similar performance in the detection
of enamel and dentin lesions, the reliability of
these devices and the correlation of their
findings with the actual and relative lesion
depths were moderate with regard to smooth-
surface caries in primary molars.

87. Take home message
• The need for early detection of caries lesions has led to the
introduction of several optical and electro-conductance-
based techniques that may aid visual caries assessment.
• Due to optical properties of teeth and the imperfect
remineralization of enamel, the optical properties of a
white-spot lesion in theory cannot return to the healthy
situation.
• In real life, lesions will therefore seldom return from ICDAS
1 or 2 to ICDAS 0 or 1 . Using standardized oral photographs
may allow the comparison of lesions before and after the
implementation of a caries preventive regimen in a
qualitative way.