Dentistry methods tested for safe caries diagnosis

Researchers are studying procedures for safe caries detection
Dental caries often arises in hard-to-reach places and therefore often causes problems for dentists in the diagnosis. Caries in the fissures (slit-like depressions in the chewing surfaces of the molars) are often hidden and therefore difficult to diagnose, reports the Berlin Charité. With the conventional so-called visual-tactile inspection (mirror and probe), the caries can not always be determined clearly. Further sensitive detection and treatment methods should help in the early detection and preservation of the natural tooth substance. However, the question often arises of how high the risk is that healthy teeth are wrongly classified as carious.

Basically, the benefit of the chosen diagnostic method for health is not only dependent on the accuracy, "but also on the subsequently selected treatment form and the caries susceptibility of a person," explains Privatdozent Dr. med. Falk Schwendicke from the Department of Dentistry and Preventive Dentistry of the Charité. The scientists of the Berlin Charité have therefore combined different detection methods with a subsequent therapy form and analyzed the long-term consequences. Their results published the experts in the journal "Journal of Dental Research".

Improved method for detecting caries explored. Picture: Karelnoppe - Fotolia

One of the most common civilization diseases
The caries is still the biggest enemy of the teeth. Almost every person is affected in the course of his life by the so-called "tooth rot", which is mainly caused by bacteria in the mouth and leads to a destruction of the hard tooth substance. Particularly fast sites are attacked that can not be reached in conventional cleaning, such. the tooth recesses (fissures) in the chewing surfaces, the interdental spaces and the tooth neck.

Accordingly, caries often remains hidden at first, which can be a major challenge for the dentist. Especially fissure caries is very difficult to diagnose, as it is often not visible from the outside and instead shows a completely intact enamel surface. Added to this is the narrowness and depth of the fissures, which further complicates the diagnosis.

Laser fluorescence provides information about the optical reaction
For this reason, the classic method of so-called "visual tactile inspection" is usually not enough, in which the oral cavity is examined by means of mirror and probe. If suspected, therefore, an X-ray can provide more accurate information, also in caries diagnosis modern methods such. used the laser fluorescence. This is an optical phenomenon in which the carious changed tooth hard substance lights up by the irradiation with light of a certain wavelength.

Scientists of the Charité study long-term consequences
However, which procedure is chosen on an individual basis depends on several factors. Because "the benefit of the chosen diagnostic method for the health is not only dependent on the accuracy, but also on the subsequently selected treatment form and the caries susceptibility of a person," said Privatdozent. Falk Schwendicke.

The expert came to this conclusion after a joint research project with other scientists of the Charité-Universitätsmedizin Berlin. As the Charité reports, using a computer model, the researchers used a combination of three different detection and therapy procedures in individuals with low and high caries occurrence, and analyzed the long-term consequences.

X-ray examination increases the risk of misdiagnosis
It was found that X-ray examinations and the use of the laser fluorescence system were associated with an increased risk of misdiagnosis, especially in persons with low caries. Regardless of the method of detection, however, the therapy chosen will have a greater impact on the patient's health. For example, if consistently treated invasive, fewer teeth could be obtained.

In addition, this process would cost more than treatment with fluoride varnish or caries sealant. "The combination of visual-tactile inspection or X-ray examination with a caries seal has the highest probability of being effective," Dr. Falk Schwendicke.

Take greater account of the long-term benefits of methods for caries diagnosis
According to the researchers, the study results would therefore suggest that not only the accuracy should be considered when assessing methods for caries diagnosis. "Clinical treatment decisions should include the long-term effects and costs of various therapies as well as their subjective impact on patients," said the scientists in the Journal of Dental Research. (No)