Caries detection is a very interesting, important and evolving area in clinical dentistry. Caries is one of the major diseases dentist detect and treat. Our current tools do present some challenges. X-Ray and visual exam were introduced in the last century and really are designed to detect very large lesions.
There are some issues to consider before purchasing a system. The first is to consider what is the particular device detecting and how does it do it?
• Visual and radiography are considered the gold standard for caries detection but they have significant limitations. Visual exam obviously only shows surface changes and sub-surface shadowing, if there is a large stained lesion.
• Radiographs are good for detecting large interproximal caries (at least halfway into enamel) but they are only providing a 2-dimensional view of the lesion and the surrounding tooth structure or restorations will mask the lesion. There are a number of case studies on our web site which illustrate the shortcomings of dental radiographs.
• DIAGNODent, Spectra, QLF and SOPRO are all fluorescence devices and they detect fluorescence or “glow” from bacterial porphyrins or stain and not anything related to the tooth surface, cracks or caries. Most of the fluorescence does not come from Strep Mutans or Lactobacillus organisms but from other bacterial found in the oral cavity.
• CARIVU is simply trans-illumination much like we did with visible light over 40 years ago. The difference is that the system uses infra-red to illuminate the tooth. This will find caries in the interproximal region and larger lesions on the walls of some restorations but they are still relying upon visual inspection of the image. When one moves to smooth surface or detecting caries around restoration margins or pits and fissures, trans-illumination is challenged.
• The Canary System uses laser based energy conversion technology to examine and measure the status of the tooth crystal structure. It can detect caries on all tooth surfaces, around the intact margins of restorations and beneath sealants. Since it can measure changes in tooth crystal structure, we have used it in clinical trials to monitor changes in lesions when treated with various preventive therapies. The latest human clinical trial done at the University of Texas compared Canary to digital radiography. They found that The Canary System detected 92% of the lesions whereas radiographs found 67% of the lesions. Most of our research papers and publications are on our web site and we continue to release data as do other researchers working independently with our system.
I would recommend that before one “dives” into this market that they look carefully at what and how these systems work and the research backing each of the claims. In my opinion these are the ideal characteristics for a caries detection system:
1. High sensitivity & specificity for caries detection
2. Detects & monitors de & re-mineralization
3. Detects smooth surface, root surface, occlusal surface & interproximal lesions
4. Detects caries around restoration margins
5. Non-invasive & safe
6. Repeatable measurements
7. Imaging and or image capture
8. System for recording & storing measurements
9. Patient Education and Motivation
10. In-vitro and in-vivo data & publications including clinical trial data demonstrating the ability of the system to detect and monitor carious lesions
11. Minimal or no preparation of the tooth surface prior to taking a reading
12. Ability to detect and monitor erosion lesions
The key is to understand what the device is measuring.
In reviewing a number of the devices on market, their research is weak and if present, the experimental design is not great.
We do need to move away from visual exam and radiography for detection, monitoring and management of caries. The key is to find the right device to provide you with the appropriate clinical information.
Disclosure: Dr. Stephen Abrams is President Quantum Dental Technologies – The Canary System.