Dental Caries ( or Decay ) Detection

To give a little clarifying background information, there are really two types of caries-pit and fissure caries, which are described above, occur in the grooves and rough places on the biting surfaces of back teeth, and smooth surface caries, which primarily occur between teeth.  Because of the physical difficulty of actually accessing the area between teeth, smooth surface caries detection is primarily accomplished by radiographic methods (x-rays).

In the days before fluoride, caries detection regarding pit and fissure caries was much easier.  Caries developed in a tooth through the enamel, entered the softer dentin and spread rapidly through this vulnerable tissue.  Then the unsupported enamel, which is very rigid, fractured like glass under biting pressure.  Literally, the enamel “caved in”, hence the term “cavity.”  Today’s fluoride-strengthened enamel is not so likely to fracture under the same circumstances, making caries detection much more difficult.  Often we find extensive caries occurring in teeth with a very small surface lesion.

About five years ago, a well-respected dental hand-piece manufacturer named Kavo came out with a new product for caries detection they called a Diagnodent.  This small hand-held device is actually a small laser.  The laser beam is directed into the tooth, and the reflection of the beam changes based upon the texture and color of the dentin underneath the enamel.  This reflection is read by the machine, and a digital numerical readout is produced which identifies carious tissue. While some caries are obvious in the advanced stage, Diagnodent can locate caries in the early stages, before the entire tooth structure is in danger.

As we become more and more preventative and proactive in our approach to medicine in general, the Diagnodent is a welcome diagnostic tool.  Now tried and true, this little device is part of most dentists’ arsenal for disease detection.  In dentistry, as in many medical modalities, far too many decisions must be made on gut feeling or intuition.  The Diagnodent, like the radiograph, provides another bolus of information upon which the dentist can develop a complete treatment plan for his patients based on scientific evidence.