Lecture 2

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Comments for Lecture 2

As I'm sure many of us have found, methods of caries detection vary greatly in the clinic. All methods available to a clinician must be employed to properly detect caries, radiology, visual inspection,tactile, UV,...etc. This will ensure the best care for patients and prevent over treatment. Photomed Laser Surg. 2004 Jun;22(3):205-10.
Paul Kocian <koci00056@umn.edu>
- Wednesday, September 15, 2004 at 08:03:36 (CDT)

The ability for bacteria to adhere to dental surfaces is necessary for colonization in the oral cavity. The oral bacteria adhere to the salivary pellicle, epithelial cells of the host and other bacteria. These colonies of bacteria are referred to as the biofilm. The bacteria in a biofilm encounter different environmental conditions, and are phenotypically different from their planktonic form. Biofilm bacteria have altered cell components such as phospholipids, and proteins. These altered cell constituents may account for enhanced resistance to antimicrobial agents. C. Black, I. Allan, S Ford, M. Wilson. "Biofilm-specific surface properties and protein expression in oral Streptococcus sanguis." Archives of Oral Biology, Volume 49, Issue 4, April 2004, Pages 295-304.
Rhonda Senjem <senj0007@umn.edu>
- Wednesday, September 15, 2004 at 06:05:29 (CDT)

I reviewed an article by Dr. Douglas K. Benn, University of Florida. In this article, he explores the use of EBD as opposed to traditional methods of caries detection and classifies patients into low, medium or high risk categories. By integrating computer software, he explains the impact of improved efficiency possible in patient management and whether to treat or monitor patients according to their computer-generated risk. DIAGNOdent caries detector is incorporated into this system to enable dentists to objectively distinguish incipient lesoins in outer enamel from those in inner enamel or dentin. Due to DIAGNOdent's accuracy, dentists can confidently suggest monitoring of caries in low risk patients rather than spending chair time on these patients. This enables more chair time for additional patients and those at medium or high risk. Incorporating this risk-assessment model, one could decrease annual patient charges which would improve access to care, increase office population size which would decrease the impact of anticipated dental work force reduction, and increase practice income. Douglas K. Benn, Applying evidence based dentistry to caries management in dental practice: A computerized approach. JADA, Volume 133, Nov. 2002
Judy Schmidt <schm1244@umn.edu>
- Wednesday, September 15, 2004 at 05:54:13 (CDT)

Keyword search on Medline - "dental caries". Imrey PB. Kingman A. Analysis of clinical trials involving non-cavitated caries lesions. [Journal Article] Journal of Dental Research. 83 Spec No C:C103-8, 2004. The article discussed the need for data analyses that fully exploit ordinal or continuous-scale outcome measures. The researchers discussed this due to the variation in lesion severities from initiation to near cavitation. Thus, in clinical trials it is necessary to have indices that reflect, in addition to cavitation, the expansion and regression of non-cavitated lesions.
Shawn Knorr <knor0011@umn.edu>
- Wednesday, September 15, 2004 at 05:48:08 (CDT)

I looked at an article dealing with the quantitative light fluorescence technology used in the detection of caries, especially early lesions. The technology can measure the change in mineral content of enamel. Research is underway and everyday use could be on the horizon. Stookey GK. J Dent Res. 2004;83 Spec No C:C84-8.
jack fiedler <fied0017@umn.edu>
- Tuesday, September 14, 2004 at 22:56:31 (CDT)

The article I read was on the use of quantative light flourescence as a means to detect early carious lesions. This method can measure small amounts of demineralization. This would be a extremely useful tool in the detection of early carious lesions. The article went to state that more indepth clinical trials are being done on this method."Optical methods--quantitative light fluorescence." Stookey GK. J Dent Res. 2004;
Chris McGrew <mcgr0181@umn.edu>
- Tuesday, September 14, 2004 at 22:12:20 (CDT)

The article I read was on the use of quantative light flourescence as a means to detect early carious lesions. This method can measure small amounts of demineralization. This would be a extremely useful tool in the detection of early carious lesions. The article went to state that more indepth clinical trials are being done on this method
Chris McGrew <mcgr0181@umn.edu>
- Tuesday, September 14, 2004 at 22:10:39 (CDT)

I chose to research the sensitivity and specificity of the DIAGNOdent because I have heard that its use in caries detection is somewhat inaccurate. The article titled "Effects of drying time and the presence of plaque on the in vitro performance of laser fluorescence in occlusal caries of primary teeth," explores this issue. The authors concluded that the the hydration state of the teeth did not significantly change the results, but the presence of plaque worsened the performance of the DIAGNOdent. The study compared teeth that were moist, teeth that were dried for 3s, 15s, or dehydrated. For the plaque portion of the study they took laser fluorescence readings on prophied teeth and then took readings on the same teeth after adding plaque. According to this article the author seems to agree that the DIAGNOdent is a good adjunct to caries detection if used correctly and not as the only source. Caries Research. 38(2):104-8, 2004 Mar-Apr.
Sara Palokangas <palo0030@umn.edu>
- Tuesday, September 14, 2004 at 22:09:56 (CDT)

The keyword I chose was "sensitivity". A basic definition in scientific terms is that sensitivity is proportion something tested out of a whole that will correctly identificied when tested. The article I looked up was called, "Evaluating diagnostic tests" from Advances in Dental Research, Vol 7, 66-69, Copyright © 1993 by International & American Associations for Dental Research. This article basically dealt with using diagnostic tests for periodontal disease. This article touched on how difficult it is sometimes from a test to be sensitive as well as specific to have the "ability to predict the percent of cases in which the disease or condition progresses to the next state of development". This sometimes makes dental research a difficult task because it is widely based upon our judgements as dentists and researchers.
joshua vang <vang0335@umn.edu>
- Tuesday, September 14, 2004 at 21:27:57 (CDT)

The article I reviewed, “Optical Methods – Quantitative Light Fluorescence” by G.K. Stookey, reviewed several clinical caries studies in the use of quantitative light fluorescence (QLF) to detect changes in mineral content associated with both demineralization and remineralization. The several studies review used QLF to evaluate caries – preventive measures, such as fluoride varnishes and fluoride toothpaste. The author addressed several practical concerns regarding the clinical use of QLF, including refinement of instrumentation, validation of detection and monitoring of early caries, and clinical test design. However, this technology seems promising as a non-destructive means of monitoring and detecting early caries. Reference: J Dent Res 83(Spec Iss C):C84-C88, 2004.
Anh Kov <vuon0016@umn.edu>
- Tuesday, September 14, 2004 at 21:07:42 (CDT)

We discussed Evidence Based Dentistry in detail and we briefly touched on Dental biofilms and microflora as an upcoming area for future endeavours. I decided to read an article on periodontal disease and overall health concern and also as a chronic disease. I agree with Dr. Zidan when saying that the periodontal health of a patient is more than just what we see and that the complex nature of this disease is more than just the interactions of one or two bacteria, rather a combination of actions and reactions that is continuously evolving. This article supports this fact and also that the interactions of many of the bacteria are complex. data taken from Clin Microbiol Rev. 2001 October; 14 (4): 727–752 DOI: Periodontal Disease as a Specific, albeit Chronic, Infection: Diagnosis and Treatment Walter J. Loesche1,2* and Natalie S. Grossman2
David Mach <machx004@umn.edu>
- Tuesday, September 14, 2004 at 21:02:14 (CDT)

For my article this week, I focused on the dental biofilm and its role in caries progression and remineralization potential. Strep. mutans is a significant component of this biofilm, as we discussed in class. Previous studies have demonstrated that fluoride lowers the calcium-binding affinity of Streptococcus mutans and approximately doubles the calcium-binding capacity. This article investigated the effect of this mechanism on calcium mobility in plaque. Fluoride increased the rate of calcium diffusion by a reduction in the binding affinity. It was shown in the article that fluoride significantly increases mobility in plaque. The author, then, suggests that this may increase the rate at which calcium is transported between plaque and a lesion below it. Therefore, fluoride can promote remineralization via this mechanism. This mechanism could also increase the penetration of antibacterials and suggests a new method for the treatment of biofilms. "Fluoride-induced enhancement of diffusion in streptococcal model plaque biofilms." Caries Research. 32(3):227-32, 1998.
Timothy J. Neuner <neun0004@umn.edu>
- Tuesday, September 14, 2004 at 20:44:42 (CDT)

Dental caries is one of the most common of all disorders, second only to the common cold and is the most common oral disease. Since the average individual has his first experience with this disease in childhood, it is particularly important to deal with it from the 1st to his 12th year of life. Fluoride is often recommended to protect against dental caries. It has been demonstrated that people who ingest fluoride in their drinking water or by fluoride supplements have fewer dental caries. Fluoride ingested when the teeth are developing is incorporated into the structure of the enamel and protects it against the action of acids. Topical fluoride is also recommended to protect the surface of the teeth. This may include a fluoride toothpaste or mouthwash. This study compared the clinical effectiveness of low fluoride toothpastes containing 600 ppm or less, with toothpaste containing 1,000 ppm or more fluoride, in preventing dental caries. This experiment concluded that the “250 ppm fluoride dentifrice was not as effective in caries prevention in permanent dentition as dentifrice containing 1,000 ppm F or more. More studies have to be carried out to test the anticaries efficacy of 500 against 1,000 ppm and above.” Caries Research. 37(2):85-92, 2003 Mar-Apr.
Marianna Elimelakh <elim0001@tc.umn.edu>
- Tuesday, September 14, 2004 at 19:54:50 (CDT)

In reference to the use and accuracy of the DIAGNOdent laser device, the article: El-Housseiny AA., Jamjoum H., Evaluation of visual, explorer, and a laser device for detection of early occlusal caries, J Clin Pediatr Dent. 2001 Fall; 26(1): 41-8, examined the correlation between the dentists clinical experience and the accuracy of diagnosis. This study revealed a reverse relationship, which I thought was interesting, what might this reveal? I would have hypothesized this relationship to show that more experience would correlate with more accurate diagnosis. They also examined the DIAGNOdent, and results indicated that it’s diagnosis were superior when compared to the explorer or visual. However these two are still valuable, thus a conclusion may be that the DIAGNOdent is a good adjunctive tool to the detection and diagnosis of early occlusal caries.
Atty Smith <smit1820@umn.edu>
- Tuesday, September 14, 2004 at 19:25:06 (CDT)

While the importance of S. mutans in caries etiology cannot be denied, this study shows that non-strep strains, as well as certain mixed groups of bacteria, can be just as cariogenic and acid-producing. This means that our emphasis on vaccinating for strep species could be a wasted effort. Instead, efforts may have to be focused on remineralization and combating acid production by the many species capable of doing so. Kleinberg I. A mixed-bacteriae ecological approach to understanding the role of the oral bacteria in dental caries causation: An alternative to Streptococcus mutans and the specific-plaque hypothesis. Critical Reviews in Oral Biology & Medicine. 13(2):108-125, 2002.
Steve Weith <weit0030@umn.edu>
- Tuesday, September 14, 2004 at 19:11:26 (CDT)

In looking at the etiology of dental caries, I chose to look at a test that could identify high risk patients. Streptococcus mutans and Streptococcus sobrinus are major pathogens causing dental caries in humans. A simple and rapid method to detect these species in human saliva simultaneously was developed using the polymerase chain reaction (PCR). Chromosomal DNA was extracted by boiling bacterial cells in lysis solution containing 1% Triton X-100. The bacterial DNA was amplified using primers with the PCR. The results indicated that the PCR method developed in this study is useful for detecting S. mutans and S. sobrinus in saliva and that it can be used in epidemiological studies to evaluate the prevalence level of these organisms. This could allow dentists to identify high risk patients before rampent caries set in. This could allow dentists to focus more on preventative rather then restorative. Oral Microbiology & Immunology; Aug2000, Vol. 15 Issue 4, p258
Matt Hendrickson <hend0485@umn.edu>
- Tuesday, September 14, 2004 at 18:46:27 (CDT)

The article I found was a study of the accuracy of the DIAGNOdent for diagnosis of fissure caries in primary and permanant teeth. The article concluded that the device was an accurate and objective method for caries detection compared with visual detection. (Anttonen V. Seppa L. Hausen H. A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children. Community Dentistry and Oral Epidemiology. 32(4):312-8, 2004 Aug.)
Paul Amundson <amun0141@umn.edu>
- Tuesday, September 14, 2004 at 18:45:16 (CDT)

During Dr. Zidan's lecture on dental caries, he spoke about how the properties of plaque as a biofilm are more than merely the sum of their component parts. The article that I reviewed supports this, and suggests that it is not necessarily the species of bacteria present, but the proportions of acid-producting bacteria that are found in dental plaque. They found that by varying the ratios of different bacterias, higher and lower Stephan curves could be produced. I believe that this research has implications for new anti-caries products geared more toward acid production and accumulation. Kleinberg, I. A Mixed-Bacteria Ecological Approach to Understanding the Role of the Oral Bacteria in Dental Caries Causation: an Alternative to Streptococcus Mutans and the Specific-Plaque Hypothesis. International and American Assoc. for Dental Research. 13(2):108-125 (2002).
Alicia Berger <berg1305@umn.edu>
- Tuesday, September 14, 2004 at 18:18:59 (CDT)

In lecture we discussed the etiology and diagnosis of caries. We have also been looking into the future of detecting this infectious disease. In the article, "A Review of Potential New Diagnostic Modalities for Caries Lesions" many new techniques were mentioned. Some of these included using infrared techniques along with ultrasounds. These all sounded interesting and the authors seemed to think that these mechanisms would be the way of the future in helping dentists with less invasive techniques. The problem I found with this article is that money and time are still an issue and there is not yet enough research available to make any dentist change from what they are used to and comfortable with. J Dent Res 83(Spec Iss C):C89-C94, 2004
Aliya Elmajri <elma0014@umn.edu>
- Tuesday, September 14, 2004 at 18:07:52 (CDT)

Dr. Zidan discussed the importance of dental caries diagnosis. I used the etiology and diagnosis of dental decay as my keyword. The journal article talked about dental caries occuring on a continuous scale. Therefore, because of the continuous scale, there is an opportunity for the diagnosis of active disease or remission. The "research aimed at remineralizing agents (that) may focus on lesions that are amenable to remineralization, and select a method that will measure small changes in early lesions." Huysmans, MC, Longbottom, C. The Challenges of Validating Diagnostic Methods and Selecting Appropriate Gold Standards. Journal of Dental Research. 83 Spec No.C:C48-52, 2004.
Whitney Hustad <hust0040@umn.edu>
- Tuesday, September 14, 2004 at 17:11:36 (CDT)

You mentioned the topic of biofilm formation in your last lecture. Article Title: Biofilm Formation of Candida albicans is variably affected by saliva and dietary sugars. This article examined the effect of human whole saliva and dietary sugars, including glucose and galactose, on the adhesion and biofilm formation. It was found that all biofilms progressively developed for up to 3–4 days and then reached a plateau even though the medium was replenished daily, implying that the cell numbers of a mature Candida biofilm attain a steady state at a critical point. In addition, the effect of an acquired pellicle on candidal adhesion and biofilm formation, salivary components are likely to influence these processes when suspended in the liquid phase of the experimental medium. The researchers concluded that dietary sugars and saliva could modify candidal adhesion and biofilm formation to varying extents. The effect of unstimulated whole saliva on candidal adhesion and biofilm formation varies depending on whether this biological fluid is in the suspended or in a fixed/attached position. The problem with this experiment lies in the complexity of human whole saliva. The subject-to-subject variations in the quality of human saliva are likely to further complicate any experimental findings. Nonetheless, this experiment does reveal how saliva modulates biofilm and pedicle formation. Reference Jin, Y., Samaranayake, L., et al. "Biofilm formation of Candida albicans is variably affected by saliva and dietary sugars. Archives of Oral Biology (2004) 49: 789-798.
Andrew Pearson <pear0235@umn.edu>
- Tuesday, September 14, 2004 at 15:39:37 (CDT)

The article I found tested remineralization of root surface lesions. In the study, the researchers demineralized teeth in vitro and tested slurrys containing fluoride vs. slurry sans fluoride. They then used Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR) to determine remineralization and caries depth. The study found that rinsing twice daily with a 250 PPM fluoride solution and daily application of a dentifrice slurry containing 1400 p.p.m. F significantly remineralized primary carious root lesions vs. no fluoride. While this study was performed in vitro and I realize that the mouth is a vastly more complex environment, this information is encouraging. We as dentists need to continually remind ourselves that certain lesions can resolve without surgical treatment.
Dan Lunstad <lund0724@umn.edu>
- Tuesday, September 14, 2004 at 13:03:16 (CDT)

Dr. Zidan talked in his lecture about the potential for demineralization of enamel and dentin where dental caries are occurring. Fluoride can be incorporated readily into the crystalline lattice of tooth mineral, resulting in a tissue less soluble in an acid environment, has been the scientific cornerstone for caries prevention. The article that I read was looking to determine to a greater extent the stoichiometry and solubility parameters that are necessary to assess the driving force for de- and re-mineralization of enamel and dentin in the oral environment. My question is aren’t we as clinicians counting on a patient to comply within certain parameters to start a remineralization process that they have potentially been completely noncompliant with in the past?Aoba, T. Solubility properties of human tooth mineral and pathogenesis of dental caries. Oral Dis. 2004 Sep;10(5):249-57.
Marjorie Voelker <voel0020@umn.edu>
- Tuesday, September 14, 2004 at 12:50:30 (CDT)

Regarding the plaque biofilm, Xie et al. investigated information flow between two unrelated plaque bacteria, Streptococcus cristatus and Porphyromonas gingivalis. They found that a surface protein in S. cristatus caused repression of the P. gingivalis fimbrial gene. In the presence of S. cristatus, P. gingivalis was unable to adhere to the biofilm and was more readily removed by saliva, and eventually eliminated from the oral cavity. Xie H, Cook GS, Costerton JW, Bruce G, Rose TM, Lamont RJ. Intergeneric communication in dental plaque biofilms. Journal of Bacteriology. 2000; 182:7067-9.
Steve Clifford <clif0047@umn.edu>
- Tuesday, September 14, 2004 at 12:50:26 (CDT)

Evidence-based dentistry is not new to dentistry. The ADA has relied on credible scientific evidence for communication and setting policies. In developing treatment plans for patients, dentists need to not only rely on the patients treatment needs but also on the best available scientific evidence to provide the best care. Ismail AI. Bader JD. ADA Council on Scientific Affairs and Division of Science. Journal of the American Dental Association. Evidence-based dentistry in clinical practice. Journal of the American Dental Association. 135(1):78-83, 2004 Jan.
Jessica Allison <alli0086@umn.edu>
- Tuesday, September 14, 2004 at 12:18:38 (CDT)

The DIAGNOdent is a laser fluorescense system best used to detect occlusal and accessible smooth surface caries. It has been found to be a valuable, reliable adjunct to a clinical exam. Lussi1,A., R. Hibst, and R. Paulus. "DIAGNOdent: An Optical Method for Caries Detection." Journal of Dental Research 83(Spec Iss C):C80-C83, 200483.
Katie Sealey <maes0008@umn.edu>
- Tuesday, September 14, 2004 at 12:00:17 (CDT)

This week I chose an article entitled "Remineralization study of artificial root caries lesions after fluroride treatment. An in vitro study using electric caries monitor and transversal micro-radiography." I chose this because the role of fluoride in remineralization was mentioned in lecture. There goal was to evaluate and compare remineralization of root caries lesions after in vitro treatment with various fluoride agents using an Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR). The different fluoride containing methods were put into 6 groups. A neutral placebo dentifrice without F, a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice, a neutral 1250 p.p.m. F dentifrice, or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) or a 1250 p.p.m. (pH 4.7) AmF dentifrice. There conclusions were that a daily application of a dentrifice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF remineralize primary root caries lesions in vitro. They went on to say that ECM and TMR are valuable complementary methods in order to analyse the remineralization processes. This was an article that was published in '04 and being such a recent article I think that the results they got were pretty much as expected. I mean, I thought it was well known that using a 1400 p.p.m. fluoride containing dentrifice with another fluoride containing adjunct would decrease the incidence of caries. Reference: Gerodontology. 2004 Jun;21(2):85-92.
Joby Jaberi <jabe0002@umn.edu>
- Tuesday, September 14, 2004 at 11:43:53 (CDT)

Dental caries fits into a very interesting category of diseases--one which much cause tissue damage before it can be detected. This causes great problems when it comes to treating the disease, especially with those who don't seek professional care on a regular basis. It has been discovered that the use of fluoride to remineralize enamel is useful in treating subclinical caries. This is a useful technique, but caries continues to challenge dental professionals on the best ways of detection before tissue damage becomes extensive. "The challenges of validating diagnostic methods and selecting appropriate gold standards." Huysmans MC, Longbottom C. J Dent Res. 2004;83 Spec No C:C48-52.
Paul Schaus <scha0764@umn.edu>
- Tuesday, September 14, 2004 at 11:43:52 (CDT)

The article I read was a comparison of different methods of caries detection. Standard bitewings were evaluated against a high-frequency sound wave device (the Ultrasound Caries Detector)in terms of their ability to detect interproximal caries on extracted premolars. In this study the ultrasound device fared better with specificity and sensitivity of 1.0 while the bitewings were .92 and .90 respectively. Even though the ultrasound was technically perfect in testing the authors made a point of stating that no testing method can substitute for intraoral examination. Diagnosis of approximal caries: Bite-wing radiology versus the Ultrasound Caries Detector. An in vitro study Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics, Volume 95, Issue 5, May 2003, Pages 626-631 Shlomo Matalon, Osnat Feuerstein and Israel Kaffe
Andy Wilcox <wilc0094@umn.edu>
- Tuesday, September 14, 2004 at 11:30:50 (CDT)

In class we were presented the limitations to visual and visually aided probing to detect dental caries. We also were shown figures on the sensitivity of new technology designed to detect caries. In this study testing intra-oral cameras while sensitivity of the digital technology far exceeded visual examination the specificity of the new technology was ranged ~ .60 as compared to visual detection ~ .90. This underlines the importance of the importance of dentists having multiple methods to detect caries so as to limit the number of unnecessary operative procedures. "The assessment of an intra-oral video camera as an aid to occlusal caries detection" International Dental Journal. 53(1):3-6, 2003 Feb.
Conor Casey <case0155@umn.edu>
- Tuesday, September 14, 2004 at 11:14:27 (CDT)

In my article, the authors studied the development and control by mechanical dental plaque removal of carious lesions. Piam,et.al stated "after four weeks of cariogenic challenge, all the occlusal surfaces showed clinical signs of mineral loss in different degrees, from light opacities to white spots. When the mesh that was bonded to the teeth to accumulate plaque was removed, and the mechanical dental plaque control (MDPC) was reinstated, increased brightness and enamel translucency were noted, directly proportional to the time of MDPC. After four weeks of MDPC, the lesion had regressed in most of the individuals. Paim,S., Modesto,A., Cury, J., Thylstrup,A. Development and control of caries lesions on the occlusal surface using a new in vivo caries model. Pesquisa Odontologica Braileira, vol.17 no. 2 Apr./June 2003
Jackie Jensen <jens0657>
- Tuesday, September 14, 2004 at 09:40:17 (CDT)

This article focuses on the shift from gross mechanical removal of caries to early detection and prevention. Hudson states that some clinicians still do not regard dental caries as a bacterial infection and do very little to control the disease. Instead these dentists are treating incipiant lesions that may not need to be; much like "treating symptoms of a disease that they don't understand." Hudson also writes about the similarities between sealants and conservative resin-based restorations and the difficulty with third-party payers in this situation. He states that as dentists it is our duty to do what is best for the patient whether the insurance company will cover it or not. He concludes by saying the paradigm shifts are inevitable and that dentistry needs to continue evolving to be successful. Hudson P. Conservative treatment of the Class I lesion: a new paradigm for dentistry. JADA 135(6):760-4 2004 Jun
Jessica Johnson <johjessi@yahoo.com>
- Tuesday, September 14, 2004 at 09:26:26 (CDT)

As mentioned previously, diagnosis is an essential part of the treatment of patients. The article "Comparison of three methods for detection of carious lesions in proximal surfaces versus direct visual examination after tooth separation." J Clin Pediatr Dent. 2003 Fall;28(1):59-62 by Mialhe FL, Pereira AC, Pardi V, de Castro Meneghim M. addressed this issue by suggesting a preventative approach. The essence of this study compared clinical, fiber-optic transillumination and bite-wing radiographic assessment of carious lesion depth in proximal areas with the results found with direct visual inspection. It was found that a "carious lesion diagnosed as non-cavitated by clinical examination or restricted to enamel by FOTI or radiographic examinations dentists should adopt a more preventive approach" to diagnosis and treatment.
Emma Otis <otis0025@umn.edu>
- Tuesday, September 14, 2004 at 09:14:43 (CDT)

In the diagnosis of caries, this article discusse the use of explorers for detection and series of recommendations informed by the evidence are made. Including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Clinical diagnosis of dental caries: a European perspective. Pitts NB.J Dent Educ. 2001 Oct;65(10):972-8.
Mesa Ulwelling <ulwe0007@umn.edu>
- Tuesday, September 14, 2004 at 08:00:18 (CDT)

In the article "Dental Caries", the disease, symptoms, detection methods, and treatments are discussed. The bacterial disease is described as infectious and trasmissible. Cavities are the symptom of the disease that are the most obvious indication of it. The detection of cavities may be done using a variety of methods as suggested in the article: radiographs, clinical exam, laser fluorescence probes and fiber-optic trans-illumination devices. "Dental Caries". Journal of Esthetic & Restorative Dentistry, 2004, Vol. 16 Issue 1, p76, 1p
Kristen Manolovits <olso1985@umn.edu>
- Tuesday, September 14, 2004 at 06:38:21 (CDT)

If we can turn our ways of thinking that dental plaque is mearly bacteria that causes disease and, instead, think of plaque as a biofilm made up of bacteria suspended in a matrix, we may come up with new ways of fighting dental disease. Just as our understanding of microbiology has evolved over the years, so must our thoughts about dental plaque. These biofilms have great differences within their matrix which, in-turn, makes their ecosystem even more difficult to understand. Fortunately, most biofilms can be easily removed by mechanical means. However, they immediately begin to reform, so the search continues for ways to combat biofilms such as dental plaque. An improved understanding of biofilm will lead to new strategies for management of these widespread diseases. Reference: "Biofilm: A New View of Plaque", The Journal of Contemporary Dental Practice, Volume 1, No. 3, Summer Issue, 2000.
Jared Rediske <redi0028@umn.edu>
- Monday, September 13, 2004 at 22:52:57 (CDT)

In “A Review of Potential New Diagnostic Modalities for Caries Lesions” the authors describe several new diagnostic techniques, each of which has the potential to measure changes in teeth occurring as a result of mineral loss due to dental caries. Methods examined here include (1) conventional fluorescence imaging (QLF), (2) infrared thermography, (3) infrared fluorescence, (4) Optical Coherence Tomography (OCT), (5) ultrasound and (6) terahertz imaging. Each of the methods measures the result of the caries process. Many of the techniques have been applied to extracted teeth and require extensive testing on vital teeth to ensure that there are no adverse reactions. The advancing interest in development of potential methods caries detection suggests that rapid, non-invasive quantifiable methods of caries detection, and possibly diagnosis, will afford future dentists the ability to provide optimal preventive advice with minimal early intervention. Reference: Hall, A., Girkin, J. “A Review of Potential New Diagnostic Modalities for Caries Lesions”. J Dent Res 83(Spec Iss C):C89-C94, 2004.
Melissa (Karter) Naidyhorski <kart0015@umn.edu>
- Monday, September 13, 2004 at 22:25:37 (CDT)

As the diagnosis of dental caries progresses and the etiology of the disease becomes more evidenced based, the treatment and management of dental caries will evolve to utilize more the biopsychosocial and the socio-cultural bases of the disease. Mouradian WE. Berg JH. "Advances in caries diagnostics and the changing face of dental practice." Journal of the American College of Dentists. 70(4):24-9, 2003 Fall
Aimee Potasek <pota0013@umn.edu>
- Monday, September 13, 2004 at 21:31:31 (CDT)

As technology continues to advance, we as dentists, have a duty to use optimal methods of diagnosis for our patients in order to provide them with the best care possible. The paper I chose examines some of the diagnostic tools supporting a shift in dentistry from treating extensively decayed teeth to a focus on treating incipient lesions. The three methods and devices discussed include: the DIAGNODent laser device, quantitative light-induced fluorescence and the Digital Imaging, Fiber-Optic Transillumination device. This new technology is undoubtedly going to improve diagnostic performance, but the main message in this paper was that the clinician cannot rely solely on one diagnostic device to determine a treatment plan, but rather assimilate many different pieces of information from a variety of sources to determine the optimal treatment and provide the best treatment possible. Pretty, Iain A, Maupome, Gerardo, et al. A Closer Look at Diagnosis in Clinical Dental Practice: Part 5. Emerging Technologies for Caries Detection and Diagnosis. Journal of the Canadian Dental Association 2004; 70(8): 540.
Dan Connors <conn0295@umn.edu>
- Monday, September 13, 2004 at 19:01:26 (CDT)

There is a need for a "modern" caries measurement method for use in recent clinical trial, in clinical practice and or in caries epidemiology. I found an article called "Modern Concepts of Caries Measurement." This article discusses modern clinical caries management concepts that can be comprised of seven steps: (1) caries detection; (2) lesion measurement; (3) lesion monitoring by repeated measures; (4) caries activity measures; (5) diagnosis, prognosis, and clinical decision-making; (6) interventions/treatments; and (7) outcome of caries control/management.
Jill Biles <bile0009@tc.umn.edu>
- Monday, September 13, 2004 at 18:31:13 (CDT)

We have learned that dental caries is a progressive curable disease. The problem is that caries can not be detected by our current methods before it is too late and frank cavitation has occurred. If caries could be detected earlier we would have the opportunity to remineralize lesions or place more conservative restorations. One hope is that tools based on fluorescence could overcome this problem. Though tools such as DIAGNOdent show similar efficacy as traditional techniques they are not yet wide spread among dentistry. Further research and development may make such tools there norm. DIAGNOdent: an optical method for caries detection. Lussi A, Hibst R, Paulus R. J Dent Res. 2004;83 Spec No C:C80-3.
Nick Lowe <lowe0082@umn.edu>
- Monday, September 13, 2004 at 17:08:19 (CDT)

A search of Dr. GV Black and dental caries management led me to this particular article entitled, "A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children," which was very interesting pertaining to the diagnosis of caries. This particular intrument proved very useful and efficient in caries diagnosis and management. The real question that we should have is, where are these instruments in our dental school? "A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children" Community Dentistry & Oral Epidemiology. 32(4):312-8, 2004 Aug
Mike Hom <homx0008@umn.edu>
- Monday, September 13, 2004 at 17:05:21 (CDT)

I searched using the key words "etiology of dental caries" and found the article "Genetic engineering and dental caries." The article explains that there are 4 major factors need in a person to cause dental caries. The factors are (1) the host (2) the microflora (3) the substrate and (4) time. If you are able to stop one or more of these factors you may be able to limit the number of dental caries. This article looks at other ways of trying to control/eliminate including genetically altering S. Mutans and changing the oral environment. Citation : Indian J Dent Res. 2003 Oct-Dec;14(4):284-8.
Justin Hagen <hage0449@umn.edu>
- Monday, September 13, 2004 at 15:16:33 (CDT)

Dr. Zidan's lecture on an evidence based approach to diagnosingy caries talked of new technologies that are replacing the "explorer-stick" method. The paper I read dealt with using an Electronic Caries Monitor, or ECM. They discussed the exiting possibilities of ECM, but that it currently is limited to occlusal surfaces. The reserchers also cautioned on the numerous other variables that needed to be accounted for to get a diagnostic result. Bulk electronic discrepencies are currently just numbers, similar to EPT in that in and of itself it isn't diagnostic. It sounds like an exciting product that is just in it's infancy. Longbottom C, Huysmans MC. "Electrical measurements for use in caries clinical trials." J Dent Res. 2004;83 Spec No C:C76-9.
Jeff J. Johnson <john2990@umn.edu>
- Monday, September 13, 2004 at 14:08:03 (CDT)

My keyword(s) from Friday's lecture: Improvements in Caries Detection. The article I found was: "Diagnosis of occlusal caries: Part II. Recent diagnostic technologies." J Can Dent Assoc. 2001 Sep;67(8):459-63. The accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. And the diagnosis of occlussal cares is very challenging and can be highly subjective, leading to a variety of treatment decisions as we are now well aware from our own personal experiences on the clinic floor. This paper in part I looked at the established methods for diagnosing occlusal caries. It states that these methods have several limitaitons, most noteably in their ability to diagnose early carious lesions. The part II of the paper looked at new and emerging technologies designed for the detection of occlusal decay ( one example: DIAGNOdent). The paper says that electrical conductance measuremnets and quantatative laser or light induced fluorenscence represent improvements over conventional diagnostic methods but mostly in vitro, which is a problem that Dr. Zidan stated in his first lecture (lack of in vivo tests). It states that the DIAGNOdent needs more tests and evalutations to prove it's worth. I think in all treatment decisions, the clinician must be aware of the limitations of the diagnostic methods that are being used. The paper states that clinical judgment based on the patient's case history, visual clues, x-rays are still the most important. Newer technologies may provide supplamental information, but as of yet are not able to replace the established methods for the diagnosis of occlusal caries.
Duane Van Nieuwenhuyzen <vann0086@umn.edu>
- Monday, September 13, 2004 at 13:29:02 (CDT)

In reviewing different types of methods for detection of caries I came across an article that focused on the consequences of diagnosis rather than the truth of diagnosis. The study seemed to contradict evidence based dentisty in a way. The study was done by reviewing the methods of different tests of caries detection. What is understood by the atricle is there is no test that is 100%, yet the evidence is still important. The article wants dentists to realize their are consequences to any type of treatment caries free or not. Nyvad, B. Caries Res. 2004 May-Jun;38(3):192-8.
Ryan Dunlavey <dunl0060@umn.edu>
- Monday, September 13, 2004 at 13:09:02 (CDT)

The emphasis in clinical practice as well as in research has shifted towards prevention of caries. These changes are making new methods of detection necessary, light fluorescence is one of these technologies. It has the ability to measure small changes in mineral content of enamel lesions quantitatively and also has the ability to monitor changes in mineral content associated with demineralization and remineralization. This technology still has a few years until it becomes incorporated into use in clinical trials, but it seems to have good possibilities in early caries detection and prevention. Optical Methods-Quantitative Light Fluorescence. Stookey G.K. Journal of Dental Research. 83(Spec Iss C):C84-C88, 2004.
Michelle Olson <olso1984@umn.edu>
- Monday, September 13, 2004 at 11:48:09 (CDT)

Townsend GC. Aldred MJ. Bartold PM. Genetic aspects of dental disorders. Australian Dental Journal. 43(4):269-86, 1998 Aug. The presence of bacteria is necessary to find disease, but often bacteria is present without disease. This is because caries is a multifactorial disease, with genetics being one component. This makes it difficult to design a study that isolates the genetic component of caries. In lab studies involving rats it was determined that there is a 50% genetic contribution to dental caries. In humans it has been shown that MZ twins have more similar caries experience that DZ twins. Another study showed that humans have proline-rich proteins in their saliva that are coded for on chromosome 12 and follow an autosomal dominant mode of inheritance. The composition of these proetins has an effect on caries experience. Another study showed that people have different responses to streptococcal antigens based upon the individual's HLA status. This may be associated with their susceptibility to caries. Thus, there is a definite link between genetics and caries experience. More research needs to be done in order to devise preventive strategies for people who are genetically predisposed.
Nicole Little <littlej@umn.edu>
- Monday, September 13, 2004 at 10:34:11 (CDT)

Altschuler GB, Belikov AV, Cernavin I. A comparison of three methods for the diagnosis of sound, stained, and carious dentine: conventional, mechanico-acoustic, and laser-acoustic methods. J Clin Laser Med Surg. 1999. Jun;17(3):115-119. We talked in class about how there are many errors made in diagnosis of carious lesions. It is evident by reading this article that to error is human and that both the mechanico-acoustic and laser-acoustic instruments are more accurate and reliable than the tactile and visual senses of a doctor. The article also states that incorporating the laser for diagnosis and the cutting of the prep would be more accurate as well as saving the dentist time by not constantly switching instruments.
Amber Cziok <czio0002@umn.edu>
- Monday, September 13, 2004 at 10:31:51 (CDT)

After Dr. Zidan's lecture, I read and article about a different approach to treatment of caries and how the paradigms of operative dentistry are changing."A shift is occurring in dentistry that involves a change from reliance on gross mechanical instrumentation of dental caries to early diagnosis and treatment of the bacterial infection that causes caries." This is an important aspect of operative dentistry that must follow closely so that dentists can maintain an evidence-based approach to their practice. Hudson P.Conservative treatment of the Class I lesion: a new paradigm for dentistry. J Am Dent Assoc. 2004 Jun;135(6):760-4.
Breynne Fordahl <ford0107@umn.edu>
- Monday, September 13, 2004 at 10:15:03 (CDT)

A fair amount of the comments here discuss the changes occurring in the detection of caries. One of these new ways, laser fluorescence devices, seems to hold the most promise. According to a study by Lussi, DIAGNOdent, a laser fluorescence device has been fairly successful in clinical trials. To summarize their findings, out of the 322 occlusal surfaces, 100 had confirmed dentinal caries. Twenty-nine of these 100 lesions were detected by visual inspection. This number increased to a total of 71 lesions detected when bitewing radiography was used for the second opinion. With laser fluorescence as the second opinion, 92 dentinal lesions were correctly detected. Lussi A, Megert B, Longbottom C, Reich E, Francescut P (2001). Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci 109:14–19.
Jared Homan <homa0023@umn.edu>
- Monday, September 13, 2004 at 10:15:03 (CDT)

My article information somehow became detached from my lecture 2 commens. Journal of Dental Research. 83 Spec No C:C89-94, 2004.
Brandon Bussler <buss0099@tc.umn.edu>
- Monday, September 13, 2004 at 06:04:18 (CDT)

In the June 2004 edition of JADA, there was an article about conservative treatment of class I lesions. This article was about a shift that is currently occurring in dentistry. The main topic was the new paradigm in dentistry and particularly about the new method(s) to treat a class I lesion. The article mentioned about the shift towards conservative care, such as removing plaque and debris and placing sealants and composites. It also mentioned that not all dentists will embrace minimally invasive dentistry. It also stated that traditional use of the explorer may cause cavitation in demineralized surfaces and spread strep. mutans. A new diagnostic tool that is being used is laser fluorescence, introduced by KaVo America in 1999, for the diagnosis of occlusal caries. I feel that although this new paradigm for dentistry is for the better of dentistry, there are still a lot practitioners out there who do not not advocate these methods and resist the movement/shift. Hudson, Philip. Conservative Treatment of the Class I Lesion: A New Paradigm for Dentistry. JADA 2004; 135: 760-764
Mickey Moua <moua0114@umn.edu>
- Sunday, September 12, 2004 at 21:45:27 (CDT)

What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms, Kidd and Feejerskov J Dental Res. 2004: 85 53-85... This article looked at the ways in which substantial pH fluctuations of tooth surface bioflims occuring daily in a normal oral cavity can affect dental tissue... They looked at not only the large carious lesion that are easily detected clinically but also the ultrastructal (subclinical) level... They looked at ways in which regular removal of the biofilm affected the caries process along with the surface of detnal tissuse after the caries process had occured and then inactivated or arrested... A very well writen and informative article...
Charles Duchsherer <duch0041@umn.edu>
- Sunday, September 12, 2004 at 20:31:37 (CDT)

In our second lecture Dr. Zidan discussed an evidence-based approach to caries diagnosis. The article I found reviewed potential new diagnostic modalities for detecting carious lesions. This is an important current topic in dentistry because there has been a paradigm shift away from the "explorer catch" toward a more comprehensive approach involving tactile, visual, and radiographic resources. Experimental methods discussed in the article include multi-photon imaging, infrared thermography and infrared fluorescence, optical coherence tomography, ultrasound, and terahertz imaging. Most of these methods have been demonstrated in laboratories only and are years away from routine clinical application.
Brandon Bussler <buss0099@tc.umn.edu>
- Sunday, September 12, 2004 at 20:27:46 (CDT)

The article I read reviewed multiple papers on the detection of dental caries. From the articles reviewed, it seemed that if explorers are used for detection, size is very important, smaller tip size being the best. However, there were some studies referenced that stated an explorer added no additional help in the detection process, and that visual assessment was sufficient. The author's opinion is that there is much diversity in what different practitioners see as a carious lesion, but there isn't enough support for any one technique providing the most acurate method of detection. Ismail, A.I. Visual and Visuo-tactile Detection of Dental Caries. J Dent Res 83(Spec Iss C):C56-C66, 2004
Carly Grothe <grot0072@umn.edu>
- Sunday, September 12, 2004 at 19:35:24 (CDT)

As Joey Petrino had mentioned in his comment the current paradigm in dentistry is changing. The approach to attack the bacteria most likely causing caries is being addressed in many different ways. Such approaches as Baysan and Lynch using ozone gas to significantly reduce bacteria in their study may just be some of the abstract ideas needed to change the way dentistry deals with caries. Effect of ozone on the oral microbiota and clinical severity of primary root caries. American Journal of Dentistry. 17(1):56-60, 2004 Feb.
Scott Larson <lars1686@umn.edu>
- Sunday, September 12, 2004 at 19:22:46 (CDT)

Similar to what Dr. Zidan stated during lecture, many new techniques and products have been developed and marketed to help dentists in the difficult process of detection and or diagnosis of dental caries in their patients. The article I read discusses a new software product called Logicon Caries Detector which analyzes digital radiographs and helps the dentist locate lesions that he/she may not detect visually or radiographically. The authors found that the software helped dentists detect 20 percent more carious lesions than they would without the software. Just as important, they were less likely to mistreat teeth that in fact do not have a carious lesion. Importantly, this was an in vivo study conducted on patients which makes the results a little more relevant to everyday clinical practice. This is an instance of an evidence based study improving clincical practice. The authors also stated that this product can be a useful tool for patient education as well. Logicon Caries Detector is the first product of its kind to be "efficacious in a clinical study under normal dental operating conditions and to be approved by the FDA at its highest level (normally reserved for lifesaving drugs and devices)." "The efficacy of a computerized caries detector in intraoral digital radiography." Journal of the American Dental Association. 133(7):883-90, 2002 Jul.
Brian Pelsue <pels0003@umn.edu>
- Sunday, September 12, 2004 at 19:08:53 (CDT)

Dentistry continues to shift more towards prevention of dental caries rather than treatment of existing lesions. A key in prevention is early detection of any decay. In the past we have relied soley on our visual and tactile senses to detect any carious lesions. This method of detection lacks in specificity and sensitivity and is therefore becoming more obsolete. New technology involving laser fluorescence has been researched heavily over the past two decades. When the tooth is fluoresed, the device can detect even minor changes in the mineral content of the tooth. This technology will help us make more accurate diagnoses in earlier stages of the disease. [Optical methods--quantitative light fluorescence.GK Sookey.Journal of Dental Research. 83 Spec No C:C84-8, 2004.]
Stacey Vogt <vogt0056@umn.edu>
- Sunday, September 12, 2004 at 13:45:27 (CDT)

Investigating the shift in paradigms from "traditional" to "evidence based" dental caries etiology and diagnosis, to which Dr. Zidan referred in his second lecture, Pitts (2004) combed recent dental literature to derive a system of distinct but related steps in the process of modern clinical caries management. Pitts' sought to update caries management methodology in caries clinical trials to better reflect the modern paradigm of evidence based dentistry. He proposed that modern caries management must be viewed within the context of the continuum of potential disease states and the modern objectives of caries management (e.g. remineralization). Towards that end, he developed the following steps in modern clinical caries management: (1) Caries detection (its presence/absence defined); (2) measuring caries lesion type, morphology, degree of progression/severity; (3) "watch & recall" with lesion monitoring at each recall before identifying that a lesion requires operative intervention; this step takes into account that incipient lesions have great potential for non-operative intervention that can result in lesion remineralization; (4) caries activity measures; unfortunately, such measures are relatively poorly developed and tested at this time; (5) diagnosis, prognosis, and clinical decision-making; at this point, the practitioner synthesizes the evidence gathered from steps 1 through 4 to make the best decision based on the best available evidence and the clinicians best judgement; (6) the interventions and treatments, both preventive and operative, that are now commonly used for caries management; and (7) adjudication of the outcome of caries control and management by examining evidence on the long-term outcomes. By providing an outline for caries management, Pitts (2004) has provided an implementable guide that may enable the clinician to apply knowledge gleaned from the evidence based dental literature and clinical trials at each step in the management and treatment of the caries process. It may provide a very usable framework for ordering and making sense of the constantly growing body of evidence that can be applied in clinical decision making. Pitts, N.B. 2004. Modern Concepts of Caries Measurement. J Dent Res 83(Spec Iss C):C43-C47. KEY WORDS: evidence based • caries detection
Lipschultz, Joshua G. <lips0033@umn.edu>
- Sunday, September 12, 2004 at 12:17:24 (CDT)

Caries is a continual problem in the United States and as we discussed in class, dentistry is shifting to focus more on prevention and early intervention. The use of fluoride is an essential component of caries prevention, however, it must be balanced with the risk of dental fluorosis. Today fluoride is available from fluoride supplements, dentifrices, rinses, gels, fruit juices, and carbonated beverages. This increased availability has raised concerns about excessive intake of fluorides. In areas where fluoride is added to the water it is essential to monitor total fluoride intake in infants fed formula since many companies add a fluoride supplement to the formula. Kumor JV. Swango PA. Linger LL. Leske GS. Green EL. Haley VB. Changes in dental fluorosis and dental caries in Newburgh and Kingston New York. American Journal of Public Health. 88(12): 1866-70, 1998 Dec.
Marika Middag <midd0058@umn.edu>
- Sunday, September 12, 2004 at 10:50:41 (CDT)

The article listed explores the paradigm shift Dr. Zidan referred to in class. Dr. Hudson, the author, focused on the treatment of early carious lesions using minimally invasive techiniques. He classifies this approach with the newer, evidence-based paradigm in dentistry, and highlights the fact that third-party payment is often not offerred for these types of procedures. He goes on to identify the problem this creates when the ideal treatment for a patient is not economically feasible. Dr. Hudson made one very interesting point in the article, referencing the commonly used term, "watch," often used by dental practitioners as an approach to the incipeint carous lesion. He made the statement, "It is time for dentists to join ranks with their medical colleagues, who rarely, if ever, choose to monitor bacterial infection in their patients (764)." "Conservative treatment of the Class I lesion: A new paradigm for dentistry." JADA. Vol 135. June 2004. Pgs. 760-764.
Liz Martin <mart1185@umn.edu>
- Saturday, September 11, 2004 at 16:52:02 (CDT)

As mentioned in lecture by Dr. Zidan, many studies have shown that explorer combined with mirror serves as a good diagnostic aid in detecting caries. But as we all know that but using explorer on a tooth with incipient lesion can damage the intact enamel thus diminishing the tooth’s ability to remineralize. The article that I found titled, “A review of potential new diagnostic modalities for caries lesions” talks about several different methods such as multi-photon imaging, infrared thermography and infrared fluorescence, optical coherence tomography, ultrasound and terahertz imagining etc. to detect caries. Although these methods are not cost effective but they may diminish the invasiveness involved by using explorer. These methods are still under investigation to determine their usefulness on vital teeth, but as Dr. Zidan said more sensitive and specific tests with validity are being tested to provide future dentist the hope to detect caries and early lesions so that we could provide our patients with appropriate treatment. Hall A, Girkin JM, “A review of potential new diagnostic modalities for caries lesions” J Dent Res. 2004; 83.
Rachana Patel <pate0108@umn.edu>
- Saturday, September 11, 2004 at 14:31:23 (CDT)

Current research has been interested in the properties of biofilms and microbial communities; especially in the oral cavity. Oral bacteria are coordinated and part of an integrated microbial community. Research studies are looking into how bacteria regulate gene expression, gene transfer, antimicrobial resistance, etc. can directly or indirectly affect the environment within the biofilm. The more we understand how dental plaque exists as a mixed microbial biofilm can lead to better control strategies against dental caries formation. Marsh PD. Dental plaque as a microbial biofilm. Caries Res. 2004 May-Jun;38(3):204-11
Chia-Yin Lo <loxx0048@umn.edu>
- Saturday, September 11, 2004 at 12:03:12 (CDT)

The diagnostic and treatment options utilizing laser fluorescence in dentistry is currently yielding high sensitivity results, especially in diagnosing and quantifying occlusal and cervical caries. Laser use is depended upon the amount of milliwatts they operate and the amount of energy at varying wavelengths they yield. Low power lasers are used for diagnostic purposes with again high sensitivity for occulsal and cervical caries, but less sensitivity for proximal detection due to technical difficulty. Photoactivated dye technique (PAD) in adjunct with laser fluorescence generates antimicrobial actions via oxidation. This combination has proven beneficial for subgingival caries, periodontal pockets, and root caries. Higher power lasers in combination with a photoactivated dye system termed photodynamic therapy (PDT) is used for oral mucosa malignancies. Cavity preparations on hard tissues have been used with lasers that operate in the middle infrared spectrum such as Er:YAG, Er:YSGG, Er,Cr:YSGG. Although great technological enhancements and modifications have occured in laser development, future developments such as combining diagnostic and therapeutic techniques into one machine and altering the physcial construction of the laser and medium of use will result in a more 'user friendly' and marketable laser unit. [Walsh, LJ. The current status of laser application in dentistry. Australian Dental Journal. 2003; 48:(3): 146-155]
Adam Beers <beer0033@umn.edu>
- Saturday, September 11, 2004 at 11:27:15 (CDT)

The journal article I chose was on using the DIAGNOdent as an adjunct to visual and radiographic examination in the diagnosis of dental caries. A quote from the paper states, "the DIAGNOdent has been found to be reasonably accurate, and the reproducibility of measurements has been high in both invitro and clinical studies. The sensitivity of DIAGNOdent was 92% and the specificity was 82% when the validation was based on observation of the fissures opened with a drill." The paper also stated that there have been no longitudinal studies published on the DIAGNOdent and that an experienced clinician doesn't neccesarily need an adjunct such as the DIAGNOdent. As of this time, I am not an advocate of the DIAGNOdent. I feel that inexperienced dentists use it incorrectly. Case in point, my best friend went to a dentist in the cities acouple years ago, this dentist used the DIAGNOdent on her teeth. She ended up having 6 cavities! I found this hard to believe since my friend was 23 at the time and had never had a cavity before. ("A follow-up study on the use of the DIAGNOdent for monitoring fissure caries in children." Community dentistry and oral epidimiology. Anttonen. 2004. vol. 32 issue 4 pg. 312.)
Sarah A Nelson <nels2267@umn.edu>
- Saturday, September 11, 2004 at 10:25:07 (CDT)

As it was discussed in todays lecture about dental caries, an early detection can pose certain difficulties. Substantial pH fluctuations within the biofilm on the tooth surface are a ubiquitous and natural phenomenon, taking place at any time during the day and night. The result may be recordable in the dental tissues at only a chemical and/or ultrastructural level (subclinical level). Alternatively, a net loss of mineral leading to dissolution of dental hard tissues may result in a caries lesion that can be seen clinically. Thus, the appearance of the lesion may vary from an initial loss of mineral, seen only in the very surface layers at the ultrastructural level, to total tooth destruction. Regular removal of the biofilm, preferably with a toothpaste containing fluoride, delays or even arrests lesion progression. J Dent Res. 2004;83 Spec No C:C35-8.
Max Barsky <bars0040@umn.edu>
- Saturday, September 11, 2004 at 09:46:55 (CDT)

As it was discussed in todays lecture about dental caries, an early detection can pose certain difficulties. Substantial pH fluctuations within the biofilm on the tooth surface are a ubiquitous and natural phenomenon, taking place at any time during the day and night. The result may be recordable in the dental tissues at only a chemical and/or ultrastructural level (subclinical level). Alternatively, a net loss of mineral leading to dissolution of dental hard tissues may result in a caries lesion that can be seen clinically. Thus, the appearance of the lesion may vary from an initial loss of mineral, seen only in the very surface layers at the ultrastructural level, to total tooth destruction. Regular removal of the biofilm, preferably with a toothpaste containing fluoride, delays or even arrests lesion progression.
Max Barsky <bars0040@umn.edu>
- Saturday, September 11, 2004 at 09:40:15 (CDT)

As dentistry continues to evolve the mind set of the dentist is changing with the new information available. Dental caries, as stated in this paper, is a disease that needs to be treated with preventive measures as well as surgical means for advanced lesions. Correct diagnosis is important so that an appropriate decision can be made in choosing treatment options. Incipient lesions require much less invasive work, or even just remineralization therapy. This preserves a lot of tooth structure. If dentists can identify the cause of the caries, they may be able to reduce the caries risk to their patients and they will be able to render minimally invasive surgery when restoring teeth. Conservative treatment of the Class I lesion: a new paradigm for dentistry. J Am Dent Assoc. 2004 Jun;135(6):760-4. Hudson P.
Joshua Hiller <hill0672@umn.edu>
- Friday, September 10, 2004 at 14:10:17 (CDT)

At the present time a new paradigm is happening in dentistry that places primary emphasis on the diagnosis and treatment of the bacterial infection that cause caries instead of the traditional mechanical instrumentation. With the new approach of treating the disease of caries instead of the symptoms as Dr. Zidan talked about in class, we need to assess the caries risk and severity, determine the appropriate response if any, and when necessary provide minimally invasive treatment. As we continue to shift from treating the symptoms to treating the disease our patients will benefit undoubtedly. Conservative treatment of the Class I lesion: a new paradigm for dentistry. J Am Dent Assoc. 2004 Jun:135(6):760-4.
Joey Petrino <petr0212@umn.edu>
- Friday, September 10, 2004 at 13:56:00 (CDT)

Eary detection of dental caries clinically prior to frank cavitation often is miss diagnosed by both the student and the novice dentist. Current reseach aims to develop better modalities of early caries detection. This paper chose to look at detecting interproximal caries using vertically reformatted CT slices. Results showed that the CT images performed significantly better than cinventional 2D digital films. Exciting news, however, is it cost effective....I highly doubt it. Dentomaxillofac Radiol. 2003 Jul;32(4):235-41
Chris Sampair <samp0106@umn.edu>
- Friday, September 10, 2004 at 13:45:30 (CDT)

Eary detection of dental caries clinically prior to frank cavitation often is miss diagnosed by both the student and the novice dentist. Current reseach aims to develop better modalities of early caries detection. This paper chose to look at detecting interproximal caries using vertically reformatted CT slices. Results showed that the CT images performed significantly better than cinventional 2D digital films. Exciting news, however, is it cost effective....I highly doubt it.
Chris Sampair <samp0106@umn.edu>
- Friday, September 10, 2004 at 13:44:39 (CDT)

An important topic of this lecture was clinical caries detection. Is the use of the explorer not good enough to detect the extent of a carious lesion? Although at times it is the use of clinical judgement with visual and tactile methods to describe a lesion, it is known that an explorer does not show the activity of a particular lesion. The article I found states that diagnosis of a clinical lesion requires the knowledge of the energy, or waves, that is applied to or emitted from a tooth. Research is continuing on this topic; a way to clinically measure the activity of a lesion (rate of fluid loss) and the mineral loss of that lesion would become very valuable in treating only those lesions that needed treatment. The article uses examples such as ultrasound and optical coherence tomography as methods to hopefully someday help in detection and diagnosis so that each lesion that needed treatment received that treatment. Hall, A and Girkin, JM. J Dent Res.2004;83 Spec No C: C89-94
Christy Bulman <holu0021@umn.edu>
- Friday, September 10, 2004 at 13:39:18 (CDT)

I used the keywords laser and dentistry to search for an article. The article I read was about using lasers in dentistry and for what procedures they are useful. One of the main points of the article is that dentists need to look at many factors when looking at investing in a laser. They need to realize the different types of lasers with varying wavelengths and the different procedures that can be done with them. Many dentists are bringing lasers into their practice only because their patients are asking about in and want it. This is not a good reason to begin using laser technology. The article discussed how laser fluorescence has the best evidence for success of all the laser technology. This is important since the current methods used for caries detection are highly variable. Reference: Lasers in dentistry: separating science from hype "Journal of the American Dental Association." 135(2):204-12 2004 Feb.
David Maki <dmaki1@umn.edu>
- Friday, September 10, 2004 at 13:01:19 (CDT)

As discussed in class, some traditional techniques of diagnosing occlusal caries have been demonstrated as highly unreliable. According to Milicich, “mirror and probe examination is only 25 percent accurate in detecting early occlusal caries.” New techniques, which are not necessarily widespread, include the use of caries detection dyes and lasers, and have been shown to increase the accuracy of diagnosis to more than 90 percent. Milicich G. “Clinical Applications of New Advances in Occlusal Caries Diagnosis.” New Zealand Dental Journal. 96(423):23-6, 2000 Mar.
Tara Regenold <davi0497@umn.edu>
- Friday, September 10, 2004 at 11:47:40 (CDT)

In the research done by Dr LongBottom he provides further light to the issues that Dr Zidan illistrated in class, simply that there are little clinically acceptable options for caries detection. The research by Dr Longbottom tries to provide a "gold Standard" for caries detection with the necessary validity. Dr LongBottom also illistrates well the problems associated with too much treatment of the symptoms and not enough focus on the caries disease. Journal of Dental Research. 83 Spec No C:C48-52, 2004.
Adam "Go Kerry" Curtis <curt0119@umn.edu>
- Friday, September 10, 2004 at 11:20:37 (CDT)

As far as dental caries detection goes, I found a research artical that comparied senior dental students with senior dental hygiene students. It stated that no significant differance could be found in detecting carious lesions with bite wing radiograph evaluation only. To no surprize, the paper showed that the accuracey of detection is mainly dependent on the depth of the lesion. Obviously, the specificity and sensitivity accuracey of carries detection varries greatly when no cavitation has occured. As Dr. Zidan pointed out, treating the symptoms is not enough. But it is difficult when you can not detect the disease. "Radiographic Detection of Approximal Caries" Wojtowicz, P. The Journal of Dental Hygiene Vol 77 Issue IV Fall 2003 Eric Scotland - Friday, September 10, 2004 at 10:18:18 (CDT)
eric scotland <scot0223@umn.edu>
- Friday, September 10, 2004 at 10:44:31 (CDT)

when studying biofilms intraorally, one must consider the location, and it's tendency to accumulate plaque. it has been showed in this study that buccal surfaces of teeth seem to accumulate the most, especially in the maxillary teeth. there were no measurements of plaque accumulation on the lingual of the the mandibular teeth. (Impact of the intraoral location on the rate of biofilm growth; clinical oral investigations. 8(2):97-101,2004 Jun.) rian suihkonen - Friday, September 10, 2004 at 10:40:35 (CDT)
rian suihkonen <suih0002@umn.edu>
- Friday, September 10, 2004 at 10:41:56 (CDT)

Applying evidence-based dentistry to caries management in dental practice. Douglas K. Benn, B.D.S.m Ph.d The use of evidence based dentistry is being incorporated within the dental office for the use of caries detection and caries management. By using a classification system to categorize people into low-medium and high risk categories, management and detection of caries will vary according to the classification that the adult fits into. EBD is integrated through all caries risk factors, screening data, caries recordings, risk level classifications and risk level treatment. EBD will then aid in the treatment of the patient once detection of caries has been detected and the underlying cause to the carious lesions is determined providing the patient will more options and a better understanding to their treatment.
Kris Phillips <phil0294@umn.edu>
- Friday, September 10, 2004 at 10:14:37 (CDT)

Dental researchers have attempted to understand the microbial nature of oral diseases over the past 120 years. Their view of plaque and its constituent microorganisms has shifted from a specific plaque hypothesis to a non-specific plaque hypothesis and back again to a theory of specific periodontal pathogens in plaque. Changes in the way plaque and its microorganisms are viewed affect the strategies used to prevent and control periodontal diseases. In recent years, dental researchers have begun to view plaque as a biofilm. This shifting view of plaque has important implications for future efforts in prevention and treatment. (Biofilm: A New View of Plaque. The Journal of Contemporary Dental Practice, Volume 1, No. 3, Summer Issue, 2000)
Matt Bruzek <bruz0012@umn.edu>
- Friday, September 10, 2004 at 10:14:35 (CDT)

Today in lecture the topic of using the dental explorer to detect hidden caries was discussed. From this topic I found the following article to be of importance to this subject. Sanchez-Figueras A Jr. Occlusal pit-and-fissure caries diagnosis: a problem no more. A science-based diagnostic approach using a laser-based fluorescence device. [Case Reports. Journal Article] Compendium of Continuing Education in Dentistry. 24(5 Suppl):3-11; quiz 19, 2003. The authors of this article suggest that when an explorer can detect caries, that the destruction to the tooth is far advanced and that hidden caries may extend far beyond the pit and fissure that is detected with an explorer tip catch. They suggest instead that earlier detection is imperative using a more scientific approach. They propose using laser fluorescence to detect and diagnose early stage carious lesions. They conclude that using the DIAGNOdent laser device in the detection of occlusal pit and fissure caries is a far superior method in diagnosing as compared to the explorer catch technique.
Karrie Powell <powe0033@umn.edu>
- Friday, September 10, 2004 at 10:09:39 (CDT)

Reinforcing the unreliability of visual detection of pit and fissure caries, a study was done on extracted teeth, clinical teeth, and previously sealed clinical teeth with varying degrees of discoloration. Teeth were excavated with air abrasion or a small carbide bur and it was determined that 92% of the lesions were carious, meeting two or more of four diagnostic criteria. Separately, those teeth that had been sealed ten or more years prior to examination showed the same 92% incidence of discoloration actually representing a carious lesion. Clearly, more accurate diagnostic tools are required for optimal treatment. Compend Contin Educ Dent. 2001 Nov; 22(11A): 996-1002.
Scott Stadsklev <stad0040@umn.edu>
- Friday, September 10, 2004 at 10:07:27 (CDT)

Reinforcing the unreliability of visual detection of pit and fissure caries, a study was done on extracted teeth, clinical teeth, and previously sealed clinical teeth with varying degrees of discoloration. Teeth were excavated with air abrasion or a small carbide bur and it was determined that 92% of the lesions were carious, meeting two or more of four diagnostic criteria. Separately, those teeth that had been sealed ten or more years prior to examination showed the same 92% incidence of discoloration actually representing a carious lesion. Clearly, more accurate diagnostic tools are required for optimal treatment.
Scott Stadsklev <stad0040@umn.edu>
- Friday, September 10, 2004 at 10:05:41 (CDT)

One of the new methods for caries detection that is recently being studied is via the Electronic Caries Monitor. The monitor measures bulk resistance through the tooth and is non-invasive. However, the device can only be used on the occlusal surfaces of teeth at this point. More research is needed to demonstrate where this new method may take us. Longbottom, C. Huysmans M.C. (2004) Elicrical Measurements for Caries Clinical Trials. Journal of Dental Research 83 (Section NC C-7-6-9).
Lissa Warder <wilk0224@umn.edu>
- Friday, September 10, 2004 at 10:01:41 (CDT)

The use of lasers in the detection of fissure caries is fast becoming the ideal way for caries detection. This study evaluated the effectivness of the laser fluorescence device DIAGNOdent in the detection of occlusal caries in children. Each child received two consecutive examinations performed by one dentist. In each exam the dentist checked each patient visually and using DIAGNOdent. In the patients that the dentist determined visually in the follow up exam that caries had emerged or progressed, the DIAGOdent value increased. In cases that the dentist determined that the tooth with inactive or active caries reversed to sound enamel, the DIAGOdent value decreased. The dentist performed these tests on both primary and permanent molars. These tests indicate that the DIAGOdent system is effective however since the carious teeth were determined by one dentist only and only by visual examination I think more tests should be done before an accurate assessment can be made. There is a definite future in the use of fluorescence lasers in caries detection as I know many more studies have already been completed and published demonstrating the effectiveness of the system. Reference: Anttonen V. Seppa L. Hausen H. A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children. [Journal Article] Community Dentistry & Oral Epidemiology. 32(4):312-8, 2004 Aug.
Cory Larson <clarson5@umn.edu>
- Friday, September 10, 2004 at 09:59:54 (CDT)

In today's changing paradigm of dental caries, early detection methods are being pushed to the front of the line in general dental practices. In today's lecture we learned that the visual and tactile methods of detecting caries are not completely accurate. The early phases of demineralization are almost impossible to detect by these methods. This article tests a device that uses flourescence to detect demineralized enamel and dentin. The results look promising. It is time to take the operator error out of caries detection and develop a method that is reliable and accurate. A. Lussi1,R. Hibst, and R. Paulus. DIAGNOdent: An Optical Method for Caries Detection. J Dent Res 83(Spec Iss C):C80-C83, 2004
Aaron Quitmeyer <quit0008@umn.edu>
- Friday, September 10, 2004 at 09:58:10 (CDT)

With regard to the etiology of dental caries, many of the environmental factors for older patients such as diet, fluoride intake and tobacco use can be controlled by the patient. However, for some patients, especially children, they have little control over their environment. The study by Shenkin JD, Broffitt B, Levy SM, Warren JJ of the Boston Unviersity School of Dental Medicine addresses this with respect to environmental smoking(second hand smoke) and its significant increased risk for primary tooth caries even when controlling for socioeconomic status and other variables. Shenkin JD, Broffitt B, Levy SM, Warren JJ of the Boston Unviersity School of Dental Medicine The association between environmental tobacco smoke and primary tooth caries. J Public Health Dent. 2004 Summer;64(3):184-6. PMID: 15341143
Gary Plotz <plot0010@umn.edu>
- Friday, September 10, 2004 at 09:56:56 (CDT)

Light fluorescence seems to be the wave of the future. This artical looked at the past reviews and performed their own in vitro study. They stated three areas of improvement that must be done before the Light fluorescence can become the standard of the future; 1. Needs software adn technology refinement, 2. Detection of early lesions must be validated that they will continue to frank decay, 3. New clinical test must be designed to test validity. The new technology seems exciting and I look forward to using it in the future. Optical Methods-Quantitative Light Fluorescence. J Dent Research 83: C84-88. G. K. Stookey. 2004.
Jeff Moos <moos0021@umn.edu>
- Friday, September 10, 2004 at 09:56:12 (CDT)

J Dent Res 83(Spec Iss C):C89-C94, 2004 The purpose of this article is to review several different modern caries detection and quantification modalities. They describe some pros and cons of each method, and in summary, they've described some fantastic non-invasive methods of caries detection, quantification, and diagnosis. Not ONE of which we've really had any experience with here in the dental school. How are we, as new praticing dentists supposed to be up to date and current in our methods, if during our education we are not exposed (even the least bit) to the newest and best methods of practice....very disappointing. MULTI-PHOTON IMAGING INFRARED THERMOGRAPHY INFRARED FLUORESCENCE OPTICAL COHERENCE TOMOGRAPHY ULTRASOUND TERAHERTZ IMAGING Has anyone had any experience with these? I sure haven't.
Ben Selden <seld0013@umn.edu>
- Friday, September 10, 2004 at 09:43:32 (CDT)

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