Ex-vivo analysis of demineralisation on irradiated teeth using optical coherence tomography

Head and neck cancer patients are prone to dental caries after radiotherapy. An ex-vivo study was conducted to assess the feasibility of optical coherence tomography (OCT) to detect tooth demineralization due to caries in irradiated teeth. Thirty-nine human molar teeth were subjected to caries lesion induction through irradiation (Group 1), pH cycling (Group 2-1), and both (Group 2-2). The OCT signal attenuation coefficient, µR was assessed and validated against microhardness test and scanning electron microscope (SEM). The µR for Group 1 increased from 10 Gy to 40 Gy, and subsequently decreased after irradiated to 50 Gy and 60 Gy due to damaged enamel microstructure. In Group 2-1, the µR decreased with duration of pH cycling from day 1 to day 14 due to the increase of porosity in enamel layer. However, the µR showed decreasing trend from day 14 to day 28 of pH cycling, resulted from mineral deposition in the enamel layer. Although no significant difference was found in the µR between Group 2-1 and 2-2, SEM of Group 2-2 demonstrated visually higher porosity and larger gaps between microstructures. Irradiation may accelerate caries damage to tooth microstructure by increasing its porosity and brittleness, but larger sample size may be needed to further prove the effect. OCT could potentially be used for early detection of tooth demineralization in vivo based on the measurable µR changes for all groups which are shown negatively correlated with microhardness value (p < 0.05).

[Application of autofluorescence microscopy and laser Induced fluorescence methods to study the dynamics of the demineralization primary teeth process in vitro]

OBJECTIVE

Improvement of methods for studying the processes of demineralization of hard tissues of temporary teeth.

MATERIAL AND METHODS

The study included primaries second molars (n=11). Samples of primary teeth were placed in a test tube with a demineralizing solution for - 1, 4, 8, 21 and 31 days. The of primary teeth samples were examined using methods - laser induced fluorescence (LIF) and autofluorescence microscopy (AFM). Assessment of the degree of demineralization of samples of temporary teeth was carried out according to the score scale developed by us.

RESULTS

The enamel of the samples is demineralized slowly and evenly for up to 8 days with minimal objective signs, starting from the 8th day of the experiment, there is a significant increase in demineralization indicators. By the 21st day, the peak of demineralization is reached with partial dissolution of the enamel, an increase in the fluorescence effect to 80 UE, and reaches a maximum of 4 points on the evaluation scale. Dentin's hard tissues are demineralized gradually without "sudden jumps" in the fluorescence effect and at the same rate throughout the experiment, reaching a maximum on 31 days (30 UE - LIF). Dentin demineralization is characterized by less dissolution, however, the phenomenon of delamination is determined by the type of exfoliation of the organic dentin matrix, starting from the 21st day of the experiment.

CONCLUSION

Enamel and dentin of deciduous teeth demineralize at different rates and have a characteristic specificity of morphological changes. Logistic regression analysis showed the consistency of the classifier for the predictive accuracy of each unit of the proposed scale for assessing the degree of demineralization of temporary teeth samples.

Non-invasive caries detection and delineation via novel laser-induced fluorescence with hyperspectral imaging

Carious is a global chronic disease; 2 billion people and 520 million children suffer from permanent and primary teeth caries respectively. Early caries detection via precise, non-invasive, non-ionizing radiation is highly appreciated. Carious deteriorate the chemical structure of sound tooth tissues, with variation in its optical properties. In this study, customized laser-induced fluorescence system consists of non-ionizing laser light source and hyperspectral camera was developed for early caries detection. Tested tooth sample was illuminated with laser source of 385 nm and 5 mW power. The emitted spectrum signature for main tooth elements including enamel, dentin, stain, and caries were captured. Logarithmic scale of spectrum signature was applied in an attempt to enhance system sensitivity to fluorescent signal. Fluorescence signature at 500 nm secured the maximum fluorescence intensity difference for different tooth elements. Consequently 2D hyperspectral image at 500 nm was constructed. Enhanced 2D image was accomplished via nonlinear filter to enhance contrast. Segmentation via K mean clustering was adopted for precise caries delineation. This narrative, facile, non-invasive, non-ionizing technique experienced precise and accurate delineation of different caries stages (normal, moderate, and severe).

An unusual disordered alveolar bone material in the upper furcation region of minipig mandibles: A 3D hierarchical structural study

Teeth are subjected to compressive loads during mastication. Under small loads the soft tissue periodontal ligament (PDL) deforms most. However when the loads increase and the PDL is highly compressed, the tooth and the alveolar bone supporting the tooth, begin to deform. Here we report on the structure of this alveolar bone in the upper furcation region of the first molars of mature minipigs. Using light microscopy and scanning electron microscopy (SEM) of bone cross-sections, we show that this bone is hypermineralized, containing abundant small pores around 1-5 μm in diameter, lacunae around 10-20 μm as well as larger spaces. This bone does not possess the typical lamellar motif or other repeating structures normally found in cortical or trabecular mammalian bone. We also use high resolution focused ion beam scanning electron microscopy (FIB-SEM) in the serial surface mode to image the 3D organization of the demineralized bone matrix. We show that the upper furcation bone matrix has a disordered isotropic structure composed mainly of individual collagen fibrils with no preferred orientation, as well as highly staining material that is probably proteoglycans. Much larger aligned arrays of collagen fibers - presumably Sharpey's fibers - are embedded in this material. This unusual furcation bone material is similar to the disordered material found in human lamellar bone. In the upper furcation region this disordered bone comprises almost all the volume excluding Sharpey's fibers. We surmise that this most unusual bone type functions to resist the repeating compressive loads incurred by molars during mastication.

Multispectral cross-polarization reflectance measurements suggest high contrast of demineralization on tooth surfaces at wavelengths beyond 1300 nm due to reduced light scattering in sound enamel

The enamel scattering coefficient decreases markedly with increasing wavelength from the visible to the near-infrared (NIR). However, beyond 1300 nm, the scattering coefficient is difficult to measure, and it is not known whether light scattering continues to decrease significantly at longer wavelengths. It is hypothesized that water absorption is a major contributor to the contrast between sound and demineralized enamel beyond 1300 nm since deeply penetrating photons in sound enamel are likely absorbed by water. Reflectance images of demineralization on tooth surfaces were acquired at wavelengths near 1450, 1860, 1880, and 1950 nm. The magnitude of water absorption is similar at 1450 and 1880 nm but varies markedly between 1860, 1880, and 1950 nm. Multispectral comparisons of lesion contrast provide insight into the mechanism responsible for higher contrast at longer NIR wavelengths. The highest contrast was at 1950 nm; however, the markedly higher contrast at 1880 compared to 1450 nm and similar contrast between 1860 and 1880 nm suggests that the enamel scattering coefficient continues to decrease beyond 1300 nm, and that reduced light scattering in sound enamel is most responsible for the higher lesion contrast at longer NIR wavelengths. This has important implications for the choice of wavelengths for caries detection and diagnostic devices, including the performance of optical coherence tomography beyond 1300 nm.

Validation of a Real-Time ISE Methodology to Quantify the Influence of Inhibitors of Demineralization Kinetics in vitro Using a Hydroxyapatite Model System

The aim was to validate a novel protocol to measure the cariostatic efficacies of demineralization inhibitors by repeating previous SMR (scanning microradiography) studies investigating the dose response of Zn2+ and F- on demineralization kinetics in vitro using real-time Ca2+ ion selective electrodes (ISEs). In this study, Ca2+ release was used as a proxy for the extent of demineralization. Forty-eight hydroxyapatite (HAP) discs were allocated into 16 groups (n = 3) and adding either increasing [Zn2+], or [F-], similar to those used in the previous SMR studies. Each HAP disc was immersed in 50 mL, pH 4.0, buffered acetic acid for 1 h, and real-time ISE methodology was used to monitor the rate of increase in [Ca2+] in the demineralization solution. Next, either zinc acetate or sodium fluoride was added into each demineralization solution accordingly. Then after each [Zn2+] or [F-] addition, the HAP disc was further demineralized for 1 h, and ISE measurements were continued. The percentage reduction in the rate of calcium loss from hydroxyapatite (PRCLHAP) at each [Zn2+] or [F-] was calculated from the decrease in Ca2+ release rate, similar to that used in the previous SMR studies. A log-linear relationship between mean PRCLHAP and inhibitor concentration was found for both Zn2+ and F-, similar to that reported for each ion in the previous SMR studies. In conclusion, real-time Ca2+ ISE systems can be used to measure the cariostatic efficacies of demineralization inhibitors.

[Differential diagnosis of dental enamel focal demineralization and fluorosis by means of spectrophotometry]

The article presents the results of spectrophotometric tooth enamel scanning for differential diagnosis of focal enamel demineralization and fluorosis. Research was conducted in vivo on teeth affected by these diseases. VITA EasyShade spectrophotometer measurements were made on the affected area and on the visually healthy part of enamel. The lightness appeared as the only one differential significant optical characteristics of tooth enamel. Lightness metrics were higher in the case of initial caries than on the healthy part of enamel when these metrics were lower in the case of fluorosis than on the healthy part of enamel.

DIAGNOdent: An Optical Method for Caries Detection

The onset of caries is characterized by demineralization of dental hard tissues. Optimal fluoridation with respective oral hygiene habits and diet may stop the progression of a lesion and even allow for its remineralization. The aim of modern dentistry must be a preventive approach rather than invasive repair of the disease. This is possible only with early detection and respective preventive measures. Some of today's diagnostic tools are not sensitive enough to detect this early onset of destruction. Tools based on fluorescence could have the possibility to overcome this problem. This overview will focus on today's knowledge of one possible tool, the DIAGNOdent.

The Challenges of Validating Diagnostic Methods Relative to a Conventional Two-year Caries Clinical Trial

This paper is directed to the question, “What are the appropriate validation criteria for the use of a new clinical trial methodology as a replacement for a conventional two- to three-year caries study?” It is important to recognize that the objective of a two- to three-year randomized, controlled caries trial is to test a precisely framed hypothesis, regarding an experimental product's efficacy relative to a control product. The external validity of conventional two- to three-year caries clinical studies in determining the efficacy and safety of anti-caries products is well-accepted. However, caries clinical trials are not without limitations and have increasingly been viewed as inefficient with respect to measuring the disease process in a holistic manner. The endpoint of a caries lesion with loss of enamel integrity (cavitation) focuses on one end of the caries progression continuum at the expense of early caries initiation and progression. Several early caries detection methods have been developed that correlate with mineral loss of the tooth surface. These diagnostics differ from conventional visual-tactile and radiographic methods in that they are capable of detecting early non-cavitated lesions, and this can generate continuous data. As diagnostic methods become accepted, they will lead to study designs that diverge from the conventional two- to three-year caries studies. Modification of the existing two- to three-year conventional caries design for assessment of product effectiveness, whether by the introduction of a new diagnostic method or by modification of the overall clinical design, must result in a clinical design that is able to differentiate known treatments on the basis of caries prevention efficacy. Given that the fluoride dose response has been characterized in the literature, this should form the basis of any validation package for new methodologies. In conclusion, a minimum expectation for acceptance as a replacement to conventional testing should be that the method or design can differentiate products of known efficacy from one another and that the efficacy relationship observed in a two- to three-year conventional study can be observed with the new method or design.

An in vitro dynamic microcosm biofilm model for caries lesion development and antimicrobial dose-response studies

Some dynamic biofilm models for dental caries development are limited as they require multiple experiments and do not allow independent biofilm growth units, making them expensive and time-consuming. This study aimed to develop and test an in vitro dynamic microcosm biofilm model for caries lesion development and for dose-response to chlorhexidine. Microcosm biofilms were grown under two different protocols from saliva on bovine enamel discs for up to 21 days. The study outcomes were as follows: the percentage of enamel surface hardness change, integrated hardness loss, and the CFU counts from the biofilms formed. The measured outcomes, mineral loss and CFU counts showed dose-response effects as a result of the treatment with chlorhexidine. Overall, the findings suggest that biofilm growth for seven days with 0.06 ml min(-1) salivary flow under exposure to 5% sucrose (3 × daily, 0.25 ml min(-1), 6 min) was suitable as a pre-clinical model for enamel demineralization and antimicrobial studies.

White spot lesions after orthodontic treatment assessed by clinical photographs and by quantitative light-induced fluorescence imaging; a retrospective study

OBJECTIVE

White spot lesions (WSL) are an important side-effect of orthodontic multi-bracket (MB) treatment. Standardized monitoring of such WSL may help in caries management.

MATERIALS AND METHODS

In this retrospective study the discriminatory power of caries assessment on routine digital oral photographs was compared to quantitative light-induced fluorescence (QLF) imaging in monitoring WSL development after debonding of orthodontic appliances. Oral and QLF photographs captured directly after debond (T1) and 1 year thereafter (T2) of 51 subjects, treated with full MB orthodontic appliances were used. Oral photographs were assessed by use of The International Caries Detection and Assessment System (ICDAS) at both time points independently and by side-by-side comparison to assess visual transition (VT). QLF photographs were categorized based on integrated fluorescence loss at T1 and T2.

RESULTS

At T1 433 and 384 lesions on 918 buccal surfaces were detected using ICDAS and QLF, respectively. For both methods these numbers were reduced at T2. Changes within ICDAS scores were recorded by VT and showed mainly lesion improvement within ICDAS score 2.

CONCLUSION

The oral and QLF photographs both showed regression of WSL after debonding of MB orthodontic appliances. The VT evaluation was found to have higher discriminatory power in comparison to ICDAS.

Use of 2D images of depth and integrated reflectivity to represent the severity of demineralization in cross-polarization optical coherence tomography

Several studies have demonstrated the potential of cross-polarization optical coherence tomography (CP-OCT) to quantify the severity of early caries lesions (tooth decay) on tooth surfaces. The purpose of this study is to show that 2D images of the lesion depth and the integrated reflectivity can be used to accurately represent the severity of early lesions. Simulated early lesions of varying severity were produced on tooth samples using simulated lesion models. Methods were developed to convert the 3D CP-OCT images of the samples to 2D images of the lesion depth and lesion integrated reflectivity. Calculated lesion depths from OCT were compared with lesion depths measured from histological sections examined using polarized light microscopy. The 2D images of the lesion depth and integrated reflectivity are well suited for visualization of early demineralization.

Longitudinal monitoring of demineralization peripheral to orthodontic brackets using cross polarization optical coherence tomography

OBJECTIVES

The aim of this study was to test the hypothesis that cross-polarization optical coherence tomography (CP-OCT) can be used to longitudinally monitor demineralization peripheral to orthodontic brackets in an extended clinical study.

METHODS

A high-speed CP-OCT system was used to acquire 3D volumetric images of the area at the base of orthodontic brackets over a period of 12 months after placement. The reflectivity was measured at 3-month intervals for 12 months to determine if there was increased demineralization. Two teeth were monitored on 20 test subjects and the brackets were bonded using two types of adhesives. This was a randomized controlled clinical study with a split mouth design such that each subject served as his or her own control. On one side, the control premolar was bonded with a bonding agent (Adper Scotchbond from 3M ESPE, St. Paul, MN) and composite (Transbond XT from 3M Unitek, Monrovia, CA) that lacked fluoride. On the other side, the experimental premolar was bonded with a fluoride releasing glass ionomer cement (GC Fuji Ortho LC from GC America, Alsip, IL).

RESULTS

There was a small but significant increase in the calculated lesion depth and integrated reflectivity over that depth (ΔR) for both adhesive types (p<0.0001) indicating increasing demineralization with time. There was no significant difference in the lesion depth (p=0.22) and ΔR (p=0.91) between the groups with the fluoride releasing glass ionomer cement and the conventional composite.

CONCLUSIONS

CP-OCT was able to measure a significant increase in demineralization (p<0.0001) at the base of orthodontic brackets over a period of 12 months.

Multispectral near-IR reflectance imaging of simulated early occlusal lesions: variation of lesion contrast with lesion depth and severity

BACKGROUND AND OBJECTIVES

Early demineralization appears with high contrast at near-IR wavelengths due to a 10- to 20-fold difference in the magnitude of light scattering between sound and demineralized enamel. Water absorption in the near-IR has a significant effect on the lesion contrast and the highest contrast has been measured in spectral regions with higher water absorption. The purpose of this study was to determine how the lesion contrast changes with lesion severity and depth for different spectral regions in the near-IR and compare that range of contrast with visible reflectance and fluorescence.

MATERIALS AND METHODS

Forty-four human molars were used in this in vitro study. Teeth were painted with an acid-resistant varnish, leaving a 4 mm × 4 mm window on the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the unprotected windows after 12-48 hours exposure to a demineralizing solution at pH 4.5. Near-IR reflectance images were acquired over several near-IR spectral distributions, visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths >500-nm. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. Cross polarization optical coherence tomography (CP-OCT) was used to non-destructively assess the depth and severity of demineralization in each sample window. Matching two-dimensional CP-OCT images of the lesion depth and integrated reflectivity were compared with the reflectance and fluorescence images to determine how accurately the variation in the lesion contrast represents the variation in the lesion severity.

RESULTS

Artificial lesions appear more uniform on tooth surfaces exposed to an acid challenge at visible wavelengths than they do in the near-IR. Measurements of the lesion depth and severity using CP-OCT show that the lesion severity varies markedly across the sample windows and that the lesion contrast in the visible does not accurately reflect the large variation in the lesion severity. Reflectance measurements at certain near-IR wavelengths more accurately reflect variation in the depth and severity of the lesions.

CONCLUSION

The results of the study suggest that near-IR reflectance measurements at longer wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.

Multispectral near-IR reflectance imaging of simulated early occlusal lesions: variation of lesion contrast with lesion depth and severity

BACKGROUND AND OBJECTIVES

Early demineralization appears with high contrast at near-IR wavelengths due to a 10- to 20-fold difference in the magnitude of light scattering between sound and demineralized enamel. Water absorption in the near-IR has a significant effect on the lesion contrast and the highest contrast has been measured in spectral regions with higher water absorption. The purpose of this study was to determine how the lesion contrast changes with lesion severity and depth for different spectral regions in the near-IR and compare that range of contrast with visible reflectance and fluorescence.

MATERIALS AND METHODS

Forty-four human molars were used in this in vitro study. Teeth were painted with an acid-resistant varnish, leaving a 4 mm × 4 mm window on the occlusal surface of each tooth exposed for demineralization. Artificial lesions were produced in the unprotected windows after 12-48 hours exposure to a demineralizing solution at pH 4.5. Near-IR reflectance images were acquired over several near-IR spectral distributions, visible light reflectance, and fluorescence with 405-nm excitation and detection at wavelengths >500-nm. Crossed polarizers were used for reflectance measurements to reduce interference from specular reflectance. Cross polarization optical coherence tomography (CP-OCT) was used to non-destructively assess the depth and severity of demineralization in each sample window. Matching two-dimensional CP-OCT images of the lesion depth and integrated reflectivity were compared with the reflectance and fluorescence images to determine how accurately the variation in the lesion contrast represents the variation in the lesion severity.

RESULTS

Artificial lesions appear more uniform on tooth surfaces exposed to an acid challenge at visible wavelengths than they do in the near-IR. Measurements of the lesion depth and severity using CP-OCT show that the lesion severity varies markedly across the sample windows and that the lesion contrast in the visible does not accurately reflect the large variation in the lesion severity. Reflectance measurements at certain near-IR wavelengths more accurately reflect variation in the depth and severity of the lesions.

CONCLUSION

The results of the study suggest that near-IR reflectance measurements at longer wavelengths coincident with higher water absorption are better suited for imaging early caries lesions.

Near-infrared imaging of demineralization under sealants

Previous studies have shown that near-infrared (NIR) reflectance and transillumination imaging can be used to acquire high contrast images of early caries lesions and composite restorative materials. The aim of the study was to determine the optimum NIR wavelengths for imaging demineralized areas under dental sealants. Fifteen natural human premolars and molars with occlusal lesions were used in this in vitro study. Images before and after application of sealants were acquired using NIR reflectance and NIR transillumination at wavelengths of 1300, 1460, and 1500 to 1700 nm. Images were also acquired using polarization sensitive optical coherence tomography (OCT) for comparison. The highest contrast for NIR reflectance was at 1460 nm and 1500 to 1700 nm. These NIR wavelengths are coincident with higher water absorption. The clear Delton sealant investigated was not visible in either copolarization or cross-polarization OCT images. The wavelength region between 1500 and 1700 nm yielded the highest contrast of lesions under sealants for NIR reflectance measurements.

Trimodal detection of early childhood caries using laser light scanning and fluorescence spectroscopy: clinical prototype

There is currently a need for a safe and effective way to detect and diagnose early stages of childhood caries. A multimodal optical clinical prototype for diagnosing caries demineralization in vivo has been developed. The device can be used to quickly image and screen for any signs of demineralized enamel by obtaining high-resolution and high-contrast surface images using a 405-nm laser as the illumination source, as well as obtaining autofluorescence and bacterial fluorescence images. When a suspicious region of demineralization is located, the device also performs dual laser fluorescence spectroscopy using 405- and 532-nm laser excitation. An autofluorescence ratio of the two excitation lasers is computed and used to quantitatively diagnose enamel health. The device was tested on five patients in vivo as well as on 28 extracted teeth with clinically diagnosed carious lesions. The device was able to provide detailed images that highlighted the lesions identified by the clinicians. The autofluorescence spectroscopic ratios obtained from the extracted teeth successfully quantitatively discriminated between sound and demineralized enamel.

Is it health or the burial environment: differentiating between hypomineralised and post-mortem stained enamel in an archaeological context

Developmental enamel defects are often used as indicators of general health in past archaeological populations. However, it can be difficult to macroscopically distinguish subtle hypomineralised opacities from post-mortem staining, unrelated to developmental defects. To overcome this difficulty, we have used non-destructive x-ray microtomography to estimate the mineral density of enamel. Using a sample of deciduous teeth from a prehistoric burial site in Northeast Thailand, we demonstrate that it is possible to determine whether observed enamel discolourations were more likely to be true hypomineralised lesions or artefacts occurring as the result of taphonomic effects. The analyses of our sample showed no evidence of hypomineralised areas in teeth with macroscopic discolouration, which had previously been thought, on the basis of macroscopic observation, to be hypomineralisations indicative of growth disruption. Our results demonstrate that x-ray microtomography can be a powerful, non-destructive method for the investigation of the presence and severity of hypomineralisation, and that diagnosis of enamel hypomineralisation based on macroscopic observation of buried teeth should be made with caution. This method makes it possible to identify true dental defects that are indicative of growth disruptions.

Effect of hydration on assessment of early enamel lesion using swept-source optical coherence tomography

Establishing reproducible methodologies for assessment of early enamel lesions using optical coherence tomography (OCT) appears to be challenging. This in vitro study longitudinally evaluated the subsurface enamel lesion progression after 3, 9 and 15 days by cross-sectional scanning using 1310 nm centered swept-source OCT (SS-OCT) under hydrated and dry conditions. The positive difference between the depth-integrated OCT signals at dry and hydrated conditions were calculated and adopted as dehydration parameter (DH). A linear regression was found between DH and the square root of demineralization time (R(2) = 0.99). Significant differences were found in DH between sound and demineralized enamel, and between different periods of demineralization (p < 0.001). Hydration state affects the reflectivity of demineralized porous enamel, and the effect can be potentially used for assessment of early enamel lesion using OCT.

Clinical evaluation of an enhanced white light and fluorescence device for early detection of caries lesions

OBJECTIVE

Sensitivity of a device based on Fluorescence Imaging with Reflectance Enhancement (FIRE) in detecting a potential incipient lesion (PIL) was compared with visual examination to demonstrate non-inferiority to it.

METHODS

Visual examination (VE) and an investigational device (ID) were used to detect PIL (actual incipient caries [AIC] and hypomineralization). Seventeen subjects satisfied data analysis criteria. Two-hundred and seventy-seven AIC and 367 hypomineralizations reached VE consensus. Ground truth was generated from consensus VE results and image information from enhanced white light (eWL) and FIRE images. Data from VE and ID in Still Image (IDSM) and Video (IDVM) modes were evaluated against ground truth.

RESULTS

Overall sensitivity of VE, IDSM, and IDVM evaluated against ground truth were 0.94, 0.884, and 0.848, respectively, for Actual Incipient Caries (AIC) detection, and 0.95, 0.916, and 0.883, respectively, for PIL detection. Sensitivity of ID in both modes was > 90% that of VE, thus demonstrating non-inferiority of IDSM and IDVM to VE.

CONCLUSION

The investigated eWL and fluorescence device is clinically effective and at least as good as expert VE in detecting PIL. An enhanced white light device with FIRE technology can be used, in Video or Still Image Detection modes, as an aid to caries diagnosis.

In vitro evaluation of the Spectra early caries detection system

OBJECTIVE

The goal of this study was to perform an in vitro evaluation of the Spectra, a new caries detector that uses light-induced fluorescence of healthy tooth structure and bacterial pigments to optically detect caries. The Spectra generates a storable color map image of examined tooth surfaces which shows areas of enamel and dentin caries. In this study, Spectra readings of occlusal surfaces were compared to clinical, radiographic, and histological assessments of caries.

METHODS

Two examiners evaluated 41 extracted molars. The teeth were radiographed and then visually assessed. The International Caries Detection and Assessment System (ICDAS) was used to classify the extent of caries. The teeth were then sectioned and assigned a histological score based on the extension of caries into enamel or dentin.

RESULTS

Teeth lacking radiographic caries had a mean Spectra reading of 1.5. Teeth having radiographic caries had a mean Spectra reading of 2.0. This difference was statistically significant. In general, higher ICDAS scores were associated with higher Spectra readings. Teeth with histologically evident deep dentin caries had significantly higher Spectra readings than intact teeth or teeth with superficial enamel demineralization. Spectra assessment of occlusal caries agrees with clinical and radiographic methods.

CONCLUSION

Spectra images illustrate the full spectrum of caries severity, from enamel demineralization to dentin decay. The Spectra is a promising technology for the diagnosis and for monitoring the progression of occlusal caries.

A comparison of methods using optical coherence tomography to detect demineralized regions in teeth

Optical coherence tomography (OCT) is a three- dimensional optical imaging technique that can be used to identify areas of early caries formation in dental enamel. The OCT signal at 850 nm back-reflected from sound enamel is attenuated stronger than the signal back-reflected from demineralized regions. To quantify this observation, the OCT signal as a function of depth into the enamel (also known as the A-scan intensity), the histogram of the A-scan intensities and three summary parameters derived from the A-scan are defined and their diagnostic potential compared. A total of 754 OCT A-scans were analyzed. The three summary parameters derived from the A-scans, the OCT attenuation coefficient as well as the mean and standard deviation of the lognormal fit to the histogram of the A-scan ensemble show statistically significant differences (p < 0.01) when comparing parameters from sound enamel and caries. Furthermore, these parameters only show a modest correlation. Based on the area under the curve (AUC) of the receiver operating characteristics (ROC) plot, the OCT attenuation coefficient shows higher discriminatory capacity (AUC = 0.98) compared to the parameters derived from the lognormal fit to the histogram of the A-scan. However, direct analysis of the A-scans or the histogram of A-scan intensities using linear support vector machine classification shows diagnostic discrimination (AUC = 0.96) comparable to that achieved using the attenuation coefficient. These findings suggest that either direct analysis of the A-scan, its intensity histogram or the attenuation coefficient derived from the descending slope of the OCT A-scan have high capacity to discriminate between regions of caries and sound enamel.

Thermophotonic lock-in imaging of early demineralized and carious lesions in human teeth

As an extension of frequency-domain photothermal radiometry, a novel dental-imaging modality, thermophotonic lock-in imaging (TPLI), is introduced. This methodology uses photothermal wave principles and is capable of detecting early carious lesions and cracks on occlusal and approximal surfaces as well as early caries induced by artificial demineralizing solutions. The increased light scattering and absorption within early carious lesions increases the thermal-wave amplitude and shifts the thermal-wave centroid, producing contrast between the carious lesion and the intact enamel in both amplitude and phase images. Samples with artificial and natural occlusal and approximal caries were examined in this study. Thermophotonic effective detection depth is controlled by the modulation frequency according to the well-known concept of thermal diffusion length. TPLI phase images are emissivity normalized and therefore insensitive to the presence of stains. Amplitude images, on the other hand, provide integrated information from deeper enamel regions. It is concluded that the results of our noninvasive, noncontacting imaging methodology exhibit higher sensitivity to very early demineralization than dental radiographs and are in agreement with the destructive transverse microradiography mineral density profiles.

Estimation of lesion progress in artificial root caries by swept source optical coherence tomography in comparison to transverse microradiography

This study aimed to investigate whether swept source optical coherence tomography (SS-OCT) could estimate the lesion depth and mineral loss quantitatively without the use of polarization sensitivity, and to examine a relationship between OCT data and transverse microradiography (TMR) lesion parameters. Twenty-four bovine root dentin specimens were allocated to three groups of 4-, 7-, and 14-day demineralization. Cross-sectional images of the specimens before and after the demineralization were captured by OCT at 1319 nm center wavelength. Following the demineralization, these specimens were cut into sections for TMR analysis. Correlations between the OCT data and TMR lesion parameters were examined. TMR images of the specimens showed cavitated lesions (lesion depth or LD(TMR): 200 to 500 μm, ΔZ or mineral loss: 10,000 to 30,000 vol % μm). The OCT images showed "boundaries," suggesting the lesion front. Integrated dB values before and after the demineralization and their difference (R(D), R(S), and ΔR, respectively) were calculated from the lesion surface to the corrected depth of boundary (LD(OCT)). A statistically significant correlation was found between LD(OCT) and LD(TMR) (p < 0.05, r = 0.68). Similarly, statistically significant correlations were found between ΔZ and R(D) or ΔR. The OCT showed a potential for quantitative estimation of lesion depth and mineral loss with cavitated dentin lesions in vitro.

Quantitative evaluation of the kinetics of human enamel simulated caries using photothermal radiometry and modulated luminescence

Photothermal radiometry and modulated luminescence (PTR-LUM) is an emerging nondestructive methodology applied toward the characterization and quantification of dental caries. We evaluate the efficacy of PTR-LUM in vitro to detect, monitor, and quantify human enamel caries. Artificial caries are created in extracted human molars (n = 15) using an acidified gel system (pH 4.5) for 10 or 40 days. PTR-LUM frequency scans (1 Hz-1 kHz) are performed before and during demineralization. Transverse microradiography (TMR) analysis, the current gold standard, follows at treatment conclusion to determine the mineral loss and depth of the artificially demineralized lesions. A theoretical model is applied to PTR experimental data to evaluate the changes in optothermophysical properties of demineralized enamel as a function of time. Higher optical scattering coefficients and poorer thermophysical properties are characteristic of the growing demineralized lesions, as verified by TMR, where the generated microporosities of the subsurface lesion confine the thermal-wave centroid. Enhanced optical scattering coefficients of demineralized lesions result in poorer luminescence yield due to scattering of both incident and converted luminescent photons. PTR-LUM sensitivity to changes in tooth mineralization coupled with opto-thermophysical property extraction illustrates the technique's potential for nondestructive quantification of enamel caries.

Clinical assessment of early tooth demineralization using polarization sensitive optical coherence tomography

INTRODUCTION

The aims of this study were to test the hypothesis that polarization sensitive-optical coherence tomography (PS-OCT) can be used to non-destructively measure and quantify the severity of the early demineralization of enamel on buccal and occlusal surfaces and assess the inhibitory effect of fluoride varnish in vivo.

METHODS

A split mouth design was used to assess the effects of fluoride varnish on inhibiting dissolution on 20 test subjects. Orthodontic bands with a buccal window were cemented on the premolars and small incisions were produced on occlusal surfaces to serve as sites for plaque retention for enhanced demineralization. Bands were removed after 30 days and PS-OCT scans were acquired in vivo of occlusal and buccal areas. Teeth were extracted, sectioned, and analyzed using polarized light microscopy (PLM) and transverse microradiography (TMR) for comparison with the PS-OCT images.

RESULTS

High contrast PS-OCT images were acquired of both occlusal and buccal surfaces in vivo. Both occlusal and buccal surfaces, showed a significant difference (P < 0.05) in the integrated reflectivity (ΔR) between the "sound" and "carious" enamel groups. Although the mineral loss (ΔZ) and ΔR measured using TMR and PS-OCT were less for the fluoride varnish-treated buccal surfaces the difference was not statistically significant (P > 0.05).

CONCLUSIONS

Our results indicate that PS-OCT can non-destructively measure early enamel demineralization on the buccal and occulsal surfaces in vivo.

Combination of high-fluoride toothpaste and no post-brushing water rinsing on enamel demineralization using an in-situ caries model with orthodontic bands

OBJECTIVE

To compare the effects on enamel demineralization and fluoride (F) retention of two different brushing–rinsing regimens.

MATERIAL AND METHODS

An in-situ caries model with orthodontic bands was used for 8–9 weeks. A total of 20 orthodontic patients participated. They were randomized into two groups: (1) a test group using 5000 ppm F (n = 10) with no post-brushing water rinsing; and (2) a control group using 1450 ppm F (n = 10) with three sessions of post-brushing water rinsing. Orthodontic stainless-steel bands were applied to the two upper first premolars, leaving 2–3 mm of space away from the exposed buccal surface in order to accumulate plaque and provoke initial caries development. The teeth were extracted after 8 and 9 weeks, then analysed using quantitative light-induced fluorescence (QLF). Additionally, oral F retention was compared for the two groups.

RESULTS

In comparison to the control group, the test regimen resulted in a non-significant smaller QLF lesion area and a significantly lower average QLF loss of fluorescence (P < 0.05). The highest F retention concentration under the band was found in the test group (P < 0.001).

CONCLUSIONS

The combination of using a 5000 ppm F toothpaste and no post-brushing water rinsing had a greater anti-caries potential and resulted in elevated oral F retention compared to a 1450 ppm F toothpaste with three sessions of post-brushing water rinsing.

DIAGNOdent measurements of cultures of selected oral bacteria and demineralized enamel

OBJECTIVE

Carious tissue fluoresces with a wavelength different from sound tissue when stimulated by light with a wavelength of 655 nm. This difference is thought to have a bacterial origin rather than indicating demineralization. This study aimed to measure fluorescence emitted by normal cultivable caries-associated bacterial flora and typical porphyrin-producing bacteria with DIAGNOdent, and to verify earlier findings that demineralization of the dental hard tissue does not affect DIAGNOdent readings.

MATERIAL AND METHODS

Bacterial samples were collected from five occlusal caries lesions in three subjects. From these, mixed anaerobic flora, Lactobacilli and mutans Streptococci were cultured in up to three different kinds of culture medium. Colonies of Lactobacilli and mutans Streptococci were also measured after transferring them to glass slides. Laboratory teaching strains of Prevotella spp., Porphyromonas gingivalis and Actinomyces odontolyticus were cultured anaerobically and fluorescence measured directly after an appropriate incubation period. Sound enamel surfaces of 15 extracted premolars were demineralized and changes in fluorescence measured.

RESULTS

DIAGNOdent readings > 20 were only obtained from young colonies of Prevotella and from colonies of mutans Streptococci cultured on mitis-salivarius-bacitracin agar. Higher measurements were obtained as the bacterial colonies aged. Lower measurements were obtained after transferring colonies to glass slides. Demineralization of enamel did not affect the DIAGNOdent measurements.

CONCLUSIONS

The change in fluorescence measured with DIAGNOdent has a bacterial origin rather than occurring as a result of demineralization. The measurements are presumably dependent on bacterial metabolites rather than bacteria themselves, and probably record synergistic effects during the carious process rather than the quantity or species of bacteria involved.

Noncontact, nondestructive elasticity evaluation of sound and demineralized human dental enamel using a laser ultrasonic surface wave dispersion technique

Laser ultrasonic nondestructive evaluation (NDE) methods have been proposed to replace conventional in vivo dental clinical diagnosis tools that are either destructive or incapable of quantifying the elasticity of human dental enamel. In this work, a laser NDE system that can perform remote measurements on samples of small dimensions is presented. A focused laser line source is used to generate broadband surface acoustic wave impulses that are detected with a simplified optical fiber interferometer. The measured surface wave velocity dispersion spectrum is in turn used to characterize the elasticity of the specimen. The NDE system and the analysis technique are validated with measurements of different metal structures and then applied to evaluate human dental enamel. Artificial lesions are prepared on the samples to simulate different states of enamel elasticity. Measurement results for both sound and lesioned regions, as well as lesions of different severity, are clearly distinguishable from each other and fit well with physical expectations and theoretical value. This is the first time, to the best of our knowledge, that a laser-based surface wave velocity dispersion technique is successfully applied on human dental enamel, demonstrating the potential for noncontact, nondestructive in vivo detection of the development of carious lesions.

Molar-incisor-hypomineralisation: a literature review

BACKGROUND

Molar-Incisor-Hypomineralisation (MIH) is a qualitative defect of 1-4 first permanent molars with or without the maxillary and mandibular permanent incisors. It seems to have been recognised first in the 1970s and prevalence varies between 2.8% and 25%, dependent upon the study.

METHODS

The dental literature was searched using a number of key terms entered into MEDLINE, the reference list of each paper as located was examined for further papers that had been missed in the initial search.

RESULTS

The review of the literature showed that teeth that are affected indicate a systemic cause at around the time of birth; investigators have put forward a number of possible causes; asthma, pneumonia, upper respiratory tract infections, otitis media, antibiotics, dioxins in mother's milk, tonsillitis and tonsillectomy and exanthamatous fevers of childhood. However, at the present time the aetiology remains unclear. Treatment of the affected permanent first molars can include restorations using adhesive intra-coronal restorations to extra-coronal restorations (e.g. preformed metal crowns). There is little evidence to support one option over another. In severe cases extraction at the optimum time may be the best option; allowing the permanent second molars to come forwards. There is little improvement in affected anterior teeth with microabrasion and direct or indirect composite resin restorations may be appropriate in some children. Ultrastructural and biochemical make up of MIH affected teeth seem to have been investigated less than other areas.

CONCLUSION

It is important that children with MIH are diagnosed as early as possible and managed appropriately; this will involve multidisciplinary input.

High contrast near-infrared polarized reflectance images of demineralization on tooth buccal and occlusal surfaces at lambda = 1310-nm

BACKGROUND AND OBJECTIVES

Sound enamel manifests peak transparency in the near-IR (NIR) at 1310-nm, therefore the near-IR is ideally suited for high contrast imaging of dental caries. The purpose of this study was to acquire images of early demineralized enamel on the buccal and occlusal surfaces of extracted human teeth using NIR reflectance imaging and compare the contrast of those images with the contrast of images taken using other methods.

MATERIALS AND METHODS

Fifteen human molars were used in this in vitro study. Teeth were painted with a clear acid-resistant varnish, leaving two 2 mm x 2 mm windows on the buccal and occlusal surfaces of each tooth for demineralization. Artificial lesions were produced in the exposed windows after a 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using NIR transillumination, NIR and visible light reflectance, and fluorescence imaging methods. Crossed polarizers were used where appropriate to improve contrast. Polarization sensitive optical coherence tomography (PS-OCT) was also used to non-destructively assess the depth and severity of demineralization in each sample window.

RESULTS

NIR reflectance imaging had the highest image contrast for both the buccal and occlusal groups and it was significantly higher contrast than visible light reflectance (P < 0.05).

CONCLUSION

The results of the study suggest that NIR reflectance imaging is a promising new method for acquiring high contrast images of early demineralization on tooth surfaces.

High contrast near-infrared polarized reflectance images of demineralization on tooth buccal and occlusal surfaces at lambda = 1310-nm

BACKGROUND AND OBJECTIVES

Sound enamel manifests peak transparency in the near-IR (NIR) at 1310-nm, therefore the near-IR is ideally suited for high contrast imaging of dental caries. The purpose of this study was to acquire images of early demineralized enamel on the buccal and occlusal surfaces of extracted human teeth using NIR reflectance imaging and compare the contrast of those images with the contrast of images taken using other methods.

MATERIALS AND METHODS

Fifteen human molars were used in this in vitro study. Teeth were painted with a clear acid-resistant varnish, leaving two 2 mm x 2 mm windows on the buccal and occlusal surfaces of each tooth for demineralization. Artificial lesions were produced in the exposed windows after a 2-day exposure to a demineralizing solution at pH 4.5. Lesions were imaged using NIR transillumination, NIR and visible light reflectance, and fluorescence imaging methods. Crossed polarizers were used where appropriate to improve contrast. Polarization sensitive optical coherence tomography (PS-OCT) was also used to non-destructively assess the depth and severity of demineralization in each sample window.

RESULTS

NIR reflectance imaging had the highest image contrast for both the buccal and occlusal groups and it was significantly higher contrast than visible light reflectance (P < 0.05).

CONCLUSION

The results of the study suggest that NIR reflectance imaging is a promising new method for acquiring high contrast images of early demineralization on tooth surfaces.

Diagnosis and management of the worn dentition: risk management and pre-restorative strategies for the oral and dental environment

The incidence of tooth wear or non-carious tooth surface loss (NCTSL) is increasing and oral rehabilitation of patients with tooth tissue loss requires strategies that address all the factors relevant to the aetiology and pathogenesis of the disease. The multifactorial nature of the disease and the variability in its clinical presentation provides treatment challenges for the clinician. Management of tooth wear must be more than just restoration. Risk assessment, compliance and a commitment from both professional and patient underpin overall success of the treatment. Understanding that long term success is affected by the patient's oral environment and how diet, lifestyle and medical factors modify this environment. Improvements in the quantity and quality of saliva and remineralization strategies to enhance the remaining tooth structure are essential pre-restorative requirements. Successful management requires recognition of the problem, stabilization of the oral environment, remineralization of the tooth structure and when appropriate restoration.

Early enamel lesion part I. Classification and detection

There has been a paradigm shift from Black's 'extension for prevention' to a minimal intervention approach in the recent time. The most important aspect in diagnosis of earliest stages of enamel demineralization involves accurate and reliable detection of such lesions. The newer diagnostic aids would enable the dentist to detect and diagnose early enamel lesions and direct appropriate preventive measures to promote remineralization and conservation of the tooth substance. A high level of caries experience necessitates preventive strategies which are more cost effective than surgical intervention and restorative procedures.

In vitro evaluation of the influence of air abrasion on detection of occlusal caries lesions in primary teeth

PURPOSE

The purpose of this study was to assess the influence of cleaning pits and fissures with an aluminum oxide air abrasion system on the detection of occlusal caries in primary teeth using loser fluorescence (LF) and visual examination.

METHODS

The sample comprised 65 pit and fissure sites on extracted primary teeth suspected to be carious. The sites were submitted to 2 visual examinations (examiner JAR) and 2 LF readings (examiner TMV). Next, the occlusal surfaces were air-abraded and re-examined thereafter using both methods. The teeth were sectioned, and the histological analysis of the sites with a stereoscopic magnifying lens at X32 magnification was used as the gold standard.

RESULTS

Cohen's kappa statistic for LF and visual examination were, respectively, 0.282/0.884 before and 0.896/0.905 after air abrasion. LF showed a sensitivity of 0.28 increasing to 0.49 and a specificity of 0.50 increasing to 0.92. Visual examination showed sensitivity of 0.78 and specificity of 0.73. Both increased after air abrasion.

CONCLUSION

The findings suggest that cleaning pits and fissures with aluminum oxide air abrasion increased the accuracy of LF and visual examination for detection of occlusal caries in primary teeth.

Fluorescence changes in remineralized and nonremineralized enamel adjacent to glass ionomer ART restorations: an in vitro study

PURPOSE

The purpose of this study was to evaluate fluorescence changes of remineralized and nonremineralized enamel margins adjacent to glass ionomer restorations during a pH cycling sequence.

METHODS

One hundred permanent molar and premolar teeth were placed in a demineralizing solution for 3 days and restored with a glass ionomer restoration (simulating Atraumatic Restorative Treatment [ART]). Half were placed in a remin solution for 7 days to create a remineralization (remin) group. Specimens were randomly divided into 4 groups (N=25): (a) 2 remin groups; and (b) 2 nonremin groups. One half of the remin and nonremin group specimens were treated with a 5,000-ppm sodium fluoride solution during pH cycling with remin fluid and an acidic beverage over 20 days. Fluorescence changes were recorded with quantitative light fluorescence (QLF). Higher fluorescence values indicated less lesion porosity. Statistical comparisons between the groups over the 5 measurement sessions of cycling were performed using repeated measures of analysis of variance with a post-hoc test, paired-sample t test and 2-sample t tests (alpha=0.05).

RESULTS

The remin groups experienced significantly less lesion porosity than the nonremin groups. Fluoride groups experienced less lesion porosity than the nonfluoride groups.

CONCLUSIONS

A brief period of remineralization and use of a prescription strength fluoridated rinse improved the enamel substrate surrounding glass ionomer restorations, resulting in less lesion porosity.

[Molar incisor hypomineralisation in the first permanent teeth]

The aim of this study was to point out the prevalence of hypomineralised molars and incisors and emphasize importance of this condition in paediatric dentistry. This condition is defined as hypomineralisation of one or more first permanent molars frequently affecting incisors and referred to as molar incisor hypomineralisation (MIH). Aetiology of MIH has not been fully clarified and numerous aetiological factors have been cited. Hypomineralised molars are more prone to caries, cause severe restorative problems and are frequently extracted due to serious damage and caries complications. Incisors can present demarcated enamel opacities, while enamel breakdown is uncommon. Considering the fact that permanent first molars with severe defects demand complex treatment, they represent a serious problem for the patient as well as for the dentist.

The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries

This paper describes early findings of evaluations of the International Caries Detection and Assessment System (ICDAS) conducted by the Detroit Center for Research on Oral Health Disparities (DCR-OHD). The lack of consistency among the contemporary criteria systems limits the comparability of outcomes measured in epidemiological and clinical studies. The ICDAS criteria were developed by an international team of caries researchers to integrate several new criteria systems into one standard system for caries detection and assessment. Using ICDAS in the DCR-OHD cohort study, dental examiners first determined whether a clean and dry tooth surface is sound, sealed, restored, crowned, or missing. Afterwards, the examiners classified the carious status of each tooth surface using a seven-point ordinal scale ranging from sound to extensive cavitation. Histological examination of extracted teeth found increased likelihood of carious demineralization in dentin as the ICDAS codes increased in severity. The criteria were also found to have discriminatory validity in analyses of social, behavioral and dietary factors associated with dental caries. The reliability of six examiners to classify tooth surfaces by their ICDAS carious status ranged between good to excellent (kappa coefficients ranged between 0.59 and 0.82). While further work is still needed to define caries activity, validate the criteria and their reliability in assessing dental caries on smooth surfaces, and develop a classification system for assessing preventive and restorative treatment needs, this early evaluation of the ICDAS platform has found that the system is practical; has content validity, correlational validity with histological examination of pits and fissures in extracted teeth; and discriminatory validity.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.

First permanent molars with molar incisor hypomineralisation

Molar incisor hypomineralisation (MIH) is a common enamel defect presenting in the first permanent molars (FPM) and permanent incisors. This article presents the clinical findings and management considerations for the FPM with MIH to the general practitioner. The various treatment options are described with emphasis placed on early diagnosis as the most important prognostic factor.

Diagnosis and treatment of molar incisor hypomineralization

Molar incisor hypomineralization (MIH) is a relatively common condition that varies in clinical severity and can result in early loss of the permanent 6-year molars. The etiology of MIH remains unclear, and the diagnosis can be confused with more generalized enamel defects such as those that occur in amelogenesis imperfecta. The management of MIH depends largely on the severity of the enamel defect. Degrees of hypomineralization can range from mild enamel opacities to enamel that readily abrades from the tooth as it emerges into the oral cavity. Usually, severely affected molars are extremely hypersensitive, prone to rapid caries development, and can be difficult to manage in young patients. The purpose of this article is to review approaches to diagnosing and treating MIH.

In vitro quantitative light-induced fluorescence to measure changes in enamel mineralization

A sensitive, quantitative method for investigating changes in enamel mineralization of specimens subjected to in vitro or in situ experimentation is presented. The fluorescence-detecting instrument integrates a Xenon arc light source and an object positioning stage, which makes it particularly suitable for the nondestructive assessment of demineralized or remineralized enamel. We demonstrate the ability of in vitro quantitative light-induced fluorescence (QLF) to quantify changes in mineralization of bovine enamel discs that had been exposed in vitro to a demineralizing gel (n=36) or biofilm-mediated demineralization challenges (n=10), or were carried in situ by three volunteers during a 10-day experiment (n=12). Further experiments show the technique's value for monitoring the extent of remineralization in 36 specimens exposed in vitro to oral multispecies biofilms and document the repeatability of in vitro QLF measurements (n=10) under standardized assay conditions. The validity of the method is illustrated by comparison with transversal microradiography (TMR), the invasive current gold standard for assessing experimental changes in enamel mineralization. Ten discs with 22 measurement areas for comparison demonstrated a positive correlation between TMR and QLF (r=0.82). Filling a technological gap, this QLF system is a promising tool to assay in vitro nondestructively localized changes in mineralization of enamel specimens.

A new in vivo method for measuring caries activity with a colorimeter

The aim of this in vivo study was to assess the association between caries prevalence and changes in mineralization measured with a colorimeter (Color Compare CC 400, JENOPTIK, Jena, Germany). After a clinical examination (defs/DMFS, initial caries lesions), an area of a deciduous tooth was etched in each of the 35 children (psi = 8.11+/-2.41 years) with 37% phosphoric acid gel for 1 min. Immediately after, this demineralization was stained with 2% aqueous methylene blue and the red/green/blue spectrum measured with a colorimeter. Twenty-four hours later, the remineralization of this area was measured following the same staining procedure. Color measurements were clearly reduced after 24 h, indicating remineralization, and they correlated highly with the age of the children (Spearman correlation coefficient r = -0.48, p = 0.004). Correlations between the number of initial caries lesions in the deciduous and permanent dentition and color measurements after demineralization were statistically significant (r = 0.41 and 0.37, p = 0.02 and 0.045, respectively). The difference between the first and second measurements correlated significantly with the number of initial caries lesions in the permanent dentition (r = 0.42, p = 0.02). The values after artificial demineralization correlated with the number of initial lesions for the permanent (r = 0.368, p = 0.045) and deciduous (r = 0.408, p = 0.015) dentition. This resistance to artificial demineralization had stronger correlation coefficients with the caries incidence than the caries experience and initial lesions, which are considered to be the most valid caries predictors. In conclusion, these data suggest that the degree of demineralization after etching and its changes with time could be associated with caries parameters. Its use in prospective clinical trials on caries activity could be a successful approach.

Molar incisor hypomineralization: review and recommendations for clinical management

Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molars (FPMs) that are associated frequently with affected incisors. Etiological associations with systemic conditions or environmental insults during the child's first 3 years have been implicated. The complex care involved in treating affected children must address their behavior and anxiety, aiming to provide a durable restoration under pain-free conditions. The challenges include adequate anaesthesia, suitable cavity design, and choice of restorative materials. Restorations in hypomineralized molars appear to fail frequently; there is little evidence-based literature to facilitate clinical decisions on cavity design and material choice. A 6-step approach to management is described: (1) risk identification; (2) early diagnosis; (3) remineralization and desensitization; (4) prevention of caries and posteruption breakdown; (5) restorations and extractions; and (6) maintenance. The high prevalence of MIH indicates the need for research to clarify etiological factors and improve the durability of restorations in affected teeth. The purpose of this paper was to describe the diagnosis, prevalence, putative etiological factors, and features of hypomineralized enamel in molar incisor hypomineralization and to present a sequential approach to management.

Early caries imaging and monitoring with near-infrared light

Enamel is highly transparent in the near infrared (NIR); therefore, this region of the electromagnetic spectrum is suited ideally for the development of new optical diagnostic tools for the detection and imaging of early dental caries. This article discusses the NIR optical properties of sound and demineralized dental enamel and the potential use of polarization sensitive optical coherence tomography and NIR transillumination for the imaging of dental caries.

[Evaluation of oral health in bulimia nervosa]

AIM

The aim of the study was to evaluate the dental status of bulimics with self inducing vomiting.

METHOD

33 bulimic female patients aged between 17 to 20, who were in need of hospitalization in the Department of Psychiatry, Poznań University of Medical Sciences, were compared to 31 age and sex matched healthy controls aged between 18 to 36. For each subject dental examination including calculation of caries, erosion and oral hygiene indexes: PlI, OHI-S, DMFT and TWI was performed. In both groups salivary flow and pH of the whole saliva were measured.

RESULTS

Bulimics manifest a significantly higher retention of dental plaque and also higher frequency of enamel erosion, which were not present in the control group. Additionally, bulimics had more intense caries. Stimulated and resting salivary flow were poor, although they had the lowest pH values but were within the normal range.

CONCLUSION

Patients with bulimia nervosa showed a higher number and severity of enamel erosion. There is also the high difference in amount of dental plaque, caries and changes in salivary secretion. These results highlight a need for close cooperation between the dentist and the patient's physician, which will then improve the diagnosis and treatment of this disease.

Measurement of the severity of natural smooth surface (interproximal) caries lesions with polarization sensitive optical coherence tomography

BACKGROUND AND OBJECTIVES

Previous studies have demonstrated that polarization sensitive optical coherence tomography (PS-OCT) can be used to image early dental caries. The purpose of this study was to compare the measured reflectivity of natural caries lesions found on smooth surfaces (interproximal lesions) with the mineral loss measured using digital microradiography (DM) in order to determine if PS-OCT can be used as a non-destructive method to measure the severity of dental decay and resolve the internal structure of caries lesions.

MATERIALS AND METHODS

A PS-OCT system operating at 1,310 nm was used to acquire polarization resolved images of natural white spot lesions and pigmented lesions on the smooth surfaces of extracted teeth. The integrated reflectivity from lesion areas was compared to polarized light microscopic images (PLM) and to the integrated mineral loss from the same lesion area measured using high resolution DM.

RESULTS

The frequently complex internal structure of caries lesions could be resolved with PS-OCT. Such structural information is potentially useful for determining whether or not the lesion is active and progressing or whether it has become arrested and remineralized and does not require intervention. There was a strong correlation between the integrated mineral loss of the caries lesions measured using DM and the integrated reflectivity in the perpendicular polarization axis of the PS-OCT system.

CONCLUSIONS

The integrated reflectivity in the perpendicular polarization channel can be used to represent the severity of demineralization in natural early caries lesions. Therefore, PS-OCT has considerable potential as a non-destructive clinical probe of early caries lesions to assess their severity, monitor their progression over-time and potentially assess lesion activity.

Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: anin vivocomparison

The aim of this clinical study was to compare the outcome of quantitative laser/light-induced fluorescence (QLF) and visual inspection (VI) for the detection of initial caries lesions on all maxillary and mandibular smooth surfaces in caries-risk adolescents. The subjects were 34 students, mean age 15 yr. A total of 879 buccal and 882 lingual surfaces were air-dried and visually examined at a magnification of x3.5. Fluorescence images of each smooth surface were captured with QLF\clin equipment, and QLF software 2.00 was used to display, store, and analyse the images. Fluorescence loss (deltaF; %) and area of the lesion (A; mm2), and fluorescence loss integrated over the lesion area (deltaQ; deltaF x A; % x mm2), were determined. The presence or absence of initial caries lesions was scored using both VI and QLF. A total of 87.2% of all smooth surfaces were scored as sound or initially carious when assessed by VI + QLF in combination: 4.9% were detected by VI alone and 7.9% by QLF alone. The parameters DeltaF, A, and DeltaQ differed significantly between lesions registered with VI + QLF and QLF alone. It was concluded that (i) QLF seems to be a sensitive method that is suitable for the detection of visually undetected initial caries lesions; and (ii) that the clinical use of QLF is limited by several confounding factors in caries-risk adolescents.