INTRODUCTION

Dental caries is one of the most common chronic disease of modern times
Present concept regarding etiology of caries is

based upon Millers chemoparasitic theory Now dental caries is multifactorial with bacteria , susceptible tooth surface and diet play a major role

Methods of caries detection

In vivo In vitro Single tooth measurements 1 Chemical analysis 2 Cross sectional micro hardness testing 3 Polarized light microscopy 4 Traditional transverse microradiography(TMR) 5 Microprobe analysis

1 Visual examination 2 Tactile examination 3 Radiographic Conventional , digital and xeroradiography 4 Fiber optic transillumination 5 Optical methodsFluorescence, light scattering 6 Electronic resistance measurements 7Ultrasonics 8Dyes

Methods for sequential measurements on tooth slabs 1 Iodine absorbitometry 2 Longitudinal microradiography 3 Light scattering 4 Surface microhardness

Ideal caries diagnostic test must be :

Accurate
Sensitive Specific

Reproducible
Reliable Should not transfer S.mutans or other bacteria from

affected area to unaffected areas Cost effective

Traditional methods
Patient complaint : Patient itself provide hint about the presence of caries Visual examination : Brownish discoloration of pit and fissure Opacity beneath pits and fissures or marginal ridges Frank cavitation of the tooth surface

Ekstrands criteria for presence or absence of occlusal caries

V0
V1 V2 V3

V4

No/Slight change in enamel translucency after prolonged air drying Opacity/discoloration hardly visible on wet surface ,but distinctly visible after air drying Opacity /discoloration distinctly visible without air drying Local enamel breakdown in opaque or discolored enamel and /or grayish discoloration from underlying dentin Cavitation in opaque /discolored enamel exposing dentin

 Use visual examination only ,is known as the

European method Use of blunt or sharp probe in a visual tactile system , known as American method ,for diagnosis of dental caries

Tactile examination
The explorer and the floss used for the tactile examination of the tooth.

Tactile findings suggestive of caries are Softness at the base of a pit or fissure and discontinuity of enamel surface Binding" or catch of the explorer tip Cavitation at the base of a pit or fissure

Uses of explorer condemned because Sharp probe tip cause physical trauma to small lesion Probing may lead to fracture and cavitation in incipient lesion Mechanical binding of explorer lead to the feeling of catch, this may depend on factors such as:
1. Sharp of the fissure 2. Sharpness of the explorer 3. Force of application 4. Path of explorer placement

Uses of floss as an adjunct to tactile sensation

Roughness on tooth surface while using floss is suggestive of caries

Radiographs
In proximal caries detection the radiographs have had a unique place.
The appearance of caries on various surfaces is in

the following order: Interproximal>Occlusal>Buccal > Lingual >Cemental. Intraoral periapical and bitewing radiographs are employed to diagnose dental caries. .

Uses of bitewing radiographs 1. Detecting incipient proximal caries 2. Examining many teeth in one radiographs 3. Checking cervical margins of restorations 4. Noting the size of pulp chambers 5. Monitoring the progress or arrest of caries

Recent methods of caries diagnosis

Xeroradiography The image produced by diagnostic X-rays . The image is recorded on an aluminum plate coated with selenium particles When X-rays are passed onto the film ,it causes selective discharge of the particles which forms a latent image .

Digital radiographic method

Two methods Video recording and digitization of conventional radiograph Direct digital radiograph
First direct digital radiography system in dentistry was Radio Visio Graphy(RVG) It uses charged couple device which works like a miniature video camera Digora image system plate uses phosphorus storage screen

Visible luminescent spectroscopy

The visible emission spectra for decayed and non

decayed regions of teeth differ Quasi monochromic light from a tungsten source dispersed with grating monochromator is focused on the teeth and emission spectra is recorded and analyzed

Computer aided radiographic method

Uses the measurement potential of computers in assessing and recording the size of carious lesions.
It provides graphic visualization of the size and

progression of caries lesion . Various softwares have been developed for automatic interpretation of digital radiographs

Digital subtraction radiography

High quality video camera is used to fed computer

image . Two standardized radiographs produced with identical exposure geometry are used -reference image and subsequent image Reference image is superimposed over the subsequent image and difference can be seen as dark area

Fiber Optic Transillumination

Useful for detection of caries ,calculus and soft tissue lesion
Principle Depend on difference in index of light transmission for decayed and sound tooth Since decayed tooth has a lower index of light transmission than the sound tooth structure ,it appear darkened

Fiber Optic Transillumination

Recent advances of FOTI

Digitally imaged FOTI

The DIFOTI unit early detection of caries without the need to use ionizing radiation Mini D caries
A ligitweight ,pen sized and cordless device that uses fiber optic technology and LEDs to accurately detect both occlusal and interproximal caries

Quantitative laser fluorescence

Quantitative laser fluorescence (QLF) is means by which the laser induced fluorescence can be measured to quantify tooth demineralization. Here the tooth is illuminated with a broad beam of blue light(488nm) from an argon in laser.

 Demineralized enamel appears dark and this

can be recorded on a photographic film or measured by means of computer. Recently, a commercial laser fluorescence system has been introduced called the kavoDIAGNO dent

 (a) White light image of early buccal

caries effecting the maxillary teeth,

(b) QLF image taken at the same time

as

(c) 6 months after the institution of an

oral hygiene programme , the lesions have resolved.

Quantitative laser fluorescence

DIAGNO dent

Criteria to asses carious progression

0-13 : No caries 14-20 :Enamel caries and preventive care advised 21-30 : Dentinal caries and preventive care advised >30 : Operative advised

Based on the principle of fluorescence ,a new

optical method is Photon undulatory non-linear conversion

Electrical conductance measurements

Use of electrical conductance measurements is that sound enamel is an insulator due to its high

inorganic content. Carious enamel has a measurable conductivity which increases with the degree of demineralization. Based on the differences in electrical conductance of sound and carious enamel, two devices were developed in 1980s. a. Vanguard electronic carious detector b. Caries meter

Endoscopic/Videoscope
This method is based on the theory that when a tooth is illuminated with blue light in wavelength of 400-500nm ,sound enamel and caries enamel demonstrate different fluorescence .
When this is viewed through a filter ,white spot lesion appears darker than sound enamel . Additionally ,a camera can be used to store the image .The integration of an intraoral camera with the endoscope is called videoscope

White light fluorescence (WLE)

A white light source is connected to endoscope by a fiberoptic cable and teeth is viewed with a filter

Intraoral television camera (IOTV)

See magnified oral conditions Very high level of sensitivity

Scanning acoustic microscope

Depend on elastic properties of demineralised lesion
It uses frequency of 380MHz ,image is built by

mechanically scanning a focus beam of ultrasound Gives information about the extent and structure of demineralised lesion

Alternating current impedance spectroscopy technique(ACIST)

This is more sophisticated method to detect carious

lesion It characterized by the electrical properties of the tooth and lesion by scanning multiple frequencies of alternating current

Ultrasonic imaging
An ultrasonic probe is used to send and receive sound waves from the surface of the tooth
Normal enamel produce no echoes while initial

white spot lesion produce weak surface echoes and areas with cavitation produce echoes of high amplitude This method is so sensitive

Dyes for detection of caries

Various dyes have been used in the detection of enamel caries and dentinal caries
Enamel caries Calcein ,Zyglo ZL-22

Dentin caries -Fuschin ,Acid red system , 9Aminoacridine

Dyes for detection of caries

Micro Air Abrasion

This method is of particular advantage in examing darkened areas in the bottom of the pit and grooves
If a suspicious darkened area is detected on visual examination ,the air abrasive technology can be used to deliver short burst of alpha alumina powder into the pit and grooves

Micro Air Abrasion

Infrared camera
Used to detect subsurface lesion
It is recognized that there exists expanded porosity in subsurface enamel lesion and that water

occupies the defect Infrared camera can be used to measure the temperature drop on the lesion surface caused by evaporation of water in the body of the lesion

Infra-Red Thermography
This technique has described as method of determining lesion activity rather than determining presence or absence of disease
Thermal radiation energy travel in the form of waves. It is possible to measure changes in the thermal energy when fluid is lost from a lesion by evaporation

Computer tomography
CT can be use in the detection caries
It is a simple method of passing of x-ray through one

side of the tooth and obtaining image on the other side Digital computer assemble the data and provide a cross-sectional image

Tuned Aperture Computed Tomography

With TACT ,it become to visually progress through

slices of the coronal anatomy and observe the region of a clinician can isolate and examine individual projections of a region ,limiting information to the depth of interest in the radiographed volume

Magnetic Resonance MicroImaging

It is non-invasive and non-destructive .Its use allows a specimen to be re-imaged after further exposure to a clinically relevant environment When a magnetic field is applied, the nuclear spins align in a finite number of allowed orientations, if these orientations are perturbed by a pulse of radiofrequency energy ,this energy is absorbed and then retransmitted . It is this retransmitted energy that is detected and thus correlated to the amount of demineralization

Photo stimulable phosphor radiography

A latent image is produced by exposing the storage

phosphor screen with x ray

Micro radiography
Transverse micro-radiography used to quantify

mineral loss Longitudinal micro-radiography- measure mineral changes in the tooth slice with monochromatic xrays

Optical Coherence Tomography

This technique utilizes broad bandwith

light sources and advanced fiber optics to achieve images . Similar to ultrasound ,OCT uses reflection of infrared light to determine not only presence of decay but also the depth of caries progression

Confocal laser scanning microscopy

Operated with argon and Kr ion laser and an appropriate set of filters
The reflected image and fluorescent image are

recorded and analyzed

Terahertz Imaging
Terahertz imaging uses waves with terahertz frequency .This wavelength from a short enough to provide a reasonable resolution but long enough to prevent a serious technique loss of signal due to scattering

Photoconductive emitters of certain crystal (Zinc telluride )exposed to short pulse seconds of visible infrared light would emit electromagnetic wave with the frequency in the terahertz image

Dye enhanced Laser Fluorescence (DELF)

This technique is base o a hypothesis that if a

fluorescent dye penetrates a caries lesion the accuracy of current laser fluorescence for caries detection is enhanced .

Species specific monoclonal antibodies

To recognize the surface of cariogenic bacteria
The probe are tagged with fluorescence molecules that measure quantitatively with spectrometer

Conclusion
Inorder to conserve tooth structure and perform

minimally invasive dentistry ,carious lesions must be detected at the earliest is extremely valuable Recent advances and application of computers in dentistry will surely make caries detection simpler