Searching for caries: Know sooner, know for sure

Digital Radiography 101 | Cynthia K. Brattesani, DDS

I’d like to depart from digital radiography this month and share with you my experiences with another profoundly useful diagnostic tool. As I’ve emphasized in the past, one of the key reasons I make my choices of equipment is to demonstrate to my patients that they come first. A new technology, KaVo’s DIAGNOdent®, enables me to assure my patients that I am providing the best care for them, and it boosts their confidence in my treatment.

Five years ago, I was impressed with research showing that laser scanning, when used in conjunction with the explorer and bitewing radiographs, produced a greater than 40 percent increase in the detection rate of caries over the use of the explorer and X-rays alone. I felt strongly that I owed it to my patients to try this technology. Since then, I’ve been using DIAGNOdent every day. I obtain the absolute best and earliest detection of carious lesions by including this diagnostic approach in my patients’ examinations.

The unit works by measuring caries fluorescence within the tooth. A laser is shined onto the tooth’s surfaces, and the reflected light is analyzed to determine the presence of caries. The results are displayed in numbers on a readout screen on the unit’s small console, or, with the recently developed standalone pen unit, on the handle of the unit itself. Along with the number display, there is an audible sound that increases in intensity as the carious lesion increases in size.

Intraoral camera view of the DIAGNOdent in use (lower quadrant)

Prior to laser scanning, the options for a suspected carious fissure or lesion that didn’t show up on a radiograph were to probe it aggressively, risking possible further damage, or to monitor it over time, taking a chance on further loss of enamel and dentin. Fortunately, we are no longer limited to these means; laser-scanning technology provides a third and highly effective tool for early caries detection.

The implications are very important. Obviously, being able to discover caries at a very early stage means that we can offer more conservative treatment, preserving tooth structure and providing smaller restorations. It also means that we can more confidently choose the right course of treatment.

The application of sealants is a prime example. Prior to laser scanning, I often worried that I might be sealing over undetected caries, which would continue to spread under the sealant. KaVo’s painless laser diagnostic system gives me a high degree of confidence that I am correctly distinguishing those surfaces that are caries-free from those that are not.

Laser scanning also enables me to more actively involve our patients in their diagnoses. After a thorough prophylaxis, we have patients actually hold the small console unit as it rests on their chests. They watch the numbers on the readout and listen for the beeping signal that indicates a potential problem. When patients see it and hear it, they believe it.

If the readings are only slightly elevated, I can confidently tell my patients that we have the option of recording the numbers and monitoring the situation over time. If the readings are sufficiently high, my patients are ready to go along with my recommendation to proceed with immediate treatment. I emphasize to them that because I am able to detect the decay at such an early stage, I can treat the tooth very conservatively. My patients truly appreciate hearing this from me, and it reinforces the message of my practice.

This technology is more than 90 percent accurate in identifying potential problem areas on occlusal surfaces before they can be detected through radiographs or the use of the explorer. What this means is that DIAGNOdent not only affords me a way to know “sooner” and know “for sure,” it also assures my patients that I am using every tool at my disposal to provide them the best possible care. I encourage you to experience for yourself what a higher degree of certainty in caries detection can mean for your practice.

Cynthia Brattesani, DDS, maintains a private practice in San Francisco. She won the prestigious ADA Golden Apple New Dentist Leadership Award in 1996. She is an enthusiastic member of organized dentistry, having held positions at the local, state, and national levels. You may reach her at [email protected].