Caries Detection Tools Keep Making Progress
Improvements in dental caries detection technology continue to be made. Whereas 20 years ago there were few, if any, advanced technologies present in the marketplace, today there are a dozen or more products making claims that they can detect caries lesions, some at a far earlier stage than visual examination or radiography.
The need to detect caries lesions specifically and to assess caries risk in a patient globally could not be greater. As caries rates in preschoolers continue to rise in the United States, and as the world brings more refined sugars into its diets, it appears there will be a worldwide climb in early childhood caries rates. Given that less than 5% of children actually receive a dental examination in a dental home by their first birthday, as recommended by the American Academy of Pediatric Dentistry and the American Dental Association, dental professionals need to partner with colleagues in the healthcare profession as a whole to screen children who use other venues for healthcare at a young age, and direct those at highest risk to a dental home for caries management early and often.
Caries assessment tools that gather environmental and historical data, perhaps along with bacterial tests, will elicit the most information regarding patients at risk for manifesting caries lesions, but not perfectly. There is a high degree of false-positives with some of these methods that are commonly employed. In order to benefit those patients most needing caries management, the dental profession needs a method of precise, specific identification of those at risk for tooth decay.
This author believes that increased specificity—while retaining good sensitivity—of caries lesion “prediction” will be best realized through the use of new technology. It will be because of the continued development of currently available or developing technologies that a patient will be scanned when the earliest stages of the disease process can be detected. If a baby who goes to the pediatrician for a 1-year well-baby visit could get the emerged primary teeth scanned for early disease (disease that would be clinically undetectable), we might be able to isolate that segment (perhaps a large segment in some populations) not only at risk, but already exhibiting disease in the earliest stages, before it has extended into clinical disease requiring surgical intervention.
Several technologies either currently exist or are under development for a specifically targeted product that might be perfected into a device that could examine the lingual surfaces of primary incisors at age 1 year or younger to “look” not at only risk, but for the clinically undetectable early signs of disease. Currently marketed technologies include laser fluorescence, LED examination of enamel contiguity, electrical conductance (impedance), digital fiber-optic transillumination, infrared or near-infrared assessment of mineralization or biofilm activity, and several others. These technologies are used in products that often make claims without clinical evidence.
Where there is clinical evidence available, it has been found that the detection ability of many devices thus far is highly sensitive but yet not adequately specific. It is hoped that these technologies can and will be further developed within the specific scenario of early childhood caries, so that a reliable, sensitive, and specific device can be created. Such a device would “see” the early stages of caries in a young child (or even an adult) that would not require immediate treatment but, through carefully performed clinical studies and documentation, would predict a continued caries process in that patient.
The series of clinical circumstances that ultimately leads to early childhood caries that manifests as lesions in an 18- to 24-month-old child likely exists at the 1-year well-baby visit, when the lesions are still too small to be clinically visible. A new device that would solve this problem will benefit millions of children in this country as well as in developing countries, where there are far too few dentists and where the risks of caries disease in children will lead to a significant health crisis if this path is left unaltered.
About the Author
Joel Berg, DDS, MS
University of Washington School of Dentistry