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Inside Dentistry

March 2014, Volume 10, Issue 3
Published by AEGIS Communications


Supersizing Prophylaxis Appointments

Intraoral fluorescing camera for early detection of caries, plaque, and gingival inflammation

Jeffrey Rosenberg, DDS

Periodontal disease and dental caries have been implicated as important markers for systemic health; unfortunately, the incidences of both conditions are rising.1,2 Dental caries is due to bacteria and acids in the oral cavity that destroy enamel, resulting in an inflammatory response in the dentin.3 Similarly, periodontal disease is caused by bacteria triggering an inflammatory response in the periodontal tissues.4 These two conditions share a root cause (ie, oral biofilm and inflammation) and may increase the risk for potentially serious consequences (eg, cardiovascular disease5), making early detection and treatment critical.

Once periodontal disease and dental caries are detected, the clinician’s work has only just begun. Helping patients understand the potential impact of these diseases—often before they experience discomfort or pain—may be a significant challenge in some cases. Clinicians need additional tools at their disposal for early detection, to enhance their patient education, and to plan for successful treatment.

Fluorescence Technology

SoproCARE™ (Sopro, part of the Acteon group; www.acteongroup.com) is a high-performance intraoral camera that can help dental professionals improve their abilities to detect biofilm and inflammation. It also effectively highlights tartar, plaque, and gingival inflammation and assists in the detection of occlusal caries.

In addition to the ability to magnify as high as 115x, SoproCARE uses state-of-the-art fluorescence technology. The intraoral camera uses white and blue LED lights to illuminate oral tissues and biofilm with a wavelength of light between 440 and 680 nm. This light is absorbed and reflected back in a phenomenon known as autofluorescence.6

The unique absorptive properties of blue light allow SoproCARE to show caries, dental plaque, and inflammation through different colors. The resulting images can be used in “real time” to help patients understand the presence of and processes behind periodontal disease and caries and prompt them to make responsible, proactive decisions about their oral health.

The Prophylaxis Appointment

SoproCARE has three unique modes—Daylight, Cario, and Perio (Figure 1 and Figure 2). When used in this order, a predictable clinical protocol is developed that, with proper training, can be implemented by general practitioners and other members of the dental team during the prophylaxis appointment.

SoproCARE Protocol

Daylight mode provides natural images of the oral environment, but the high level of magnification allows the operator to detect clinical details invisible to the naked eye. With the camera in the Daylight mode, the operator should start by looking for fissures, cracks in teeth or restorations, and wear for further exploration in the other modes.

The next step is imaging in Cario mode, which uses blue light for visual detection of enamel breakdown and caries. Any carious lesions that were identified in Daylight mode will be readily detectable through the red color in Cario mode (Figure 1).

Perio mode utilizes SoproCARE’s blue and white light to detect oral biofilm and any tissue inflammation (Figure 2). Biofilm is displayed as white for newer plaque and yellow or orange for older plaque. Inflammation of the gingiva can range from pink to deep magenta. The camera can connect to any image management program, making it easy to integrate results into a patient’s chart.

Patient Examination

In addition to the findings from SoproCARE images in the Daylight, Cario, and Perio modes the dentist’s examination includes gathering the following additional information from the patient:

• Medical history/blood pressure

• Patient concerns

• Periodontal conditions/recommendations

• Recall/home care plan

• Follow-up on previous recommendations

• Review of radiographic data, cosmetic issues, bite/wear, etc

With this information readily available, the clinician can initiate a conversation with patients about their unique systemic–oral health status and involve patients in the process of making decisions to improve their oral health.

Risk Assessment/Treatment Planning

The author uses a large monitor as a highly impactful way of sharing the “report card” with patients. The visual representation of current oral biofilm accumulation or tissue inflammation is explained to the patient through the easy-to-understand color-coded system. Furthermore, progression of previously diagnosed conditions and future risk can be discussed. The SoproCARE images can thus begin or continue a discussion of the importance of home care.

Because of the early detection it makes possible, light-induced fluorescence can facilitate earlier, less invasive treatment.7 Suspicious grooves and cervical lesions, for example, can be evaluated to determine the extent of treatment necessary. Repeat imaging with SoproCARE can help clinicians create a record to track disease progression and treatment success, providing continuity between appointments that keeps the patients involved and accountable for their oral health.

Summary

Perhaps more than any other appointment, the prophylaxis appointment provides a unique opportunity for risk assessment and patient education and motivation. In this digital age, the days of handing a patient a mirror to discuss their oral health status are over. The SoproCARE camera represents technology that is familiar to and comfortable for today’s digitally savvy dental patient and also provides state-of-the-art detection for practitioners.

After becoming familiar with the protocol described above, dental professionals will find it easy to incorporate into a practice’s current prophylaxis workflow. SoproCARE and its images facilitate an efficient, comprehensive, co-discovery experience that reinforces the concepts of preventive care, oral–systemic health, and early disease detection.

Disclaimer

Dr. Rosenberg tested a prototype and received a final camera to assist in writing this manuscript.

References

1. Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent. 2009;22(1):3-8.

2. Papapanou PN. The prevalence of periodontitis in the US: forget what you were told. J Dent Res. 2012;91(10):907-908.

3. Southward K. The systemic theory of dental caries. Gen Dent. 2011;59(5):367-375.

4. Ramamoorthy RD, Nallasamy V, Reddy R, et al. A review of C-reactive protein: A diagnostic indicator in periodontal medicine. J Pharm Bioallied Sci. 2012;4(Suppl 2):S422-S426.

5. Nakano K, Nemoto H, Nomura R, et al. Detection of oral bacteria in cardiovascular specimens. Oral Microbiol Immunol. 2009;24(1):64-68.

6. Terrer E, Koubi S, Dionne A, et al. A new concept in restorative dentistry: light-induced fluorescence evaluator for diagnosis and treatment. Part 1: diagnosis and treatment of initial occlusal caries. J Contemp Dent Pract. 2009;10(6):E086-E094.

7. Rosenberg JM, Shuman L, Morgan A. Technology enhances caries diagnosis and treatment. Dent Today. 2011;30(1):162-166.

About the Author

Jeffrey Rosenberg, DDS
Private Practice
Philadelphia, Pennsylvania

For more information, contact:

SoproCARE
856-222-9988
www.soprocare.com


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Image Gallery

Figure 1 Schematic illustration of Perio mode: White at the neck denotes soft deposits; orange
shows calcified deposits and tartar; and red reveals inflamed areas.

Figure 1

Figure 2 Schematic illustration of Cario mode. The areas warning of carious activity appear red.

Figure 2

Figure 3 Pretreatment view of biofilm and apparent stain in Daylight mode.

Figure 3

Figure 4 View of Figure 3 in Perio mode. Soft bacterial deposits are white, calcified deposits are orange-yellow, and inflamed tissues are purplish-pink-red.

Figure 4

Figure 5 View of suspicious grooves in magnified Daylight mode.

Figure 5

Figure 6 The biofilm is removed from the occlusal grooves with air polishing to complete the evaluation. The presence of caries is indicated by the red in Cario mode.

Figure 6