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An Update on Demineralization/ Remineralization

Course Number: 73

Advancing Approaches for Clinical Caries Measurement

The standard methods for caries diagnosis in the past were the combination of the dental “visual/tactile” examination together with conventional film radiography. Slowly, fiber-optic transillumination became a regular clinical adjunct for caries examination in the clinical setting. The use of laser fluorescence for measuring pit and fissure caries has become a more commonplace clinical instrument. Fiber-optic transillumination advanced further with the use of the DIFOTI™ system, which stands for “Digital Imaging Fiber-Optic Transillumination.” Other caries detection methods include electrical resistance, laser detection devices such as DIAGNOdent and Quantitative Light-induced Fluorescence or QLF™. QLF, for example, is capable of following lesions over time, which can provide important information on both lesion progression and reversal. Conventional radiography is slowly giving way to various forms of digital radiography, and some advances in quantitative digital radiography may not be far off. The NIH caries management symposium cited earlier10 addressed various methods of early detection and caries measurement, but the evidence for implementing most of these fell short of expectations at the time. More recent research has demonstrated that many of these new approaches took the recommendations of the NIH conference to heart and are moving forward to generate more substantial data packages in support of these technical advances. The key concept of all of these approaches is to make early clinical assessments of lesions that can be stopped before they are irreversible and need restoration. It is even more exciting to consider the concept of being able to detect the caries lesions in their very early stages and have quantitative measurements of their condition. The object is then to apply “remineralization” therapy to reverse the lesions through products such as fluoridated toothpastes which are well documented to be clinically effective, while using quantitative early detection methods to assess the progress of our therapy. Specific recommendations for patients, or even specific lesions, could be made and monitored for effectiveness long before intervention with a restoration would be necessary.