presentation on denal caries and its prevalence world wide

2. PREVALENCE OF
DENTAL CARIES
Dr.sinu jayaprakash
2nd yr post graduate
Dept of pedodonttics

3. C
O
N
T
E
N
T
S
• Introduction
• Aims of epidemiology
• History
• Global prevalence
• Indian prevalence
• Diagnostic trends
• reference

4. INTRODUCTION
A current review of the available epidemiological data from many countries clearly indicates
that there is a marked increase in the prevalence of dental caries.
This global increase in dental caries prevalence affects children as well as adults, primary as well
as permanent teeth, and coronal as well as root surfaces

5. INTRODUCTION
• The term epidemiology is derived from greek word ‘epion’ the people ‘logos’ means study
• It is the science that deals with study of factors that influence the occurence and distribution
of health, disease defects, disability or death in a group of individuals.
• the study of distribution and determinants of health related states or events in specified
populations and the application of this study to control the health problem
clark 1965)
Last 1988

6. HISTORY
• Dental caries or tooth decay is one of the most common of all disorders, second only to
common cold.
• Dental caries has afflicted more humans longer than any other disease.
• It was first appeared about 1400 BC years ago.
• From that time to the present, dental caries affected almost all human populations, at all
socioeconomic levels, and at all ages.
• Some isolated populations like Eskimos, some African natives, and inhabitants of rural India
are “immune” to dental caries because they are not exposed to western food habits

7. DEFINITION FOR EPIDEMOLOGY
• A branch of medicine or dentistry that deals with the incidence and prevalence of
disease in large population and with the detection of cause and source of disease
(WHO 1985)

8. AIMS OF EPIDEMOLOGY
According to the international epidemological society (iea) the study of epidemology
has 3 basic aims.
• Describe, distribution and magnitude of health and disease problems in human populations.
• Identify etiological factors in pathogenesis of the disease
• Provide data essential to the prevention control, treatment of diseases and setting up of
priorities among these services
• Eliminate /reduce health problems
• Promote the health and wellbeing of society as a whole.

9. USES OF EPIDEMOLOGY
• To know whether the community health is getting better or worse
• To aid in risk assessment and identification of disease
• To analyse clinical decisions
• To provide efficient and effective health services

10. CLASSIFICATION OF EPIDEMIOLOGICAL SURVEYS
DESCRIPITIVE
ANALYTIC
EXPERIMENTAL

11. Descriptive epidemiology:
Which deals with the description and the distribution of disease,with comparison of its frequency
different segments of the same population
Analytic epidemiology
Observational studies designed specifically to examine the hypothesis developed as a result of the
descriptive study
Experimental epidemiology:
Experimental studies on human populations,to test in a stringent manner those hypotheses that
stand the test of observational and analytical studies.

12. PREVALANCE
• The term prevalence refers specifically to all current cases(old or new) existing at all given
point of time, or over a period of time in a given population.
POINT PERIOD

13. POINT PREVALENCE
• Frequency of all diseases in given population at one point of time
• May take day ,several days or weeks depending on population sample.
• Formula:
no:of cases affected by disease at given point of time
Estimated/total population examined at point time
• Also called prevalence rate
• Expressed in %
100

14. PERIOD PREVALANCE
• Less commonly used
• Measures the frequency of all current cases existing during defined period of time
• Formula:
Total no:of affected cases during given period of time
Estimated population examined at risk
100

15. INCIDENCE RATE
• Defined as the number of new cases occurring in a given population during specified period
of time.
• Formula:
No:of new cases of specific diseases during given period of time
Population or total no:of cases examined
100

16. DMFT
DMFS
Average no:of decayed,missing or filled permanent teeth in a individual or child at that
particular age
Refers to the average no of decayed missing due to caries or filled permanent tooth
surface in an individual or child at particular population of specified age group

17. • Dmft/dmfs
Deft/defs
Refers to average number of decayed, missing due to caries or filled primary
teeth/surface children at specified age group
Average no:of decayed, extracted due to caries or indicated for extraction and filled
primary teeth/surfaces resp of child at specified age group
• To differentiate b/n natural exfoliation from missing due to caries

18. FACTORS AFFECTING DMF TEETH
SOCIOECONOMIC
STATUS
• Low socioeconomic
status caries rate high
FAMILY HISTORY
• High s.mutans and
lactobacillus count in
mother are associated
with high caries rate in
child
SUGAR CONSUMPTION
• High correlation b/n
form, frequency and
duration of sugar
consumption and
dental caries
FLOURIDE
EXPOSURE
• High
exposure to
fluoride,
lower is
caries status

19. RISK FACTORS FOR CARIES
• High level of s.mutans ,lactobacilli and other bacterial species
• Frequent ingestion of sugar over a long period of time
• Inadequate access to dental care
• Low socioeconomic status
• Inadequate salivary flow or lack of buffering capacity

20. GLOBAL PREVALENCE OF DENTAL CARIES

21. DISTRIBUTION OF DENTAL CARIES
ACCORDING TO WHO REGIONS
• The oral health of children at12 years old is the object of several epidemiological studies conducted
around the world.
• According to the world health organization (1997), the importance given to this age group is due to
this age that children leave primary school.
• It is possible that at this age all the permanent teeth except third molars, have already erupted.
• Thus, the age of 12 was determined as the age of global monitoring of caries for international
comparisons and monitoring of disease trends

22. • DMFT index, the average worldwide was 2.11 (± 1.32).
• Half the country had about 1.8 teeth decayed, missing or filled.
• Values ranged from 0.2 to 7.8.

23. • It is observed that the american region (amro) and the europe region (euro) present a risk of
1.14 and 1.10 times higher than the average in the world
• Average increase in PAR is 14% and 10%, respectively.
• Afro region was with a 19% lower risk compared to the average of all countries surveyed.

25. • Spatial distribution of caries at 12 years-old in the world according to quartiles.
• High dmft indices in most countries of south america, northern europe and south asia.
• A significant proportion of african countries have low rates of caries.

26. • WHO AFRICAN REGION (AFRO) • The WHO African region have 46 countries.
• The data ranged from 1977 to 2004
• With respect to the DMFT index, there was an
average of 1.7 (± 1.3). the region does not present a
precarious scenario.
• Relative risk it was found that Mozambique had a risk
3.2 times higher than the average for the region.
• Tongo and Tanzania already had PAR 82.5% lower
than the regional average.

28. WHO REGION OF AMERICA
• The region of the America have 47 countries.
• 40 countries had data on caries
• The DMFT index showed an average of 2.4 (± 1.4).
• Half of the countries had DMFT equal to 2.1.
• With the highest levels found in Ecuador and Martinique (6.3
and 5.2, respectively).
• Belize and Haiti had low (0.60 and 0.65 respectively).

30. WHO REGION OF SOUTH ASIA
• Southeast Asian region consists of 11 countries.
• (East Timor) had no data on dental caries
• The average years of studies completed was 1999.
• The studies ranged from 1984 to 2008
• The DMFT index showed an average of 1.95 (± 1.24) and a
median of 1.65.
• The minimum and maximum values were 0.50 to 3.94,
respectively.
• India and Thailand respectively show a PAR of 101.84% and
89.55% more caries compared to the reference value.

31. • Nepal and Sri Lanka - lowest risk being about 74% and 54% .
• It was observed that India, Thailand, Indonesia and Korea are in the categories of risk (RR> 1.00)
for the highest DMFT.

33. WHO EUROPEAN REGION (EURO)
• European region comprises 53 countries.
• Data from 51 countries were available.
• The average publication year was 1998.
• The surveys ranged from the years 1973 to 2008.
• The mean dmft index was 2.3 (± 1.3).
• Half of the countries in the region of europe had 2.2 teeth
decayed, missing or filled teeth.
• Index ranged from 0.7 to 7.8.
• According to the par, it was observed that
most western european countries have lower risks compared to
the regional average.

35. WHO EASTERN MEDITERRANEAN REGION (EMRO)
• Comprising the EMRO region 21 countries.
• Data on caries was available for 20 countries
• Only quatar did not provide data.
• Researches ranged from 1987 to 2008.
• Average dmft index found in the region was 2 (± 1.3).
• Half of the countries had a index of 1.6 and the values ranged from 0.4 to 5.9.
• Dmft-it is observed that only four countries (20%) had higher values than the
target recommended by who in 2000 (dmft = 3).
• They are: saudi arabia, lebanon, jordan and yemen.

37. • Saudi Arabia presented a RR three times higher than the regional average,
followed by Lebanon and Jordan with RR of 1.7.
• Egypt and Sudan appeared to countries with lower risks, respectively, 0.20 and 0.25 and Libya
with RR of 0.45.

38. WHO WESTERN PACIFIC REGION (WPRO)
• The WPRO comprises 27 countries.
• available for 24 countries in the region.
• The researches ranged between 1984 and 2007.
• DMFT index, the average for the region was 1.93 (± 0.9). Half of the
countries had an index of 1.75.
• PAR - six countries had a higher risk with reference to the regional
average.
• Brunei Darussalam had an increase of 127% in the risk of caries,
followed by the Republic of Korea
and Tonga (both with an increase of 47%), Philippines (37%),
Islands (28%) and
Samoa (18%).
• Singapore, Kiribati, China and Australia showed a 52% lower risk
• RR with reference to the regional average-more risk in the
Philippines, Korea, Mongolia and Vietnam.

40. PREVALENCE OF DENTAL CARIES IN
INDIA

41. DENTAL CARIES IN INDIA
• 1939 Taylor and day reported low prevalence of dental caries in children from kangra valley which is
a part of N.Punjab at that time.
• 1940,day and tendon carried out an investigation in another group of children in Punjab and
reported dental caries prevalence is less in india compared to American children.
• 1941,shourie,KL conducted multicentric epidemiological investigation involving sample of 6866
children in various parts of the country(delhi,ajmer,madras ) age group of 5-8yrs
• 1985-86,tewari and others conducted a nationwide epidemiological study covering 19 states,2
union territories involving age group 5-6 yrs,15yrs and 30-35 yrs

42. DENTAL CARIES IN INDIAN CHILDREN BELOW 5YRS
• Only few investigations carried out in India due to difficulty in obtaining sample,
uncooperative behaviour of young children, difficulty in detailed examination.
• The available data from Karnataka, West Bengal & Chandigarh indicate that dental
is very low in first year of life. Prevalence 1%
• At age of 3 almost half of primary tooth is carious (deft 0.4). % of children affected is
13.2 to 23%. (Chandigarh)
• At 5 year age almost half of the children are affected,
• Prevalence in Karnataka is 66.3% at 4-5 yr age in urban population. Rural 58.4%
• Avg deft figures are 2.9 & 2.3 respectively.
• Calcutta low caries rate : 25.9% (Sarkar & choudary)

43. • Ashima etal, northern india, Prevalence of dental caries at 5 yr age : 48%, deft avg 2.7
• Socioeconomic has a negative association with caries status.
• Kuriakose , Trivandrum in pre-school children is 57%, among 600 children examined.
• Mean dmft is 2.58 and mean dmfs is 4.10.
• Caries severity was highest in low income group with dmft 3.18 (high income group), 1.95 (low
income group).

44. PREVALENCE OF DENTAL CARIES IN 5-6 YR OLD CHILDREN
• Chopra et al 1995, Aboher rural), prev 24% deft 0.6
• (Kavita etal 1984, Lucknow), deft 4.4,prev 89%
• Tiwary in Haryana prevalence in 113 primary school children of 5 yrs: 36.3%, dmft 0.87
• 157 children of 6 yrs showed 38.2 %, dmft 0.91.
• Deciduous molars were most affected by caries.
• Mandal et al, Bengal, Orissa, Sikkim Prevalence of restored teeth was 1.2 %. deft 1.86, 2.36 & 2.5
in urban areas, 1.48, 1.59, 0.70 in rural areas.
• Sharma et al from Meghalaya deft 6.36, Manipur deft 5.53, Assam deft 5.35, Nagaland deft 6.40 in
urban area.
• Sehgal in 1960, Anita 1962, Damley 1985 Mumbai( found high deft figures. 5.9, 6.64, 5.3 respectively.

45. • Gupta etal from Karnataka, Andhra & Kerala, deft to be low as 0.6 in Bangalore rural, 0.83 in
Hyderabad rural, high in Trivandrum 2.10
• Rao et al 1999 in Darward deft is 0.01 to 0.03. , Udupy deft is 0.2,
• Gopinath V.K(Chennai) 3-6 yr was 36 % with DMFT 0.17 & 0.06 for males and females.
• Ratnakumari from Trivandrum 67.5%, in 6 yr old children. With DMFT 1.40 and dmft 2.42
•

46. AGE 12 YR
• Eastern region DMFT + dmft is 2.0 ( Calcutta-Urban & Orissa-Urban &Rural)
• Hariprakash (1993), Norbo(1998), Singh AA(1999)- 1.2, 0.86, 1.01 respectively indicating caries
rate has increased recently.
• Southern region, Shaury (1942) in Tamil nadu reported 55% with DMFT 1.5
• Nagaraja rao from Uduppy ( 1980) DMFT 4.1

47. ADULT POPULATION
• Northern region , Damley reported DMFT 1.7 in rural areas of Haryana
• Tiwary et al in UP, Haryana, J&K, chandigarh: DMFT in 30-35 yrs, 1.13, 1.5, 4.9, 4.38, in urban
1.22, 3.04, 5.8, 4.36 in rural
• Eastern states, Tiwary & Huda in 30-35 yrs found to be 1.75 in urban and 1.85 in rural areas.
• Southern India, Tamil nadu by Ramachandra et al 1973, 2.88 in urban area, 2.10 in rural area.
• Gupta et al, Kerala, A.P, Karnataka found to be 2 in urban area, 1.0 in rural area.

48. AGE 15
• Shaury 1941 , DMFT 1.2, from Urban Delhi. 1.1 in rural Delhi.
• Tiwary & Chawla 1977, in Chandigarh urban area show high prevalence DMFT 4.7
• Gauba et al from Punjab DMFT 5.0
• Tiwary etal 1985 DMFT 4.4 from Kashmir
• Damley in 1985 reported 4.7 from urban Mumbai. Which declined to 1.99 in recent
investigations by Damley in 1988
• Gupta et al 1987, disease is low compared to western region in the southern states
• Karnataka 2.0, Andhra & kerala is 1.0, Calicut 1.9, Trivandrum 0.98. Rural areas of Kerala,
Andhra and Karnataka ranges from 0.91 – 1.07 ( Gupta et al)

49. To conclude dental caries was prevalent more in u rban area compared to rural area. Decayed
component contributed maximum to total deft/DMFT and defs/DMFS, followed by e/m (missing
due to caries), and f/F ( filling component).

50. DIAGNOSTIC TRENDS

51. What is diagnosis?
• Diagnosis is an art and science that results from the synthesis of scientific knowledge, clinical
experience, intuition & common sense
Caries diagnosis
• Implies deciding whether a lesion is active, progressing rapidly or slowly or whether is already
arrested

52. ASSESSMENT TOOLS
Stepwise progression toward diagnosis & treatment planning depends on thorough assessment
of the following
• Patient History
• Clinical examination
• Nutritional analysis
• Salivary analysis
• Radiographic assessment

54. CONVENTIONAL METHODS OF CARIES
DETECTION
• VISUAL-TACTILE METHOD
• RADIOGRAPHY
• CARIES DETECTING DYES
• FIBEROPTIC TRANSILLUMINATION
• ELECTRONIC CARIES MONITOR

55. HIGH RISK LOW RISK
Medical history Medical history
Medically comprimised No such problem
xerostomia
Long term cariogenic medicine
Social history Social history
Socially deprived Middle class
High caries in siblings Low caries in sibling
Low knowledge of caries High knowledge of caries

56. HIGH RISK/LOW RISK
Dietry habits Dietry habits
Sugar intake: frequent infrequent
Use of flourides Use of flourides
Non fluoridated area Fluoridated area
No fluoride supplement Fluoride supplements used
No plaque control Plaque control
Poor oral hygiene Good oral hygiene
saliva saliva
Low flow rate and buffering capacity Normal flow rate and buffering capacity
Increase s.mutans and lactobacillus Decrease s.mutans and lactobacillus

57. HIGH RISK/LOW RISK
Clinical evidence Clinical evidence
New lesion No new lesion
Premature extractions No extraction for caries
Anterior caries resn Sound anterior teeth
Multiple/repeated restoration No/few restoration
No fissure sealant Fissure sealant
Multi-band orthodontics No appliances

58. VISUAL-TACTILE METHODS
VISUAL METHODS:
• Detection of white spot, discoloration / frank cavitations
Without aids, unreliable
• Magnification loupes- head worn prism loupes (X 4.5) or surgical microscopes(x 16) may be
used
• They are comfort, relatively inexpensive, available in various magnification
• Use of temporary elective tooth separation

59. • TACTILE METHODS:
• Explorers are widely used for the detection of carious tooth structure
Right angled probe- no.6
Back action probe- no.17
Shepherd's crook- no. 23
Cowhorn with curved ends- no.2
• Dental floss

60. Use of explorer is not advocated y??
• Sharp tips physically damage small lesions with intact surfaces
• Probing can cause fracture & cavitation of incipient lesion. It may spread the organism in the
mouth
• Mechanical binding may be due to non-carious reasons
Shape of fissure
Sharpness of explorer
Force of application
Path of explorer placement

61. Use of explorer
• Explorer is useful to remove plaque and debris and check the surface characteristics of
suspected carious lesions.
• Gentle pressure just required to blanch a fingernail without causing any pain or damage
• All surfaces of a tooth are cleaned of debris and plaque, using an air syringe and examined
visually. Suspicious areas are explored to check for the surface texture

62. SMOOTH SURFACE CARIES
Non- cavitated:
• No signs of cavitation after visual or tactile examination.
• Location: where dental plaque accumulates (gingival margin).
• Surface characteristics: Matted (not glossy) when a tooth is dried.
Areas of demineralization
• not in close proximity to the gingival margin
• not covered by plaque
• smooth and glossy -not active non-cavitated carious lesions .
Visual enamel opacity under sound marginal ridge indicate undermined enamel due to dental
caries -non-cavitated carious lesion in dentin

63. Cavitated Lesions:
• Where there is visual breakdown of a tooth surface, it is classified as cavitated carious lesion.
active cavity on a smooth surface has soft walls or floors shown below
Questionable Area:
• All stained smooth coronal tooth surfaces that do not have the characteristics of non-
or cavitated lesions are classified as questionable

64. Caries in Pit or Fissure Surfaces
• All discolored areas should be explored using gentle pressure.
• There is no need to penetrate a suspected lesion with an explorer.
• If a discolored and non-cavitated area is soft when explored, it is recorded as non-cavitated
carious pit or fissure .
• A cavity is detected when there is an actual hole in the tooth in which an explorer could easily
enter the space.
• An active cavity has soft walls or floors (detected using gentle exploring)
• If there is visual enamel opacity under an ostensibly sound or stained pit or fissure, then the
enamel is undermined because of dental caries and the tooth surface is classified with a non-
cavitated carious lesion in dentin

65. ROOT CARIES
• Root surface caries comprises of a continuum of changes ranging from minute discolored
areas to cavitation that may extend into the pulp
• For diagnostic purpose; they may be:
Active root surface lesion:
• well-defined area showing yellowish or light brown discoloration
• covered by visible plaque
• presence of softening/ leathery consistency on probing with moderate pressure

66. Inactive root surface lesion (arrested):
• well-defined dark brown/ black discoloration
• smooth and shiny
• hard on probing with moderate pressure
Arrested Caries
• Arrested (remineralized) lesions can be observed clinically as intact, but discolored, usually
or black spots.
• The change in color is presumably due to trapped organic debris and metallic ions within the
enamel.
• These discolored, remineralized lesions are intact and are highly resistant to subsequent caries .
The arrested caries need not be removed

67. Recurrent caries
• It is diagnosed whenever there is softness due to caries at a defective margin, and when the
of a periodontal probe can enter the defect without any resistance.
• A restoration with a discolored margin or a small marginal ditch (<0.5 mm or the head of the
probe) is recorded as an early recurrent carious area .
• A larger defect should be classified as advanced recurrent carious area

68. RADIOGRAPHY
• Carious lesions are detectable radiographically when there has been enough demineralization
to allow it to be differentiate from normal
• They are valuable in detecting proximal caries which may go undetected during clinical
examination.
• On average they have around 50% to 70% sensitivity in detecting carious lesions.
• 40% demineralization is required for definitive decision on caries

69. Radiographic examinations include;
• Bitewing radiographs
• IOPA radiographs using paralleling technique
• Dental panoramic tomograph
• The two important decisions related to radiographic examination are
(1) when to take a radiograph and
(2) how to evaluate a radiograph for presence of signs of dentalcaries

70. Incipient occlusal lesions:
• Not very effective.
• Caries starts on the walls of the pits & fissures and tends to spread perpendicular to the DEJ
• Only detectable change is a fine gray shadow at the DEJ.
Moderate occlusal lesions:
• First to induce specific changes helping in a definitive diagnosis
• Broad based, thin radiolucent zone in dentin with minimal or no changes in enamel
• Presence of a band of increased opacity between the lesion and the pulp chamber due to
calcification within primary dentin
• This feature is not seen in buccal caries
OCCLUSAL CARIES

71. Severe occlusal lesions:
• Readily observed both clinically and radiographically
• Appear as large cavities in the crowns of the teeth
• However pulp exposure cannot be determined

72. PROXIMAL CARIES
Incipient lesions:
• Commonly seen in the caries-susceptible zone
• Presents as a notch on the outer surface not involving more than half of enamel
• Diagnosis can be missed, best viewed under a magnifying glass.
• Density along the proximal surface is high which does not permit the detection of loss of small
amounts of mineral content
Moderate proximal lesions:
• Involve more than outer half of enamel but do not extend into DEJ
• May have one of type of appearance:
67% - triangle with broad base towards outer surface
16% - a diffuse radiolucent image
17% - combination of both

73. Advanced proximal lesions:
• Radiolucent triangular cone invading into the dentin
• In addition, it spreads along the DEJ and subsequently into dentin
• This forms a 2 nd cone with base at DEJ
• Does not involve more than half of dentin
• In some cases, lesions penetrated into dentin may appear not to have penetrated enamel
Severe proximal lesions:
• Penetrating more than half of dentin
• Narrow path through enamel, an expanded radiolucency at DEJ, with a progress towards pulp
• Lesions may or may not appear to involve pulp
• Undermined enamel fractures under masticatory load leaving a large cavity

74. Facial & Lingual Caries
• They start as round lesions and enlarge to become elliptical or semilunar
• Presence of well defined non-carious enamel around radiolucency
• When superimposed on DEJ, they may mimic occlusal caries
• Clinical examination helps in definitive diagnosis

75. ROOT SURFACE CARIES
• Also called cemental caries with an incidence of 40%- 70% of the aged population
• Buccal, lingual, proximal
• Usually it is a lesion of dentin associated with recession
• defined, saucer-like radiolucency

76. RECURRENT CARIES
• Occurs immediately next to restorations
• Results from microleakage or residual caries
• Incidence- 16%
• Radiolucency depends on amount of demineralization & extent of restoration
• Mesio/disto-gingival & occlusal margins- clearly seen
• Under facial/ lingual restorations-difficult to detect
• Materials like Ca(OH),composite & silicate cements

77. OTHER RADIOGRAPHIC SHADOWS
• Radiolucent Cervical Burn out:
1. Evident at the neck of tooth well demarcated above by enamel cap& below by
alveolar bone level
2. It is triangular in shape being less apparent at the center of tooth - good alveolar
bone height will enhance cervical burn-out
• Radiopaque zone beneath amalgam restorations
• Tin & zinc ions are released into underlying dentin

78. • Bitewing radiograph were used for diagnosis of proximal decay,because caries tends
to occur most frequently just below the contact point either mesially or distally.
• Today bitewing radiograph are in use for detection of hidden occlusal dentin lesions.
• The use of radiograph must be intrepretated with cauton as it presents a two
dimensional object.
• Another aspect is that net mineral loss must exceed atleast 20% -30% in order to be
radiographically visible

79. Pitfalls Of Radiography
• 2 dimensional view of 3 dimensional object
• Radiographic depth of a lesion is often less than actual depth
• Overlapping of proximal surfaces on a radiograph
• Occlusal (incipient) caries of enamel difficult to detect
• Dental anomalies like hypoplastic pits mimic proximal caries
• Cervical burnout often confused with root caries

80. TOOTH SEPARATION
• Separating the teeth for visualizing the posterior approximal surface
has been known since the last century.
• Use of orthodontic modulus or bands
• Taking impressions of the approximal surfaces thus separated have
been used to assist in the detection of cavitation

81. RECENT ADDITION TO CARIES DECTECTION
• Fibroptic transillumination
• Electrical conductance measurement
• Direct digital radiography
• Digital fiberoptic transllumination
• Xeroradiography
• Laser luminescence
• Optical caries monitor
• Ultra sound
• Endoscopic method of caries dectection
• visible luminescent spectroscopy
• Caries detector dyes:diagnodent

82. Research in the past two decades has lead to the development of new technologies that asses
changes in fluorescence of enamel & dentin due to loss of mineral
Benedict- 1929, normal teeth fluorescence
Optical methods used are
Quantitative light- induced fluorescence- QLF™
Infrared laser fluorescence - DIAGNOdent

83. FIBEROPTIC TRANSILLUMINATOR
• Known since a lot of years but rarely used
• A shadow visible in dentine has been suggested as the criteria
• Doesnot dectect small lesions
• Use is limited
• Different index of light transmission for decayed & sound tooth. Decayed
tooth structure has decreased index & appears dark
• The tooth is illuminated using fiberoptics
• Have a high level intra & inter-examiner variability
• Digital imaging FOTI introduced, images captured by a CCD camera & fed into
the computer for image analysis
• DIFOTI can detect caries on all types of teeth & also detect incipient &
recurrent caries before their visibility on radiographs

84. XERORADIOGRAPHY
• It is similar to photocopy machine
• Consists of Aluminum plate coated with selenium which provides a uniform electrostatic charge
• X- rays - selective discharge of particles - Latent image
• Processing unit: Latent image - positive image
• Very good Edge enhancement i.e., differentiating areas with different densities
• Twice more sensitive than D speed film, but equivalent to E speed film
• Differ from conventional x-rays by demonstrating a broader latitude of enhancement called edge
exposure
• Due to small structures and area of subtle density difference are made more visible

85. • Advantages:
1. More convinence
2. Reduction in radiation dose
3. economical
Disadvantages:
1.
Electrostatic charge may cause
patient discomfort
2.
Processing to be completed by
15 minutes

86. DIGITAL IMAGING
• Proposed by pitts and senson 1986
• A digital image is an image formed & represented by a spatially distributed set of discrete
sensors & pixels
• 2 types of non- film receptors
• Direct digital imaging – digital image receptor
• Indirect digital imaging – video camera for forming digital images of a radiograph
• Two types of detectors are used in Direct digital imaging
• Photostimulable phosphor ( PSP) –barium fluorohalide
• Charged couple device (CCD) – silicon
• Image is stored on a computer

87. 4 MAJOR COMPONENTS
• x-ray image detection
• Digitalization
• Image processing
• Image display
Advantages
• Image manipulation
• Reduction in the radiation
• Ability to enlarge specific
area
• Reversibilty of image and
use of colour

88. SUBTRACTION RADIOGRAPHY
• Structured noise is reduced in order to increase the detectablity of changes in the radiograph
• Structured noise refers to the information on the radiograph which have no diagnostic value
• It requires 2 identical images. The subtracted image is a combination of these two,
representing a difference in their densities
• Sensitive enough to detect changes of 0.12 mm
• 90% accurate in detecting mineral loss upto 5%
• Black end of gray scale suitable for proximal & recurrent caries
• Contrast can be enhanced with color aid

89. DYES FOR CARIES DETECTION
• They selectively complex with carious tooth structure which is later disclosed with the help of
fluorescence
• Aids in both quantitative & qualitative analysis of the lesion
DYES FOR ENAMEL CARIES:
Procion: N2 & (OH) groups irreversibly complex with caries
Acts as a fixative
Calcein: complexes with calcium & remains bound to the tooth
Zyglo ZL-22: fluorescent tracer dye, not used in vivo
Brilliant blue: 10% aqueous Brilliant Blue , not used in vivo

90. DYES FOR DENTIN CARIES
• 1% acid red 52 in propylene glycol
complexes specifically with
denatured collagen, hence used to
differentiate infected and affected
dentin
• Iodine penetration method (Pot
iodide) for evaluating enamel
permeability
DISADVANTAGES
• Dye staining and bacterial penetration are independent
phenomena, hence no actual quantification
• They also stain food debris, enamel pellicle, other organic
matter
• Dye aided carious removal- laborious
• Stains DEJ

91. ELECTRIC MEASUREMENTS FOR CARIES
• First proposed by Magitot in 1878
• Tooth demineralization due to caries process causes increased porosity of tooth structure.
• This porosity contains fluid containing ions.
• This leads increased electrical conductivity, conversely, leads to decreased electrical resistance
or impedance
• ECM device uses a fixed-frequency (23 Hz)alternating current which measures ‘bulk
resistance’ of tooth

92. • Two systems Vangaurd system – 25 Hz – ordinal scale of 0 –9
• Caries meter L – 400 Hz – 4 colored lights
green –no caries
yellow – enamel caries
orange – dentin caries
red –pulp involvement

93. ECM limited to occlusal sites.
• Cannot be used where amalgam filling is present
• Materials have different responses at different frequencies.
Electrical Impedance Spectroscopy (EIS) operates over different frequencies & thus determine
more accurately than these differences.
EIS can be used on both occlusal & proximal surfaces

94. Factors affecting electrical measurements
• 1. Porosity
• 2. Surface area
• 3. Thickness of the tissues
• 4. Hydration of enamel
• 5. Temperature
• 6. Concentrations of ions in the dental tissue fluids

95. ORIGIN OF FLUORESCENCESOUND ENAMEL:
• Baseline fluorescence is a result of inorganic matter & organic molecules
• Whiter teeth < darker teeth
• Fluorescence is a result of absorption ie, electrons move to higher states following absorption
& fall back to their original states , emitting energy in form of light
• False positives: Calculus Composite restoration Remnants of polishing paste Stain

96. CARIOUS ENAMEL:
• Light scattering in lesion- light path shorter than that in enamel
• Light scattering acts as a barrier for the excitation light penetrating dentin
• Besides scattering of light, bacteria & their metabolites can contribute to fluorescence
• Proved by agar diffusion test
• Bacterial metabolites like protoporphyrins &meso- porphyrins produce intense fluorescence
red spectral region

97. Quantitative Light-induced Fluorescence
• Detection of carious lesion & quantifying mineral loss
• Argon ion laser(488nm) / Xenon arc lamp Blue light transmitting filter
• ↓ Fluorescence of enamel- demineralized areas appear as dark spots
• ↓ Passes thro’ high pass filter
• ↓ Captured on CCD
• ↓ Transferred to computer thro’ a frame grabber

98. Hardware consists of:
• measurement probe
– transmits monochromatic light Control unit
– illumination device & imaging electronics Computer fitted with frame grabber
– digitalize image from CCD•
• Good reliability & reproducibility

99. • acquiration of measurement results with high precision and repeatability; easy use, reliable
software measurement cycles
• The contrast between demineralised enamel and sound enamel has almost increased by a factor
ten
• other things can be detected and quantified also, like dental plaque, calculus, and staining

100. Applications:
• Quantify in situ effects of fluoride treatments on demineralization of enamel lesion
• Monitor caries activity in orthodontic patient
• Evaluative caries preventive measures in caries prone patients
• Longitudinal quantification of incipient caries lesion on smooth surface
• QLF technology must be combined with visual examination in order to detect hypocalcified
area due to development defects, fluorosis

101. DIAGNODENT – KAVO
• Spectral investigation of carious teeth revealed that good contrast between sound and
enamel
• Fluorescence: carious teeth > sound teeth
• Intensity of fluorescence: 655nm < 488nm (QLF)
• But contrast between sound & carious tooth is better in 655nm
• Infra-red rays are less absorbed by enamel , hence penetrate deeper into dentin & fluoresce
carious dentin

102. Component parts:
• Laser diode – 655nm, modulated at 1mW peak power - excitation light source - modulated
eliminate long λ ambient light also passing thro’ the filter
• Photodiode + long pass filter - detector - transmission >680nm long pass filter – absorbs
scattering
• Optical fiber – transmit excitation light - bundle of 9 fibers arranged concentrically around
optical fiber
• Digital display – quantitatively analyze fluorescence

103. Procedure.
• 1. Clean tooth surfaces preferably with an air polishing device (e.g. PROPHYflex) to completely
remove plaque, stains and calculus from fissure areas.
• 2. Dry the tooth.
• 3. Perform clinical examination
• 4. Diagnose and evaluate quantitative measurement of DIAGNOdent

104. Use of DIAGNOdent:
• Baseline value: record fluorescence of sound spot on the smooth surface of tooth. This value
the subtracted electronically from the fluorescence on the site to be measured
• Occlusal tip & smooth surface tip
• Maximum fluorescence value is indicated by rising tone
• Decision making for operative intervention set peak value at 30, ↓sensitivity but ↑specificity
safety fraction for stained fissures/ calculus

105. Interpretation of values:
• Display Therapy: value: 0 - 14 No special measures.
• 15 - 20 Usual prophylactic measures.
• 21 - 30 More intensive prophylaxis or restoration:
• indication is dependent on
•caries activity.
•caries risk.
•recall interval, etc. from 30 Restoration and more intensive prophylaxis.

106. Uses of DIAGNOdent:
• To measure both sensitivity & specificity of lesions
• Detection of occlusal & accessible smooth surface caries
• Decision making for operative intervention
• Reproducible method for caries detection epsl at D2 & D3 levels
• Longitudinal monitoring of caries
Disadvantages:
• Measures false positives
• Not useful in approximal caries detection
• Lack of repositioning systems that may affect reproducibility of results

107. REFERENCE
• Epidemiology of Dental Caries in the World
Rafael da Silveira MoreiraCentro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz,
Recife, Pernambuco Brasil
• Textbook of pediatric dentistry prof.s.g damle
• Textbook of public healthy dentistry,soban peter