Table 2 Adjunctive technologies available for clinical carious lesion detection and assessment
From: Minimum intervention oral care: staging and grading dental carious lesions in clinical practice
Technology | Mode of action | Advantages | Disadvantages |
|---|---|---|---|
Fibre-optic transillumination and digital transillumination15,61,62 | Increased light scattering by demineralised dental hard tissues resulting in reduced transmission of light through the tooth | Non-invasive. Allows for immediate interpretation. Colour changes observed may also indicate if lesion extends into dentine | Diagnostic accuracy limited. Some research has shown it to have low sensitivity. Operator experience needed to interpret outcomes |
Blue-violet light is directed onto the tooth surface. Causes excitation of fluorophores within dentine resulting in fluorescence of the tooth. Demineralised enamel and dentine exhibit reduced fluorescence. Images are captured and analysed to determine the amount of demineralisation | Non-invasive. Can provide quantitative values informing extent and allowing monitoring over time. Can support early detection of lesions | Some models require a darkened environment. Interpretation can vary between operators. Training needed. Can be affected by staining or restorations | |
Low energy light is directed at the tooth. Differences observed in energy absorption and subsequent wavelength of emitted light between sound and carious hard tissues | Non-invasive. Immediate feedback. Can provide quantitative values. Intensity of fluorescence detected could indicate lesion extent | Interpretation may vary between operators | |
A low frequency electrical current is passed through the tooth. Demineralised enamel and dentine contain higher concentrations of fluid/ electrolytes, which are more conductive than sound enamel and dentine. The resulting increase in conductance or reduced impedance of the electrical current through the tooth tissue is measured | Non-invasive. Provides quantitative measurements. Can be used for monitoring carious lesions over time | Sensitivity and specificity shown to be variable | |
Imaging is undertaken to assess light emission resulting from a chemical reaction between photoproteins in solution and free calcium ions released from actively demineralising dental hard tissues. The luminescence is recorded by an intra-oral camera and overlaid onto an image of the tooth surface, providing a map of where active demineralisation is occurring | May provide single-visit assessment of carious lesion activity. Early detection of lesions. Non-invasive. Can allow monitoring over time | Operator training needed | |
Machine learning algorithms trained on a wide range of digital images analyse images to identify patterns and features associated with carious lesions | Automated and objective. Can analyse large numbers of images quickly. Demonstrated increased sensitivity for enamel lesions; however, this could lead to invasive intervention earlier than indicated | Accuracy dependent upon size and diversity of training dataset. Validation by dental professionals still advised due to risk of false positive or negatives. Limited benefits in detecting moderate and severe carious lesions |
