Advantage of Introducing Quantitative Light-Induced Fluorescence in School Dental Checkups

Objective, safe, and easy-to-use means of evaluating demineralized lesions have not been available outside of dental offices, so dental checkups at schools must primarily rely on visual inspection in Japan. However, dentists have to perform visual inspections of numerous students with insufficient time and light sources. Consequently, the accuracy of school dental checkups in Japan depends on the skill of individual dentist.

Recently, some laser or fluorescence devices used to evaluate carious lesions have been developed. Although in vitro and in vivo studies have reported the reliability of these devices, they have not yet been introduced for use in school dental checkups. In this paper, the authors aimed to evaluate advantages of introducing quantitative light-induced fluorescence-digital (QLF-D) in school oral examinations. 

Three experiments were conducted from May 2014 to March 2016. Experiment No. 1: Three dentists who had professional backgrounds of >3 years performed visual inspections. They inspected early demineralized lesions in incisors and canines in 10 child patients. After the visual inspection, images of the teeth were taken by QLF-D. The numbers of tooth planes with early demineralized lesions were compared between the methods. Experiment No. 2: Demineralized lesions of approximal planes in upper and lower molars excluding distal planes in posterior end molars (48 surfaces) were visually inspected by three dentists who had professional backgrounds of >3 years. Following the visual inspection, the same regions were analyzed by QLF-D under the same conditions. The numbers of tooth planes with demineralized lesions were compared among the methods. Experiment No. 3: Five adult males without past and present systemic illness history whose ages ranged from 27 to 29 years participated in the study as test subjects. The subjects were asked to forego teeth brushing for 60 hours. At 60-hours, images of the upper and lower central incisors, lateral incisors, and canines were taken by QLF-D. After taking the images by QLF-D, plaque was stained by using a traditional staining method (Dent. Liquid Plaque Tester: Lion Corporation, Tokyo, Japan), and oral photographs were taken by using a single-lens reflex camera. Plaque distribution was evaluated in the images taken by QLF-D and the camera, respectively.

Experiment No. 1.: The three dentists found 0.67 tooth planes on average. QLF-D found 22 tooth planes with early demineralized lesions in the same samples. Experiment No. 2.: Fourteen approximal tooth planes of molars were found to have demineralized lesions by x-ray imaging. QLF-D detected 71.4% of the tooth planes out of the 14, whereas visual inspection found 7.1%. Experiment No. 3.: The Pearson’s correlation coefficient for the evaluations of plaque distribution between the QLF-D and traditional staining methods was 0.77 (P < 0.001). No statistically significant systematic error was found through the Bland-Altman Plot analysis. 

In conclusion, QLF-D was a very effective means of detecting both an early demineralized lesion and a demineralized lesion in the approximal tooth plane. And detection by QLF-D of an early demineralized lesion could be useful for encouraging children to receive daily habits and oral hygiene instruction. Also, QLF-D was found to be an effective means of detecting plaque and demineralized lesions in school oral checkups.

Article by Koji Watanabe, et al, from Japan.

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