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.
Full access: http://suo.im/4wAlf4
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