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VOLUME 20 , ISSUE 10 ( October, 2019 ) > List of Articles


Performance of Fluorescence-based Systems in Early Caries Detection: A Public Health Issue

Elodie Terrer, Amel Slimani, Nicolas Giraudeau, Bernard Levallois, Paul Tramini, Eric Bonte, Chau Hua, Marion Lucchini, Dominique Seux, Béatrice Thivichon, Anne Le Goff, Frédéric Cuisinier, Hervé Tassery

Keywords : Advanced diagnostic methods, Cohort study, Dental caries, Dental health, Epidemiology, Prevention

Citation Information : Terrer E, Slimani A, Giraudeau N, Levallois B, Tramini P, Bonte E, Hua C, Lucchini M, Seux D, Thivichon B, Le Goff A, Cuisinier F, Tassery H. Performance of Fluorescence-based Systems in Early Caries Detection: A Public Health Issue. J Contemp Dent Pract 2019; 20 (10):1126-1132.

DOI: 10.5005/jp-journals-10024-2665

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Modern clinical caries management involves early stage caries diagnosis and should fit with dental health policy. The objective of this study was to achieve early caries detection in enamel and dentine with a laser-based system (DIAGNOdent™ pen) first and secondary with a new fluorescence intra-oral camera (Soprolife®). A visual inspection with a loupe was used as control. Materials and methods: Following the consolidated standards of reporting trials recommendations, 628 occlusal fissures were included for analysis. Results: The sensitivity and specificity of both devices varied depending on the cutoff threshold of the caries score, and the ROC curve showed higher values for the Soprolife® than for DIAGNOdent™ pen. The values of the area under the curve decreased from 0.81 (Soprolife® in daylight) to 0.79 (Soprolife® in fluorescent mode) and 0.67 for DIAGNOdent™ pen. DIAGNOdent™ pen reproducibility (intra and inter-investigator) showed a wide dispersion, with many values scattered beyond the confidence limits (±2 SD), and the weighted kappa coefficient, which was quite low (0.58), confirmed this tendency. Conclusion: Caries prevalence in terms of public health policy is of interest and caries detection increased significantly when using an fluorescence-based intra-oral camera. Clinical significance: The clinical significance of these findings is that fluorescence could help improve caries diagnosis, reduce clinical misinterpretations, and finally benefit the patients.

  1. Akarslan ZZ, Erten H. The use of a microscope for restorative treatment decision-making on occlusal surfaces. Oper Dent 2009 Jan-Feb;34(1):83–86. DOI: 10.2341/08-45.
  2. Lussi A. Comparison of different methods for the diagnosis of fissure caries without cavitation. Caries Res 1993;27:409–416. DOI: 10.1159/000261572.
  3. Bassiouny MA. Dental erosion due to abuse of illicit drugs and acidic carbonated beverages. Gen Dent 2013 Mar–Apr;61(2):38–44.
  4. Kaplowitz GJ. An update on the dangers of soda pop. Dent Assist 2011 Jul–Aug;80(4):14–23, vi.
  5. Salas MMS, Nascimento GG, et al. Estimated prevalence of erosive tooth wear in permanent teeth of children and adolescents: an epidemiological systematic review and meta-regression analysis. J Dent 2015 Jan;43(1):42–50. DOI: 10.1016/j.jdent.2014.10.012.
  6. Erten H, Uçtasli MB, et al. Restorative treatment decision making with unaided visual examination, intraoral camera and operating microscope. Oper Dent 2006 Jan–Feb;31(1):55–59. DOI: 10.2341/04-173.
  7. Huth KC, Neuhaus KW, et al. Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars. J Dent 2008 Dec;36(12):1033–1040. DOI: 10.1016/j.jdent.2008.08.013.
  8. Huth KC, Lussi A, et al. In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars. J Dent 2010 Dec;38(12):1019–1026. DOI: 10.1016/j.jdent.2010.09.001.
  9. Lussi A, Hibst R, et al. DIAGNOdent: an optical method for caries detection. J Dent Res 2004;83(Spec No C):C80–C83. DOI: 10.1177/154405910408301s16.
  10. Tassery H, Levallois B, et al. Use of new minimum intervention dentistry technologies in caries management. Aust Dent J 2013 Jun;58(1):40–59. DOI: 10.1111/adj.12049.
  11. Terrer E, Koubi S, et al. A new concept in restorative dentistry: light-induced fluorescence evaluator for diagnosis and treatment. Part 1: Diagnosis and treatment of initial occlusal caries. J Contemp Dent Pract 2009 Nov;10(6):86–94. DOI: 10.5005/jcdp-10-6-86.
  12. Terrer E, Raskin A, et al. A new concept in restorative dentistry: LIFEDT-light-induced fluorescence evaluator for diagnosis and treatment: part 2 - treatment of dentinal caries. J Contemp Dent Pract 2010 Jan;11(1):95–102. DOI: 10.5005/jcdp-11-1-95.
  13. Muller-Bolla M, Joseph C, et al. Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents. Eur Arch Paediatr Dent 2017 Jun;18(3): 187–195. DOI: 10.1007/s40368-017-0285-9.
  14. Lussi A, Megert B, et al. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci 2001 Fev;109(1):14–19. DOI: 10.1034/j.1600-0722.2001.109001014.x.
  15. Pretty IA. Caries detection and diagnosis: novel technologies. J Dent 2006 Nov;34(10):727–739. DOI: 10.1016/j.jdent.2006.06.001.
  16. Iranzo-Cortés JE, Terzic S, et al. Diagnostic validity of ICDAS and DIAGNOdent combined: an in vitro study in pre-cavitated lesions. Lasers Med Sci 2017 Apr;32(3):543–548. DOI: 10.1007/s10103-017-2146-5.
  17. Ismail AI, Sohn W, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 2007 Jun;35(3): 170–178. DOI: 10.1111/j.1600-0528.2007.00347.x.
  18. Panayotov I, Terrer E, et al. In vitro investigation of fluorescence of carious dentin observed with a Soprolife® camera. Clin Oral Investig 2013 Apr;17(3):757–763. DOI: 10.1007/s00784-012-0770-9.
  19. DeLong ER, DeLong DM, et al. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988 Sep;44(3):837–845. DOI: 10.2307/2531595.
  20. Gomez J, Zakian C, et al. In vitro performance of different methods in detecting occlusal caries lesions. J Dent 2013 Feb;41(2):180–186. DOI: 10.1016/j.jdent.2012.11.003.
  21. Goel D, Sandhu M, et al. Effectiveness of Air Drying and Magnification Methods for Detecting Initial Caries on Occlusal Surfaces Using Three Different Diagnostic Aids. J Clin Pediatr Dent 2016;40(3):221–226. DOI: 10.17796/1053-4628-40.3.221.
  22. Rechmann P, Charland D, et al. Performance of laser fluorescence devices and visual examination for the detection of occlusal caries in permanent molars. J Biomed Opt 2012 Mar;17(3):036006. DOI: 10.1117/1.JBO.17.3.036006.
  23. Rechmann P, Rechmann BMT, et al. Caries detection using light-based diagnostic tools. Compend Contin Educ Dent 2012 Sep;33(8): 582–593, vi.
  24. Alwas-Danowska HM, Plasschaert AJM, et al. Reliability and validity issues of laser fluorescence measurements in occlusal caries diagnosis. J Dent 2002 May;30(4):129–134. DOI: 10.1016/S0300-5712(02)00015-5.
  25. Wenzel A, Hintze H. The choice of gold standard for evaluating tests for caries diagnosis. Dentomaxillofac Radiol 1999 May;28(3):132–136. DOI: 10.1259/dmfr.28.3.10740465.
  26. Wenzel A, Verdonschot EH, et al. Impact of the validator and the validation method on the outcome of occlusal caries diagnosis. Caries Res 1994;28(5):373–377. DOI: 10.1159/000262004.
  27. Rodrigues JA, Hug I, et al. Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42(4):297–304. DOI: 10.1159/000148162.
  28. Bader JD, Shugars DA. A systematic review of the performance of a laser fluorescence device for detecting caries. J Am Dent Assoc 2004 Oct;135(10):1413–1426. DOI: 10.14219/jada.archive. 2004.0051.
  29. Lussi A, Imwinkelried S, et al. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Res 1999 Jul–Aug;33:261–266. DOI: 10.1159/000016527.
  30. Anttonen V, Seppä L, et al. Clinical study of the use of the laser fluorescence device DIAGNOdent for detection of occlusal caries in children. Caries Res 2003 Jan–Feb;37(1):17–23. DOI: 10.1159/000068227.
  31. Heinrich-Weltzien R, Weerheijm KL, et al. Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries. ASDC J Dent Child 2002 May–Aug;69(2): 127–132.
  32. Theocharopoulou A, Lagerweij MD, et al. Use of the ICDAS system and two fluorescence-based intraoral devices for examination of occlusal surfaces. Eur J Paediatr Dent 2015 Mar;16(1):51–55. DOI: 10.1007/s40368-014-0147-7.
  33. Sitbon Y, Attathom T, et al. Minimal intervention dentistry II: part 1. Contribution of the operating microscope to dentistry. Br Dent J 2014 Feb;216(3):125–130. DOI: 10.1038/sj.bdj.2014.48.
  34. Perrin P, Ramseyer ST, et al. Visual acuity of dentists in their respective clinical conditions. Clin Oral Investig 2014 Dec;18(9):2055–2058. DOI: 10.1007/s00784-014-1197-2.
  35. Gimenez T, Braga MM, et al. Fluorescence-Based Methods for Detecting Caries Lesions: Systematic Review, Meta-Analysis and Sources of Heterogeneity. PLoS One 2013 Apr 4;8(4):e60421. DOI: 10.1371/journal.pone.0060421.
  36. Manton DJ. Diagnosis of the early carious lesion. Aust Dent J 2013 Jun;58(1):35–39. DOI: 10.1111/adj.12048.
  37. Fontana M, González-Cabezas C. Noninvasive Caries Risk-based Management in Private Practice Settings May Lead to Reduced Caries Experience Over Time. J Evid-Based Dent Pract 2016 Dec;16(4): 239–242. DOI: 10.1016/j.jebdp.2016.11.003.
  38. Neuhaus KW, Longbottom C, et al. Novel lesion detection aids. Monogr Oral Sci 2009;21:52–62. DOI: 10.1159/000224212.
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