The Front Line Defense Against Caries
Dental hygienists are underutilized for documenting tooth health
Ashley Leavitt, RDH
The initial focus for dental hygienists is oral health and disease prevention. With today's technology, that role can be carried further in early caries detection. Dental hygienists are underutilized for routinely documenting tooth health and caries progression. By implementing easy-to-use technology into their daily routine, hygienists can document any changes to tooth structure. This becomes a valuable motivational tool for both the patient and the practice.
Caries diagnosis is the art or act of identifying a disease from its signs and symptoms. This is distinct from the detection of the signs and symptoms themselves. The diagnosis forms the basis for making informed treatment decisions.1 The world of dentistry is continually expanding as the available technology evolves, allowing dental practices to provide patients with improved resources.
Important initial documentation is gathered at new patient exams through intraoral images, which can be helpful when comparing information from caries detection with a real-life photograph.
DIAGNOdent (KaVo Kerr) uses laser fluorescence to aid in the detection of caries within the tooth structure. As the incident laser light is dispersed into the site, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display. Clean, healthy tooth structure exhibits little or no fluorescence and will result in very low scale readings on the display.2 This instrument is a good first step in indicating to the practitioner if there is a hidden lesion under the occlusal surface.
Spectra (Air Techniques) is the only caries detection aid providing both color and numerical indications of the extent of the decay. Spectra is a non-invasive caries detection aid that helps eliminate the guesswork in detecting and diagnosing tooth decay, while enhancing case acceptance through better patient education. In contrast, explorers have low sensitivity for caries detection, provide virtually no diagnostic feedback, and can cause damage by breaking enamel rods and causing an iatrogenic cavitation when forced into an incipient carious lesion.3 Spectra images can be saved in the patient's chart, and yearly readings can be gathered to determine if a lesion is progressing or reversed.
SoproCARE (Acteon) gives the dental professional a new visual tool to educate the patient on the importance of good dental hygiene and periodontal health. Utilizing fluorescence technology, SoproCARE illuminates dental tissue to reveal occlusal caries, plaque, tartar, and gingival inflammation. SoproCARE can be used as an intraoral camera.4
DEXIS CariVu (KaVo Kerr) is a compact, portable caries detection device that uses patented transillumination technology to support the identification of occlusal, interproximal, and recurrent carious lesions and cracks. The transillumination technology makes enamel appear transparent, while porous lesions trap and absorb light. It allows the practitioner to see through the tooth, exposing its structure and the development of any carious lesions. CariVu images read like familiar X-ray images. It uses non-ionizing radiation, which is ideal for children, pregnant women, and patients who are X ray averse.5
Providing a visual for the patient improves understanding and increases case acceptance by facilitating conversation and trust. Together, the patient and the dentist are able to make an evidence-based decision on the information gathered.
For dental hygienists, time management is crucial in adapting caries detection as part of the routine. However, it is possible to integrate efficiently, and the benefits to patients and their overall dental health is a driving force. Detecting early caries also provides the opportunity to implement a caries prevention protocol and course of appropriate care.
About the Author
Ashley Leavitt, RDH
Traveling Dental Hygienist