Comparing potential early caries assessment methods for teledentistry

BMC Oral Health

Robert S Jones¹  Zachary Van Hilsen² 

[1] Division of Pediatric Dentistry, School of Dentistry, University of Minnesota, 6-150 Moos Health Science Tower, 515 Delaware Street S.E., Minneapolis, MN 55455, USA;School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA

关键词: Light-Emitting Diode;    Detection system;    Optical Coherence Tomography;    Imaging;    Caries;    Telehealth;   

Others  :  1126102
DOI  :  10.1186/1472-6831-13-16

 received in 2012-10-04, accepted in 2013-02-08,  发布年份 2013

【 摘 要 】

Background

Optical caries detection has the potential to be incorporated in telehealth medicine for preventive dental screening. The objective of this study was to evaluate and compare visible and near infrared detection methods for identifying early non-cavitated ex vivo occlusal demineralization.

Methods

Six blinded examiners were used to compare the accuracy of the following three examinations in detecting occlusal demineralization: Midwest Caries ID™ (MID), visual photographic examination (CAM) and Cross Polarization Optical Coherence Tomography (CP-OCT). For each diagnostic method, two examiners assessed the extracted tooth samples 1–2 weeks apart. Teeth were then sectioned and lesion depth was confirmed (n = 42) by a blinded histological examination using a glycol based caries indicator dye. The sensitivity (Sen), specificity (Sp), Intraclass Correlation Coefficient (ICC), and Area under the Receiver Operator Curve (AUC) were calculated.

Results

For detecting any demineralization versus sound pit and fissure enamel, the mean Sen/Sp found was 46.9/85.0 for MID, 80.5/52.5 for CAM, and 83.4/45.0 for CP-OCT. For detecting non-cavitated demineralization that progressed into the dentin, the mean Sen/Sp found was 17.3/88.0 for MID, 48.0/57.8 for CAM, and 44.2/72.7 for CP-OCT. AUC values were statistically significant (P < 0.05) in three out of four examiner assessments when MID and CP-OCT were used to detect any demineralization. AUC values were significant for a single CAM examination. When assessing deeper non-cavitated lesions, none of the assessment methods were able to yield AUC values that were significantly different than a random ‘coin flip’ test. When examining reliability, MID demonstrated the highest ICC score (0.83) and CP-OCT had the lowest (0.49).

Conclusion

Although MID and CP-OCT were useful in detecting the presence of demineralization, examiners were not able to utilize these devices to adequately assess the depth of the demineralization. This study found that MID and CP-OCT did not have markedly superior diagnostic values from simple CAM assessment for use in teledentistry.

【 授权许可】

   
2013 Van Hilsen and Jones; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM: Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent 2007, 29(3):209-213.
• [2]Kopycka-Kedzierawski DT, Bell CH, Billings RJ: Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry. Pediatr Dent 2008, 30(4):329-333.
• [3]Brown LJ, Kaste LM, Selwitz RH, Furman LJ: Dental caries and sealant usage in U.S. children, 1988–1991: selected findings from the Third National Health and Nutrition Examination Survey. J Am Dent Assoc 1996, 127(3):335-343.
• [4]Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies Pediatr Dent 2005, 27(7 Suppl):31-33.
• [5]Guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for children Pediatr Dent 2005, 27(7 Suppl):84-86.
• [6]Hale KJ: Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003, 111(5 Pt 1):1113-1116.
• [7]Policy on use of a caries-risk assessment tool (CAT) for infants, children, and adolescents Pediatr Dent 2005, 27(7 Suppl):25-27.
• [8]Crall JJ: Rethinking prevention. Pediatr Dent 2006, 28(2):96-101. discussion 192–108
• [9]Tsang P, Qi F, Shi W: Medical approach to dental caries: fight the disease, not the lesion. Pediatr Dent 2006, 28(2):188-191. discussion 192–188
• [10]Steiner M, Helfenstein U, Marthaler TM: Dental predictors of high caries increment in children. J Dent Res 1992, 71(12):1926-1933.
• [11]Ramos-Gomez F, Ng MW: Into the future: keeping healthy teeth caries free: pediatric CAMBRA protocols. J Calif Dent Assoc 2011, 39(10):723-733.
• [12]Heller KE, Reed SG, Bruner FW, Eklund SA, Burt BA: Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. J Public Health Dent 1995, 55(3):148-153.
• [13]Rodrigues JA, Hug I, Neuhaus KW, Lussi A: Light-emitting diode and laser fluorescence-based devices in detecting occlusal caries. J Biomed Opt 2011, 16(10):107003.
• [14]Hastar E, Yildiz E, Aktan AM: The effect of fissure sealants on the values of two different caries detection devices. Photomed Laser Surg 2012, 30(12):683-687.
• [15]Aktan AM, Cebe MA, Ciftci ME, Sirin Karaarslan E: A novel LED-based device for occlusal caries detection. Lasers Med Sci 2012, 27(6):1157-1163.
• [16]Fried D, Xie J, Shafi S, Featherstone JD, Breunig TM, Le C: Imaging caries lesions and lesion progression with polarization sensitive optical coherence tomography. J Biomed Opt 2002, 7(4):618-627.
• [17]Staninec M, Douglas SM, Darling CL, Chan K, Kang H, Lee RC, Fried D: Non-destructive clinical assessment of occlusal caries lesions using near-IR imaging methods. Lasers Surg Med 2011, 43(10):951-959.
• [18]Shimada Y, Sadr A, Burrow MF, Tagami J, Ozawa N, Sumi Y: Validation of swept-source optical coherence tomography (SS-OCT) for the diagnosis of occlusal caries. J Dent 2010, 38(8):655-665.
• [19]Kang H, Jiao JJ, Lee C, Le MH, Darling CL, Fried D: Nondestructive Assessment of Early Tooth Demineralization Using Cross-Polarization Optical Coherence Tomography. IEEE J Sel Top Quantum Electron 2010, 16(4):870-876.
• [20]Holtzman JS, Osann K, Pharar J, Lee K, Ahn YC, Tucker T, Sabet S, Chen Z, Gukasyan R, Wilder-Smith P: Ability of optical coherence tomography to detect caries beneath commonly used dental sealants. Lasers Surg Med 2010, 42(8):752-759.
• [21]Huang D, Swanson EA, Lin CP, Schuman JS, Stinson WG, Chang W, Hee MR, Flotte T, Gregory K, Puliafito CA: Optical coherence tomography. Science 1991, 254(5035):1178-1181.
• [22]Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel-Gutenbrunner M, Pieper K: Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res 2008, 42(2):79-87.
• [23]Diniz MB, Rodrigues JA, Hug I, Cordeiro Rde C, Lussi A: Reproducibility and accuracy of the ICDAS-II for occlusal caries detection. Community Dent Oral Epidemiol 2009, 37(5):399-404.
• [24]Ekstrand KR, Martignon S, Ricketts DJ, Qvist V: Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 2007, 32(3):225-235.
• [25]Jablonski-Momeni A, Stucke J, Steinberg T, Heinzel-Gutenbrunner M: Use of ICDAS-II, Fluorescence-Based Methods, and Radiography in Detection and Treatment Decision of Occlusal Caries Lesions: An In Vitro Study. Int J Dent 2012, 2012:371595.
• [26]Diniz MB, Lima LM, Eckert G, Zandona AG, Cordeiro RC, Pinto LS: In vitro evaluation of ICDAS and radiographic examination of occlusal surfaces and their association with treatment decisions. Oper Dent 2011, 36(2):133-142.
• [27]Ramos-Gomez FJ, Crystal YO, Domejean S, Featherstone JDB: Minimal intervention dentistry: part 3. Paediatric dental care - prevention and management protocols using caries risk assessment for infants and young children. Br Dent J 2012, 213(10):501-508.
• [28]Domejean S, White JM, Featherstone JD: Validation of the CDA CAMBRA caries risk assessment–a six-year retrospective study. J Calif Dent Assoc 2011, 39(10):709-715.
• [29]Guerrieri A, Gaucher C, Bonte E, Lasfargues JJ: Minimal intervention dentistry: part 4. Detection and diagnosis of initial caries lesions. Br Dent J 2012, 213(11):551-557.
• [30]Darling CL, Huynh GD, Fried D: Light scattering properties of natural and artificially demineralized dental enamel at 1310 nm. J Biomed Opt 2006, 11(3):034023-034011.
• [31]Lenton P, Rudney J, Chen R, Fok A, Aparicio C, Jones RS: Imaging in vivo secondary caries and ex vivo dental biofilms using cross-polarization optical coherence tomography. Dent Mater 2012, 28(7):792-800.
• [32]DeLong ER, DeLong DM, Clarke-Pearson DL: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988, 44(3):837-845.
• [33]Christenson RH, Committee on Evidence Based Laboratory Medicine of the International Federation for Clinical Chemistry Laboratory M: Evidence-based laboratory medicine - a guide for critical evaluation of in vitro laboratory testing. Ann Clin Biochem 2007, 44(Pt 2):111-130.
• [34]Simonsen RJ: From prevention to therapy: minimal intervention with sealants and resin restorative materials. J Dent 2011, 39(Suppl 2):S27-S33.
• [35]Young D, Ricks CS, Featherstone JD, Fontana M, Fournier SM, Geiermann SP, Hurlbutt M, Kutsch VK, Loftus R, Luther JR: Changing the face and practice of dentistry: a 10-year plan. J Calif Dent Assoc 2011, 39(10):746-751.
• [36]Baumgartner A, Dichtl S, Hitzenberger CK, Sattmann H, Robl B, Moritz A, Fercher AF, Sperr W: Polarization-sensitive optical coherence tomography of dental structures. Caries Res 2000, 34(1):59-69.
• [37]Chen Y, Otis L, Piao D, Zhu Q: Characterization of dentin, enamel, and carious lesions by a polarization-sensitive optical coherence tomography system. Appl Opt 2005, 44(11):2041-2048.
• [38]Patil CA, Kalkman J, Faber DJ, Nyman JS, Van Leeuwen TG, Mahadevan-Jansen A: Integrated system for combined Raman spectroscopy-spectral domain optical coherence tomography. J Biomed Opt 2011, 16(1):011007.
• [39]Huminicki A, Dong C, Cleghorn B, Sowa M, Hewko M, Choo-Smith LP: Determining the effect of calculus, hypocalcification, and stain on using optical coherence tomography and polarized Raman spectroscopy for detecting white spot lesions. Int J Dent 2010, 2010:879252.