Highly sensitive methods not always the best choice over the long term
The early detection of tooth decay and preservation of natural tooth substance as far as possible – these are the goals of sensitive diagnostic and treatment methods. But how high is the risk of healthy teeth being erroneously diagnosed as caries? Scientists at the Charité – Universitätsmedizin Berlin have combined various tooth decay detection methods with a successive form of therapy and have analyzed their long-term benefits. The results of the study have been published in the science magazine Journal of Dental Research*.
Tooth decay occurring in fissures, i.e. slit-like indentations in the occlusal surfaces of the molars, is often hidden and therefore difficult to detect. So-called visual-tactile inspections using a mirror and probe are frequently insufficient. Radiology examinations and modern methods using laser fluorescence can provide more precise findings. Fluorescence is a light optical phenomenon, in which certain materials, e.g. tooth substance, 'light up' following exposure to light of a certain wavelength.
"In terms of real health benefits the selection of a diagnostic method is not only based on the accuracy of the procedure, but also on the subsequently selected form of treatment and risk of tooth decay in the specific patient", says Privatdozent Dr. Falk Schwendicke from the Department of Restorative and Preventive Dentistry of the Charité. Together with his research team and using a computer model he compared three different detection and treatment methods in persons with low and high caries rates and then analyzed the long-term effects. The scientists demonstrated that the risk of a misdiagnosis is high in association with the use of radiological examinations or light optical methods based on laser fluorescence. This applies especially to persons with low caries risk.
Regardless of the employed detection method, the subsequently selected treatment method has a greater impact on any potential health benefits: the constant use of invasive measures results in fewer teeth being retained and is also more costly than treating the affected areas with fluoride varnish or tooth decay sealant. "The combination of visual-tactile inspection or radiology examination with a dental sealant has the highest possibility of being effective", comments Dr. Falk Schwendicke. These study results suggest that any method employed to diagnose tooth decay should be assessed not only in terms of its accuracy, but also as regards the related long-term benefits.
* Falk Schwendicke, Michael Stolpe, Hendrik Meyer-Lueckel, Sebastian Paris. Detecting and Treating Occlusal Caries Lesions: A Cost-Effectiveness Analysis. Journal of Dental Research. Feb. 2015, Vol.94(2) 272-80. doi: 10.1177/0022034514561260.
Privatdozent Dr. Falk Schwendicke
Department of Restorative and Preventive Dentistry
Charité – Universitätsmedizin Berlin
t: +49 30 450 662 556
Back to Overview