Tools for Diagnosing Decay

 

Back in the day, the dentist would look at your x-rays and inspect your mouth along with a dental mirror and a dental explorer (an instrument that used to pick at your teeth looking for soft spots). Later studies have shown that the dental explorer is not a very accurate method for decay diagnosis even though it is used today by nearly all dentists.

One improvement is to use an intraoral camera. With this camera the dentist can take a photograph of your tooth and show it on a screen, even a TV screen. Not only will this show stain or decay on teeth but will show existing fillings which may be breaking down or decaying, or even cracks in teeth. With the tooth on a 32 inch high definition TV you can really get a good look at the patient’s teeth and make better decisions on what needs to be treated.

We are in the digital era with our radiographs (x-rays), but that is not always better for spotting decay. In any case the dentist gets a look for decay on the x-rays and can even email them to other doctors, insurance companies or even to the patient. I have recently purchased an upgrade to the sensor, so the quality keeps getting better.

The Carivu is a rather new instrument for locating decay between the teeth. I’ve had patients where there was no conclusive sign of decay between the teeth on the x-rays. But using the Carivu, and instrument where a red light is shined through the tooth and an image is captured. When shining a light through a light through a tooth, it should be like shining a light through a mineral. But bacteria can attack the tooth structure, destroying the mineral part and leaving a protein mush behind. The light does not go through this area the same way. I have found this to be a very helpful and accurate tool to help find decay.

Another tool to find decay is the Diagnodent, this time on the biting surfaces of the teeth. This tool measures fluorescence of the tooth, marking the difference between healthy tooth structure and decay. This tool received FDA approval in the 1990s and has now been used for almost 20 years. There have been newer instruments that are used to find decay in this way, but this was one of the first to be used in this country. I have found this tool to be very helpful as well.

So, what do we want for our patients? In the ideal world it’s better to find decay and treat it as early as possible so that the smallest amount of tooth structure needs to removed and restored. Some patients do not want this level of treatment and would rather wait for something more definitive (hence a larger filling, or something even larger than a filling) to show up. Not all dentists have nor do they believe in all the new gadgets that are available. Within reason, having the modern tools of the 21st century provide better treatment and ultimately less treatment for patients.