Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network

doi:10.1016/j.adaj.2017.08.009

The Journal of the American Dental Association

Volume 148, Issue 12, December 2017, Pages 922-929

https://doi.org/10.1016/j.adaj.2017.08.009 Get rights and content

Abstract

Background

A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically.

Methods

Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ² test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster.

Results

The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07).

Conclusions

Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives.

Practical Implications

Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention.

Section snippets

Methods

The results we present here were generated as a part of a larger study conducted in dental practices in the network. The network is a consortium of dental practices established to answer questions raised by dental practitioners in everyday clinical practice and to evaluate the effectiveness of strategies to prevent, manage, and treat oral diseases and conditions.17, 18

Practitioners and patients

The participants included 93 dentists from all 6 network regions. As shown in Table 1, of these 93 practitioners, 34 were women, 69 were non-Hispanic white, and 69 graduated from dental school more than 15 years before the study. There was a fairly equal distribution of practitioners per region, ranging from 13 in the Western region to 18 in the South Central region.

As shown in Table 1, 72% of the patients were 19 years or older, with a mean (standard deviation) age of 32 (17) years. More than

Discussion

Dental care has slowly evolved from a time when all carious lesions, regardless of size, were restored to today’s “early detection and management.”⁸ Diagnosing caries can be thought of as a process that involves 3 steps: detection, assessment of the severity, and assessment of the activity,²⁰ which will lead to an appropriate treatment plan. Assessment of severity and activity can be established on the basis of cues such as color, feel, and luster of the lesion²¹ as well as the caries risk of

Conclusions

Despite the statistically significant associations between the clinical characteristics that we examined and the presence of caries extending into dentin and despite the apparent use of these characteristics by the participating practitioners, these characteristics do not seem to be strong independent predictors of dentinal caries in clinical practice. In response to the question “When you treated the lesion, what did you find?”, practitioners reported active caries extending into the dentin in

Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7th Ave South, SDB 111, Birmingham, AL 35294-0007.

References (34)

E.A.M. Kidd et al.
Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists
J Dent
(1993)
J.D. Bader et al.
The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries
J Evid Based Dent Pract
(2006)
J.C. Hamilton et al.
Early treatment of incipient carious lesions: a two-year clinical evaluation
JADA
(2002)
S.K. Makhija et al.
Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: findings from The National Dental Practice-Based Research Network
JADA
(2014)
C.F. Brantley et al.
Does the cycle of rerestoration lead to larger restorations?
JADA
(1995)
S.K. Makhija et al.
The prevalence of questionable occlusal caries: findings from The Dental Practice-Based Research Network
JADA
(2012)
V.V. Gordan et al.
Restorative treatment thresholds for occlusal primary caries among dentists in the dental practice-based research network
JADA
(2010)
G.H. Gilbert et al.
Purpose, structure, and function of the United States National Dental Practice-Based Research Network
J Dent
(2013)
W.E. Norton et al.
Concordance between clinical practice and published evidence: findings from the National Dental Practice-Based Research Network
JADA
(2014)
R.F. Sawle et al.
Has occlusal caries become more difficult to diagnose?
Br Dent J
(1988)

C.E. Ketley et al.

Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars

Br Dent J

(1993)

C.M. Pine et al.

Dynamics of and diagnostic methods for detecting small carious lesions

Caries Res

(1996)

N.B. Pitts

Diagnostic tools and measurements: impact on appropriate care

Community Dent Oral Epidemiol

(1997)

A. Ouellet et al.

Detection of occlusal carious lesions

Gen Dent

(2002)

A. Lussi

Comparison of different methods for the diagnosis of fissure caries without cavitation

Caries Res

(1993)

Fejerskov O, Kidd E, eds. 2008. Dental Caries: The Disease and Its Clinical Management. 2nd ed. Hoboken, N.J.:...

A.I. Ismail et al.

Dental caries in the second millennium

J Dent Educ

(2001)

Cited by (7)

Instant identification of dental white spot using K-means algorithm via laser-induced fluorescence and associated hyperspectral imaging
2023, Journal of Photochemistry and Photobiology B: Biology
Dental caries (DC) is a chronic illness that affects 2 billion individuals worldwide, with 520 million of those suffering from it in their primary teeth. It is apparent that early DC detection and subsequent minimally invasive therapy are crucial clinical requirements. The first reversible clinical indication of demineralization is dental white spot (DWS) lesions. However, diagnosing DWS poses extreme challenges for practitioners. In this investigation, a customized laser-induced fluorescence system with a hyperspectral imaging (HI) camera and a non-ionization laser light supply was created for DWS localization and early DC detection. A UV laser diode source with a wavelength of 395 nm was used for light stimulation for the 10 test samples of teeth. The emitted signature of the main tooth components, including dentin, DWS, enamel, and DC, was recorded. An attempt was made to increase the system's sensitivity to the fluorescent signal by applying a logarithmic scale to the spectral signature. Moreover, further discrimination may be achieved by signal strength. We identified that the fluorescent signal's peak intensity at 771 nm works best for discriminating DWS from normal areas, or DC. For characterizing dentin, the re-emitted frequency at 500 nm has the maximum intensity. Next, we presented our imaging grouping strategy that combines visual enhancement through a moving average, MA, filtering and segmenting an image using K-means clustering (K-mc) (K = 8) for instant and precise DWS grouping for the constructed HI images at (500 nm and 771 nm). Despite the tiny structure and its DWS white appearance, our approach could successfully demarcate the DWS on the tested teeth. Dental examiners might benefit from our simple, non-invasive, non-ionizing optical diagnosis approach to help them make their first assessments and experience accurate and exact delineation of the DWS to obtain immediate and higher rates of early-stage DC detection.
Non-invasive caries detection and delineation via novel laser-induced fluorescence with hyperspectral imaging
2022, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Early diagnosis of tooth decay could eliminate disease progression [4,5]. Caries visual inspection is the classical examination mode; alternatively such technique cannot secure early caries diagnosis [2,6,7]. On the other hand, dental radiography is accompanied with ionizing radiation; it cannot be adopted frequently in short time period [8].
Carious is a global chronic disease; 2 billion people and 520 million children suffer from permanent and primary teeth caries respectively. Early caries detection via precise, non-invasive, non-ionizing radiation is highly appreciated. Carious deteriorate the chemical structure of sound tooth tissues, with variation in its optical properties. In this study, customized laser-induced fluorescence system consists of non-ionizing laser light source and hyperspectral camera was developed for early caries detection. Tested tooth sample was illuminated with laser source of 385 nm and 5 mW power. The emitted spectrum signature for main tooth elements including enamel, dentin, stain, and caries were captured. Logarithmic scale of spectrum signature was applied in an attempt to enhance system sensitivity to fluorescent signal. Fluorescence signature at 500 nm secured the maximum fluorescence intensity difference for different tooth elements. Consequently 2D hyperspectral image at 500 nm was constructed. Enhanced 2D image was accomplished via nonlinear filter to enhance contrast. Segmentation via K mean clustering was adopted for precise caries delineation. This narrative, facile, non-invasive, non-ionizing technique experienced precise and accurate delineation of different caries stages (normal, moderate, and severe).
Laser induced fluorescence with 2-D Hilbert transform edge detection algorithm and 3D fluorescence images for white spot early recognition
2020, Spectrochimica Acta - Part A: Molecular and Biomolecular Spectroscopy
Citation Excerpt :
Many optical techniques can be employed for caries detection, such as Raman spectroscopy, elastic scattering, diffuse reflectance (DR) spectroscopy, absorption spectroscopy, and photoacoustic imaging [11–13]. However, all these techniques suffer from lack of simplicity, and reliability [11,14–19]. Furthermore, these techniques require direct contact with tested sample tissue.
There is a must for non-invasive caries detection method to supplement traditional visual assessment by the clinician before lesion progression reaches a stage requiring invasive therapy.
In this paper, the nature of tissue response to light interaction has been used for early diagnosis, using laser induced fluorescence spectroscopy. Human tooth sample was illuminated with He-Ne laser sources (633 nm) with energy 5 mW. The reflected and emitted spectra of investigated samples were collected using hyperspectral camera to develop multispectral images. The variation of reflected and emitted energy as function in wavelength was employed to generate characteristic spectrum of each tooth tissue. Human teeth caries lesion releases their excess energy by emitting fluorescence light producing chemical footprint signature for each tooth elements and caries state.
This non-invasive, non-contact, and non-ionizing hyperspectral imaging system was employed to diagnose and classify different caries types and stages. Reconstructed 3D fluorescence images offered discrimination between enamel and dentin caries at 633 nm illumination spectral line; white spot lesion was clearly detected and recognized at far visible and infrared wavelength ranges.
This study reports on customized optical imaging system that can offer high sensitivity, high resolution. Optimum stimulating wavelength for early caries detection was reported to be 633 nm. This novel approach can offer a full map of caries degree status.
Design and implementation of novel hyperspectral imaging for dental carious early detection using laser induced fluorescence
2018, Photodiagnosis and Photodynamic Therapy
Citation Excerpt :
Therefore an optical imaging system, for early diagnosis of carious, is highly beneficial [6–8]. This approach can offer early detection, cutback cost, as well as minimize treatment time [9–12]. The light-tissue interactions, for diagnostic application, must not affect the tissue structure.
Early detection of carious is vital for demineralization reversal, offering less pain, as well as precise carious removal. In this study, the difference in optical properties of normal tissue and human carious lesion has been used for early diagnosis, using laser induced fluorescence spectroscopy. The optical system consists of light source in visible band and hyperspectral camera, associated with designed digital image processing algorithm. The human tooth sample was illuminated with visible band sources at 488, and 514 nm with energy of 5 m watt. The reflected and emitted light from the tested sample was captured using hyperspectral camera in an attempt to generate multispectral images (cubic image). The variation of reflected and emitted energy as function of wavelength was employed to generate characteristic spectrum of each tooth tissue. Human teeth carious tissue lesion releases its excess energy by emitting fluorescence light producing chemical footprint signature; this signature is dependent on the elemental composition of tooth elements and carious state. This non-invasive, non-contact and non-ionizing imaging system with associated novel pattern recognition algorithm was employed to diagnose and classify different carious types and stages. It was reported that the perceived fluorescence emission is function of the illuminating wavelength. While enamel and dentin carious were distinguished and characterized at 514 nm illuminating wavelength; white spot lesion were contoured and recognized at 488 nm. Therefore, full recognition could be achieved through generated cubic image after sample irradiation at 488 nm and 514 nm. In conclusion, this study reports on a customized optical image system that can offer high sensitivity, high resolution, and early carious detection with optimum performance at 514 nm and 488 nm.
The Burden and Management of Dental Caries in Older Children
2018, Pediatric Clinics of North America
Citation Excerpt :
A recent study showed that clinicians making decisions regarding suspicious occlusal caries lesions were more likely to monitor (40%) and recommend oral hygiene instructions (21%) than to place sealants (3%). Surgical intervention was implemented in 39% of suspicious occlusal carious lesions, and of those so treated 61% had dental caries.42 Because almost a third of these patients did in fact not have dental caries, evidence-based preventative management, including the use of sealants, should have been considered an appropriate alternative.
Evaluation of fluoride varnish treatment of postorthodontic white spot lesions by visual inspection and laser fluorescence—A randomized controlled study
2022, Clinical and Experimental Dental Research

View all citing articles on Scopus

Dr. Makhija is an associate professor, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7th Ave South, SDB 111, Birmingham, AL 35294-0007.

Dr. Shugars is a professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Dr. Gilbert is a professor, Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, AL.

Dr. Litaker is an associate professor, Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, AL.

Dr. Bader is a professor, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Dr. Schaffer is a private practitioner, Phoenix, AZ.

Dr. Gordan is a professor, Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, University of Florida Health Science Center, Gainesville, FL.

Dr. Rindal is a senior investigator, HealthPartners Institute, and associate dental director for research, HealthPartners Dental Group, Minneapolis, MN.

Dr. Pihlstrom is an associate director for Evidence Based Care and Oral Research, Permanente Dental Associates, Portland, OR.

Dr. Mungia is an assistant professor, Department of Periodontology, University of Texas Health Science Center at San Antonio, San Antonio, TX.

Dr. Meyerowitz is a professor, University of Rochester, Eastman Institute for Oral Health, Rochester, NY.

: The study protocol was registered at ClinicalTrials.gov (NCT02340767).

: Disclosure. None of the authors reported any disclosures.

: This study was supported by grant U19-DE-22516 from the National Institutes of Health.

: The National Dental Practice-Based Research Network Collaborative Group comprises practitioner-investigators, faculty investigators, and staff members who contributed to this activity. Lists of these people are at http://nationaldentalpbrn.org/tyfoon/site/fckeditor/SOCL%20Collaborative%20Group_staff_revised_final.pdf and http://nationaldentalpbrn.org/tyfoon/site/fckeditor/Practitioner%20list%20for%20Decision%20Aids%20for%20the%20Management%20of%20Suspicious%20Occlusal%20Caries%20Lesions_020217_2.pdf. A website devoted to details about The National Dental Practice-Based Research Network is located at http://NationalDentalPBRN.org.

: The authors extend their gratitude to The National Dental Practice-Based Research Network's practitioners who participated in the study as well as to the network’s regional coordinators (Midwest region: Tracy Shea, RDH, BSDH; Western region: Stephanie Hodge, MA; Northeast region: Christine O’Brien, RDH; South Atlantic region: Hanna Knopf, BA, Deborah McEdward, RDH, BS, CCRP; South Central region: Claudia Carcelén, MPH, Shermetria Massengale, MPH, CHES, Ellen Sowell, BA; Southwest region: Stephanie Reyes, BA, Meredith Buchberg, MPH).

: Opinions and assertions contained in the study are those of the authors and are not to be construed as necessarily representing the views of the respective organizations or the National Institutes of Health.

: The informed consent of all human participants who participated in this investigation was obtained after the nature of the procedures had been explained fully (protocol X140925003).

View full text

Original ContributionsCarious LesionsSurface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network

Abstract

Background

Methods

Results

Conclusions

Practical Implications

Section snippets

Methods

Practitioners and patients

Discussion

Conclusions

J Dent

J Evid Based Dent Pract

JADA

JADA

JADA

JADA

JADA

J Dent

JADA

Has occlusal caries become more difficult to diagnose?

Br Dent J

Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars

Br Dent J

Dynamics of and diagnostic methods for detecting small carious lesions

Caries Res

Diagnostic tools and measurements: impact on appropriate care

Community Dent Oral Epidemiol

Detection of occlusal carious lesions

Gen Dent

Comparison of different methods for the diagnosis of fissure caries without cavitation

Caries Res

Dental caries in the second millennium

J Dent Educ

Original Contributions
Carious Lesions
Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network