Fluorescence-Based Methods for Detecting Caries Lesions: Systematic Review, Meta-Analysis and Sources of Heterogeneity

Background Fluorescence-based methods have been proposed to aid caries lesion detection. Summarizing and analysing findings of studies about fluorescence-based methods could clarify their real benefits. Objective We aimed to perform a comprehensive systematic review and meta-analysis to evaluate the accuracy of fluorescence-based methods in detecting caries lesions. Data Source Two independent reviewers searched PubMed, Embase and Scopus through June 2012 to identify papers/articles published. Other sources were checked to identify non-published literature. Study Eligibility Criteria, Participants and Diagnostic Methods The eligibility criteria were studies that: (1) have assessed the accuracy of fluorescence-based methods of detecting caries lesions on occlusal, approximal or smooth surfaces, in both primary or permanent human teeth, in the laboratory or clinical setting; (2) have used a reference standard; and (3) have reported sufficient data relating to the sample size and the accuracy of methods. Study Appraisal and Synthesis Methods A diagnostic 2×2 table was extracted from included studies to calculate the pooled sensitivity, specificity and overall accuracy parameters (Diagnostic Odds Ratio and Summary Receiver-Operating curve). The analyses were performed separately for each method and different characteristics of the studies. The quality of the studies and heterogeneity were also evaluated. Results Seventy five studies met the inclusion criteria from the 434 articles initially identified. The search of the grey or non-published literature did not identify any further studies. In general, the analysis demonstrated that the fluorescence-based method tend to have similar accuracy for all types of teeth, dental surfaces or settings. There was a trend of better performance of fluorescence methods in detecting more advanced caries lesions. We also observed moderate to high heterogeneity and evidenced publication bias. Conclusions Fluorescence-based devices have similar overall performance; however, better accuracy in detecting more advanced caries lesions has been observed

The Acid Test of Fluoride: How pH Modulates Toxicity

Background: It is not known why the ameloblasts responsible for dental enamel formation are uniquely sensitive to fluoride ($F^−$). Herein, we present a novel theory with supporting data to show that the low pH environment of maturating stage ameloblasts enhances their sensitivity to a given dose of $F^−$. Enamel formation is initiated in a neutral pH environment (secretory stage); however, the pH can fall to below 6.0 as most of the mineral precipitates (maturation stage). Low pH can facilitate entry of $F^−$ into cells. Here, we asked if $F^−$ was more toxic at low pH, as measured by increased cell stress and decreased cell function. Methodology/Principal Findings: Treatment of ameloblast-derived LS8 cells with $F^−$ at low pH reduced the threshold dose of $F^−$ required to phosphorylate stress-related proteins, PERK, eIF2α, JNK and c-jun. To assess protein secretion, LS8 cells were stably transduced with a secreted reporter, Gaussia luciferase, and secretion was quantified as a function of $F^−$ dose and pH. Luciferase secretion significantly decreased within 2 hr of $F^−$ treatment at low pH versus neutral pH, indicating increased functional toxicity. Rats given 100 ppm $F^−$ in their drinking water exhibited increased stress-mediated phosphorylation of eIF2α in maturation stage ameloblasts (pH<6.0) as compared to secretory stage ameloblasts (pH∼7.2). Intriguingly, $F^−$-treated rats demonstrated a striking decrease in transcripts expressed during the maturation stage of enamel development (Klk4 and Amtn). In contrast, the expression of secretory stage genes, AmelX, Ambn, Enam and Mmp20, was unaffected. Conclusions: The low pH environment of maturation stage ameloblasts facilitates the uptake of $F^−$, causing increased cell stress that compromises ameloblast function, resulting in dental fluorosis

Surfing the spectrum - what is on the horizon?

Diagnostic imaging techniques have evolved with technological advancements - but how far? The objective of this article was to explore the electromagnetic spectrum to find imaging techniques which may deliver diagnostic information of equal, or improved, standing to conventional radiographs and to explore any developments within radiography which may yield improved diagnostic data. A comprehensive literature search was performed using Medline, Web of Knowledge, Science Direct and PubMed Databases. Boolean Operators were used and key-terms included (not exclusively): terahertz, X-ray, ultraviolet, visible, infra-red, magnetic resonance, dental, diagnostic, caries and periodontal. Radiographic techniques are primarily used for diagnostic imaging in dentistry, and continued developments in X-ray imaging include: phase contrast, darkfield and spectral imaging. Other modalities have potential application, for example, terahertz, laser doppler and optical techniques, but require further development. In particular, infra-red imaging has regenerated interest with caries detection in vitro, due to improved quality and accessibility of cameras. Non-ionising imaging techniques, for example, infra-red, are becoming more commensurate with traditional radiographic techniques for caries detection. Nevertheless, X-rays continue to be the leading diagnostic image for dentists, with improved diagnostic potential for lower radiation dose becoming a reality

Effects of acid-base status and fluoride on the composition of the mineral in developing enamel and dentine in the dog

Developing molar teeth of the dog were sectioned, embedded in copper containing polymethyl methacrylate, polished and their Ca/P and Ca/Na molar ratios investigated with the electron microprobe. The teeth were obtained at 30 days from 9 pups fed regimes of different acid-base status with or without fluoride supplementation from birth to sacrifice at 30 days. No clear trends in their Ca/P or Ca/Na ratios with variation in the diet were observed. However, evaluation of the Ca/P ratio of the enamel as a function of depth revealed that this ratio was 0.80 +/- 0.15 at the mineralization front. This suggests that in enamel brushite rather than octacalcium phosphate is the precursor phase of the mineral

Developments in caries diagnosis and their relationship to treatment decisions and quality of care - ORCA Saturday Afternoon Symposium 1997

This symposium report evaluates the achievements made in caries diagnostic research since the previous symposium held in 1992. The symposium aimed at presenting the state of the art of caries diagnostic methods, on presenting the links between caries diagnosis and subsequent treatment decisions and their effect on the treatment outcomes, particularly the quality of dental care. The variation among dentists in diagnosing (small) caries lesions and in treatment decision making is considerable. This has been explained by the imperfection of caries decision making tests, but also by making incorrect treatment decisions due to incorrect or partial understanding of diagnostic test parameters. Meta-analyses into the performance of caries diagnostic tests revealed that the available quantitative methods are very promising. It was concluded that these methods had high correlations with lesion depth. They were considered suitable to monitor small changes in lesions. Many obstacsel have been experienced in attempting to transfer the outcomes of diagnostic research into clinical practice and it was concluded that caries diagnosis researchers should co-operate with manufacturers to introducing valid new diagnostic tools to the market. Main research priorities for the coming 10 years are to conduct cost-effectiveness and cost-utility studies of caries diagnostic tools, to continue to review the performances of diagnostic tests, to transfer diagnostic knowledge and experience to the general practitioners particularly by constructing evidence-based clinical guide-lines, to study the relationship between diagnosis and treatment decision, and to assess the effect of diagnostic and treatment decisions on the outcome of care