Dentistry Improvements in Dental Technology

Dentistry

Improvements in dental technology and cavity detection: Saliva-testing, quantitative light fluorescence, and digital radiography

Recent dental research has tended to stress the treatment of cavities. But exciting new research has begun to focus on the prevention and early detection of problematic areas in patient's mouths. Because of the need for early detection of cavities, innovations in saliva testing for problematic teeth, quantitative light fluorescence, and digital radiography are equally, if not important as other areas of research. Because of these new innovations, recent statistical trends in cavity prevalence in young children may decline within our lifetimes. It has been much publicized that, flying in the face of previous trends: "while fluoridation and improved oral hygiene have resulted in fewer cavities overall among Americans in recent years, cavities in young children are on the rise. According to an August 2005 report by the Centers for Disease Control and Prevention, the incidence of cavities in children ages two to five increased 15.2% from 1988-1994 to 1999-2002, the only child and adolescent age group to exhibit increased tooth decay" ("Tooth Decay in Young Children Increasing," AAPD, 2006).

Even though this decay can be treated with improved fillings, according to one dentist: "Fillings deteriorate and need to be replaced with larger fillings, often leading to root canals, crowns and even tooth loss...That is why stopping the formation of cavities is so important...It's the initial cavity or caries that we're worried about...If we can prevent that, then we prevent this whole lifelong process from occurring" ("USC Dental Researchers Develop First Test for Predicting Cavities in Children," Science Daily, 2005). Of course, both research in cavity prevention and treatment is essential to ensure that modern dentistry continues to have an overall positive effect on patient health. But new forms of implants and bonding materials are no replacement for research that aids in the early detection of children who are at-risk for developing cavities in the future. "The pronounced decline in the prevalence, incidence, and patterns of caries in children during the 1970s and '80s" reduced research in this area until recently (Stookey, 2004).

One of the most hopeful developments is a new form of dental technology, pre-detection through saliva. This may revolutionize the oral health of children even before they have developed cavities. According to University of Southern California researchers at the USC School of Dentistry, a new test called the Caries Assessment and Risk Evaluation (CARE) exam predict a child's future cavity history to plus or minus one cavity with greater than 98% confidence. The CARE test measures the relative proportions in saliva of different types of sugar chains, known as oligosaccharides that are also present on tooth surfaces. Certain sugar chains repel cavity-causing bacteria while other sugar chains actually facilitate the process of bacteria bonding to a tooth causing a cavity. "The effect of sugar chains on the tooth's ability to resist disease is analogous to the effect of 'good' and 'bad' cholesterol on blood vessels...[but] unlike cholesterol, humans' sugar chain makeup is 100% genetically determined and cannot be changed" ("USC Dental Researchers Develop First Test for Predicting Cavities in Children," Science Daily, 2005). However, proper dental care can minimize the effects of these sugars.

The test can be performed by a non-dental professional, such as a school nurse, who then sends the results to a laboratory to be analyze, as CARE is not a test to diagnose or treat cavities. "This is a test that can be used to evaluate susceptibility and risk...If we can identify those people that are at risk and put in place preventive measures, it is going to prevent them from suffering" later in life ("USC Dental Researchers Develop First Test for Predicting Cavities in Children," Science Daily, 2005). Also, because CARE can be performed outside of regular dental visits, which can be costly for poor families, the "test has important public health implications in areas where families cannot afford routine dental exams" ("USC Dental Researchers Develop First Test for Predicting Cavities in Children," Science Daily, 2005). Finally, a "different version of the test identifies the particular teeth at risk" which is even more useful when the patient is deemed at greatest risk for developing cavities. Preventative dental treatment for the poor is especially critical, as physical and financial burden of cavities only increase with age, and "the cost of dental care can be prohibitive and is not covered by Medicare" ("USC Dental Researchers Develop First Test for Predicting Cavities in Children," Science Daily, 2005).

While this new technology is no replacement for old-fashioned dental visits, and there is a danger that parents scrimping and saving on such visits for their children may see CARE as such, it is an important weapon for dentists in preventing problems later on in children's lives. Also, it must be communicated to parents that children with normal or high levels of 'good sugars' cannot neglect basic care. Other studies have pointed to the fact that dental hygiene and other facts can still impact children's dental health. "Contrary to previous findings, most young children with decayed 'baby' teeth are not underweight, and actually may be overweight or at risk of being overweight," a University of Buffalo study found, suggesting that most were overweight, contrasting with pre-1990s studies that indicated such children were underweight, indicating malnutrition or a failure to thrive. The BMI-for-age in the children was "significantly higher than the 50th percentile" of children in their age group ("Kids with Cavities Overweight, Not Underweight," Science Daily, 2005). Exposure to second-hand smoke also increases cavity risk, according to the University of Rochester, and this relationship between cavities and second-hand smoking persists even after researchers controlled for "many variables, including age, sex, race, region, dentist's visits, nutritional status and blood lead levels" (Anderson, 2001). Thus, although the saliva test may be predictive, it seems that improving the patient's dental care and home environment may still minimize their risk to develop problematic teeth later on in life.

Another new technology involved in early cavity detention is measuring changes in the fluorescence of enamel associated with the loss of mineral, a technology known as quantitative light fluorescence. It quantifies the extent of demineralization in dental lesions and can identify a problematic area even before it becomes a cavity. Of course, for many years, "the loss of mineral from the enamel and dentin has been known to alter the optical properties, or visual appearance, of teeth; the commonly cited example of this is the so-called 'white spot'" but this test can do so before such loss is visible to the naked eye (Stookey, 2004). Quantitative light fluorescence has compared favorably with longitudinal microradiography in the measurement of mineral changes in enamel. However, this treatment is also no replacement for examination by a dentist. "QLF technology must be combined with a visual clinical examination...it was found that there is a significant learning curve for a clinical examiner to achieve the necessary expertise" to make effective use of the information, unlike the saliva test, which in marked contrast can be administered even by a untrained healthcare provider as a preventative technique (Stookey, 2004).