Title	Enamel Defects from using a dental probe to detect carious lesions
Clinical Question	In a young adult patient, does using a dental probe to detect carious lesions, compared to a visual inspection, result in enamel defects of a molar’s occlusal surface?
Clinical Bottom Line	Based on the evidence, using dental probes to detect carious lesions is not recommended due to the damage it causes to the enamel making it more susceptible to cavitation’s. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 17167258 Kuhnisch/ 2007 18 patients age range from 17 to 26 years old. Twenty sound molars and twenty molars with initial caries were observed. Randomized Controlled trial Key results A randomized clinical trial of 40 third molar teeth from 18 subjects ages 17-26 years old was tested. The molars were categorized into groups based on the soundness of the occlusal enamel. There were twenty third molars in the sound enamel group and twenty third molars in the initial caries group. Ten molars were probed using a dental explorer from each group and the teeth were extracted and analyzed using Scanning Electron Microscopy (SEM). SEM results showed surface defects, enamel break-offs and enlargements up to 1mm in size on the occlusal surface of the probed molars that had initial carious lesions. Surface defects were also found on two molars with sound mineralized enamel.
Evidence Search	Dental Caries;[Mesh] AND;Diagnosis;[Mesh]) AND; Dental Instruments;[Mesh]
Comments on The Evidence	This study incorporated both randomization and control, important elements of experimental design. This study provides a good level of evidence.
Applicability	These results apply to dentists who rely on using dental explorers to detect pit and fissure caries.
Specialty	(Restorative Dentistry)
Keywords	Caries detection, caries diagnosis, visual inspection, dental probing, enamel defects
ID#	514
Date of submission	01/13/2010
E-mail	wallmann@livemail.uthscsa.edu
Author	Christine Manning
Co-author(s)	Elizabeth Wallmann
Co-author(s) e-mail
Faculty mentor	Joseph Connor, DDS
Faculty mentor e-mail	connorj@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Judy Philip (San Antonio, TX) on 04/13/2012 I performed a search on this topic in April 2012, and found this RCT to still be the highest level of evidence for this CAT.