ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In a patient with occlusal caries, a laser fluorescent device can be used as an adjunct to radiographic imaging to detect dentin decay.
Clinical Question In a patient with occlusal caries, is a laser fluorescent device as accurate as radiographic imaging at detecting dentin decay?
Clinical Bottom Line A laser fluorescent device is able to detect dentin caries better than radiographs because its sensitivity is better than radiographs. Laser fluorescence device is good adjunct to detect occlusal caries.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11330928Lussi/2001240 patients; 332 occlusal surfaces evaluatedControlled Clinical Study
Key resultsMcNamara test showed that laser fluorescence in adjunct to other tests produced better results 117% than visual inspection (VI) alone (29%) or VI and BW combined (45%). Kappa=0.93. LFD showed highest sensitivity in detecting dentinal caries (92%) compared to other tests (VI-31%, BW-63%). Spearman correlation coefficient was .98
#2) 15551982Bader/2004systematic review of articles on DIAGNOdent studies (invitra and invivo)Systematic review
Key resultsRadiographs have lower sensitivity but higher specificity. DD and BW sensitivity were 0.77 and 0.65 respectively. DD and BW specificity was 0.81 for both methods.
Evidence Search Fluorescence device and radiography
Comments on
The Evidence
In vivo study found LFD to have high sensitivity compared to other methods- visual inspection or bite wing radiographs. All the teeth evaluated were accessed and the extent of the decay was visually but not histologically evaluated. Another study needs to compare LFD to histological findings. Plaque, composite restorations, and calculus will interfere with the test and lead to false positive readings. At the time of the study, there were no guidelines to follow on when to treat occlusal decay based on fluorescent device reading. Authors should conduct a study where they open teeth based on LFD reading. Systematic review had similar sensitivity and specificity.
Applicability In clinical cases where dentist has to evaluate decay extent. Fluorescent device can be used as an adjunct to detect dentinal decay. Based on the findings decisions on treatment can be made more predictably.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Laser fluorescence device, occlusal caries, bitewing, radiographs
ID# 2529
Date of submission: 08/06/2013spacer
E-mail piskorska@livemail.uthscsa.edu
Author Inna Piskorska, DDS
Co-author(s) Jaanki Patel
Co-author(s) e-mail patelj2@uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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