Chapter 4. Clinical Operations

Dental Office Technology

Should the clinic consider using DIAGNOdent to diagnose dental decay?

DIAGNOdent is a laser-probe handpiece that uses 1-milliwatt, 655-nanometer wavelength light for the detection of tooth decay. It works by shining pulsed light of a known wavelength onto the tooth surface via specially-designed tips. After a baseline measurement of the patient's healthy tooth structure is made, the tip is placed on questionable areas of the tooth and slowly rotated or rocked with a pendulum-like motion. The unit's internal processor interprets changes in the level of fluorescence of the light emitted back by the tooth as indicative of caries. A numerical reading is displayed on the front of the unit and an audible signal is sounded. KaVo America claims that the device works through non-cavitated tooth structure and can be used, over time, to monitor changes in the degree of decalcification of a suspect area.

Photo of DIAGNOdentBader and Sugars published a systematic review of the literature on DIAGNOdent in the October 2004 issue of the Journal of the American Dental Association. (Bader JD, Shugars DA. 2004. A systematic review of the performance of a laser fluorescence device for detecting caries. Journal of the American Dental Association, 135:1413-1425.)

Twenty-five studies were included in the review. The authors concluded from their literature review that DIAGNOdent is more sensitive (i.e., detecting caries when it actually exists) than traditional diagnostic methods. However, the device is less specific (i.e., not detecting caries when it does not actually exist) than visual methods, leading to potentially more false-positive diagnoses. Unfortunately, a false-positive diagnosis of dentinal caries may lead to tooth preparation with irreversible damage. The reviewers concluded that DIAGNOdent should not be relied upon as a clinician’s primary diagnostic tool. However, clinicians could use the device after visual/tactile examinations to provide additional information about the chances of disease on the surface in question or to identify surfaces with demineralization to signal the use of preventive services such as fluoride varnish or sealants.

The Air Force Dental Evaluation and Consultation Service wrote the following comments about this study:

“The diagnosis of occlusal caries may be highly subjective. Restorative intervention on the basis of poor diagnostic information could lead to overtreatment. Visual and tactile methods alone, in the absence of cavitation, generally have relatively poor diagnostic capability for occlusal surfaces. Radiographs tend to only reveal significant caries. There is an obvious need for diagnostic methods that can accurately detect dentinal involvement at an earlier stage. As new diagnostic technologies emerge, they must be thoroughly investigated and evaluated before clinical use. According to this review article DIAGNOdent is more sensitive than traditional diagnostic methods, however, the increased likelihood of false-positive diagnoses limits its usefulness as the principle diagnostic instrument.”

Read a scholarly review pdf of DIAGNOdent.



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