Thursday, March 28, 2013
If Doctor McCoy on Star Trek had been a dentist he wouldn’t have used a Tricorder he would have used a Canary.
As a dentist you are taught to diagnose dental disease by observing a physiologic change in a tissue, and then based on training and experience to determine if that change is pathologic. Does it represent disease? We have a number of tools to help us do this; a sharp stick to explore the tooth and a probe to stick under the gums. We use our eyes to observe the surface colors; we feel the tissues and measure pockets with a tiny dip stick.
All of these techniques have something in common; they are inconsistent, subjective and not very accurate.
The best example is checking for occlusal decay. We are taught, essentially, to check for decay by using a sharp stick. We poke the occlusal surface with an explorer, and then depending on our training, experience and tactile sensitivity, we determine whether or not decay is present by how it feels.
Where exactly you push, the angel you push, how hard you push, and most importantly how sharp the explorer tip is, will all influence the diagnosis. Furthermore how it feels does not always correspond to the level of disease. Every dentist has opened a tooth and found significantly more or less decay than anticipated from the feel of the explorer.
A high tech diagnostic device scans the tissue looking for change. It will then convert the physiologic change to a digital format and report that change to the operator for interpretation or it will use computer algorithms to evaluate the observed changes and determine if pathology is present.
In the last decade several caries detection devices have been introduced to dentistry using a variety of scanning technologies. These have included lasers, specific light frequencies and electrical impedance. One of the first of these and the best known is DIAGNOdent from KaVo. It uses laser fluorescence to determine the presence of caries in occlusal groves.
DIAGNOdent was a good start but has several limitations. It only works with clean, non-restored occlusal surfaces. The newest caries detection technology approved by the FDA called The Canary System—so named because it is an early warning system like the canary in the coal mine—does much more.
The Canary System uses a low-power, pulsating laser light to scan teeth for the presence of dental caries. The laser light is absorbed by the tooth and converted into luminescence and a tiny amount of heat. Simultaneous measurement of the reflected heat and light using fifty-two different algorithms evaluates the crystalline structure and can help determine the presence and extent of tooth decay.
Extensive research shows it to be highly accurate and more sensitive to early changes than traditional methods of diagnosis.
Canary can detect decay on smooth enamel surfaces, root surfaces, biting surfaces, between teeth and around existing amalgam or composite fillings up to 5 mm deep. That means in theory the Canary could be used in place of radiographs for the detection of interproximal decay.
- It “sees” under an amalgam. The Canary is the only caries detection system I am aware of that allows you to detect decay under and around an existing amalgam restoration. There is no more watching and guessing only to find that there is extensive decay lurking under a filling that seems OK on the surface and has no radiographic evidence of disease.
- It gives you a number. The readings, called the Canary Number, range from zero to one hundred. Twenty or less is considered healthy. Between twenty and seventy is decay. More than seventy is advanced decay. You can observe a suspicious area over time and determine if there are changes that require treatment rather than watch an area until the decay is obvious.
- Early detection. The Canary finds decay and enamel breakdown at such an early stage that you can treat it with non-invasive remineralization options such as Clinpro 5000. Then you can evaluate the treatment using the Canary and actually document remineralization. This means less drilling and less lost tooth structure.
It is time to move beyond the sharp stick method and join Dr. McCoy using digital high tech diagnostics. The future is coming and it will be amazing!