Improving Clincal Dental Caries Trial Efficiency Using New Diagnostic Modalities

Traditional clinical caries trials (CCT) have relied on visual and tactile inspection (VTI) to diagnose caries leading to poor validity and reliability. Little emphasis has been given to the quantification of pre- and/or early carious lesions (ECL) which has the potential to reduce length and cost of CCT. Objectives: To review the validity and reliability of new modalities for caries diagnosis, particularly the diagnosis of smooth surface and fissure ECL; and to investigate the potential of these new modalities to improve cost and time efficiency in CCT. Methods: A literature search was conducted (using MEDLINE) to identify validation studies on Digital Imaging Fiber-Optic Transillumination (DIFOTI), Electrical Conductance Measurement Systems (ECMS), Quantitative Light-induced Fluorescence™ (QLF), DIAGNOdent^®(DD) and photography. Results: DIFOTI and ECMS have limited application in CCT at present. The diagnosis of occlusal surface ECL by DD demonstrated acceptable in vitro and in vivo sensitivity but poor specificity. However, DD may be applicable as a diagnostic adjunct for ECL. The portability, relative affordability and adequate reliability of DD mean it is applicable in field trial settings with multiple operators. QLF has reported high reliability in vivo. QLF was superior to DD for measuring smooth surface enamel mineral loss in vitro, and comparable for quantification of smooth surface dentinal caries in vitro. More accurate quantitative or qualitative measurement of ECL by DD and QLF may facilitate shorter CCT than the conventional 24-36 months. Further validation studies of photographic image analysis are required. Conclusions: The utilisation of new diagnostic modalities such as DD for fissure ECL and QLF for smooth surface ECL may facilitate more efficient CCT. Further in vivo studies of diagnostic applications of DD and QLF are hampered at present by the lack of an appropriate in vivo gold standard for dental caries.