Sometimes the presence of caries is easy to detect. Other times the process is more challenging as we balance conserving tooth structure, being cautious about proximity to the pulp and removing all of the affected dentin. One of the tools that we have to add precision to this process is caries detection dye. The science behind the dye is simple as the organic matrix of less mineralized dentin takes up the stain. The idea being that healthy dentin is unaffected and retains a natural color, while carious dentin will be discolored. The challenge is that mineralization is not directly correlated with bacterial infiltration and caries. The circumpulpal dentin and that at the dentino-enamel junction is less mineralized. Therefore the dentin at the depth of the prep and close to the pulp often takes up the dye, resulting in a false positive result and potentially over preparation and increased risk of pulpal trauma.
There are numerous studies that have addressed this lack of specificity of caries detection dyes. Despite our uncertainty at times tactile and visual examination have proven to be effective modalities for accurate caries removal, so trust your senses. If you are going to use caries detection dye here are some things to consider. First, the tooth should be well isolated before placement. Utilize an explorer or spoon excavator to assess the density of the dentin and determine caries. When placing the dye rinse away quickly and thoroughly. The dye is less accurate as the prep depth approaches the pulp and at the junction of the dentin and enamel. I prefer the green dye to red, as this can become confusing with being able to visualize the pulpal tissue.
Good article. I’ve always said that tertiary dentin many times will look like decay when a dye is used. Using an explorer and the mind is the best diagnostic tool of all. Like radiographs, I use dyes all of the time. Neither of them make a diagnosis but both give information that I can use to make a diagnosis.
Have you heard of Spectra Carie Detection form Air Techniques? Unlike an explorer that can actually cause more harm than good, Sepctra is a true noninvasive hand held device that uses fluorescence technology to indicate the extent of decay with color and numerical readings. It eliminates the guesswork. We offer FREE in-office demos if you are interested in seeing/hearing more. Visit our website for more information on Specta. http://www.airtechniques.com/Dental/index.cfm
Kelly I have heard of it, and heard great things although I have not actually had the opportunity to use it in my office. I understand that it actually cause fluorescence of the bacteria, or is it the porphyrins they produce?
Dr. Brady – caries detection dyes can certainly be a component of a caries detection regimen. A complementary tool for early caries detection is The Canary System – a caries detection device that uses both infrared and luminescence technologies. This device is able to detect both surface and sub-surface lesions as small as 50 microns and as deep as 5 mm. The technology that powers The Canary System, PTR-LUM, is directly linked with the crystalline structure of enamel, and is not dependent on the presence of bacterial byproducts. For more information, visit http://www.thecanarysystem.com.
Dr. Brady, caries detection dyes can certainly be a part of a caries detection regimen. A complementary tool that dental professionals can employ for early caries detection is The Canary System. This device uses both infrared and luminescence technology to detect both surface and subsurface lesions as small as 50 microns and up to 5 mm deep. The technology that powers The Canary System, called PTR-LUM, is directly linked with the crystalline structure of enamel, and is not dependent on bacterial byproducts. For more information, check out http://www.thecanarysystem.com
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