Hygienists have tools for repair of decay without using a drill
Caries detection and treatment has undergone significant technological changes in the past two decades with less-invasive protocols now available. Dr. Michael A. Miyasaki discusses one such protocol, the CarieScan PRO, which can detect and quantify early demineralization of the occlusal and smooth buccal and lingual surfaces of the teeth.
By Dr. Michael A. Miyasaki 
Hygienists now have the tools to provide a great clinical service – repair of decay without a drill. Caries detection has undergone significant technological changes over the past two decades with the tip of our explorer now giving way to less invasive protocols. Radiographs using ionizing radiation are becoming a public concern and have the inherent weakness of not indicating decay until it is often well developed.
A relatively new development is the CarieScan PRO which uses AC Impedance Spectroscopy technology (ACIST) to determine changes in tooth mineral density. This is the same technology used to measure and quantify bone mineralization throughout the body. My hygienist can use the CarieScan PRO system to detect and quantify early demineralization of the occlusal, and smooth buccal and lingual surfaces of the teeth which our patients value. This encourages them to stay active in our practice.
What sets CarieScan PRO apart from other similar units is its improved Sensitivity (detection of caries) and Specificity (confirmation of health) with an unmatched accuracy of 92.5% (fig 1). This high degree of accuracy means fewer false positives giving me more confidence in my diagnosis.
Fig 1
Putting ourselves in our patient’s shoes we’d all like to catch those soft areas early before a full blown filling needs to be placed deep against our pulp. As clinicians, we appreciate having a "second set of eyes" looking into the enamel knowing that with today’s fluoride use we are challenged to find decay that can be quite extensive below the apparently intact enamel. We’d also like a better way to communicate the "need" to our patients when they present with almost undetectable, asymptomatic decay. CarieScan PRO helps us accomplish all these points.
Fig 2
Setting up the CarieScan PRO for use is quick. Disposable sleeves wrap nicely over the unit to prevent cross-contamination, and leave the single-use disposable sensor tip exposed (fig 2).
The CarieScan PRO technique is simple. A lip hook is placed and the tooth to be measured is dried with air for 5 seconds to remove the visible moisture. The sensor tip is placed on the portion of the tooth to be analyzed, and while pressing firmly (fig 3) the CarieScan PRO takes its reading and displays both a color coded result on its LED InDECAYtor, and a digital measurement of 0-100 on an LCD screen in about a second.
Fig 3
Red is associated with a reading of 100 indicating a high probability that there is dentinal decay. Green is associated with a reading of 0 indicating health, and Yellow indicates varying degrees of possible demineralization more accurately defined by its quantified numerical reading. For more on this, click here.
As with our probing depths, patients can easily understand the significance of these objective and quantified readings. This information can also be compared historically using the CarieScan PRO Remote View software which sends the data to your computer via Bluetooth so to be stored and compared over time.
With earlier detection, clinical intervention may consist of remineralization therapy and the efficacy of this treatment can be monitored and quantified over time truly making this approach more appropriate than in the past.
I find that CarieScan PRO is a great adjunct for me and my patients to detect and communicate health or disease, and determine the most appropriate conservative treatment. Patients appreciate that we have invested in technology to detect disease earlier, that we can quantify the condition of their teeth, and that we have another way to involve them in their health especially today where their dollars mean so much to them.
I also believe that this type of technology helps in retaining your current patients, keeping your patients active in your practice, as you have ongoing monitoring that they are involved in. I would encourage you to visit www.CarieScan.com for more information.
Dr. Michael A. Miyasaki has practiced for 25 years, and has a private practice focusing on comprehensive, minimally-invasive aesthetic restorative dentistry and function in Sacramento, Calif. He has been involved with dental education for over 20 years and his primary educational focus today is to bring information to doctors and their teams so that they continue to provide high quality and predictable treatment experiences for their patients, thereby enhancing their practices’ success. He is the CEO of HDiQ Dental and founder of Principle-based Dentistry, International. He can be reached at DrMike@P-bdi.com.
