Caries-Detector Dyes

[Smilemaker100]

To believe or not believe? That is the question 😕

Caries-Detector Dyes have been used more or less for the last 30 years , however, not everyone agrees to their efficiency.

While I was in dental school, we had one lecture in an operative dentistry course devoted to caries detection tools including the dyes. My teacher seemed to be a proponent of the dyes. Out of curiousity, I tried to find some articles related to the subject . I came across some articles which seemed to indicate that studies have shown that the employment of caries-detector dyes resulted in a significant amount of false positive findings 😱 . Theoretically, the dye is supposed to specifically stain demineralized dentin. However, some authors have suggested that it really is nonspecific as it also seems to stain sound dentin.

http://www.cda-adc.ca/jcda/vol-66/issue-4/195.html

You can imagine how I felt when I had a written essay type exam for that particular course and had a question on the use of caries detector dyes. 😕 I was so tempted to quote findings in these articles, but at the risk of losing points on the exam, I just wrote what was taught to me in class. I felt kind of uneasy about that experience. I really felt like talking with the teacher but I had only read the articles a little close to the exam date and didn't have time to talk with the prof and didn't want to be too confrontational. I like to stay out of trouble ! 😀

I even recall being a dental assistant and seeing this dentist with 20 years of experience regularly using the Caries Dye Detector and I didn't know what to say at the risk of getting into some argument. I have used the dye and really don't find it that fantastic. I presently feel kind of unsure about using this detector.

I presently use the classic methods of caries detection ( Xrays and tactility) which I think haven't really been contested ( well actually, some say that the explorer can damage the tooth...that's a whole other argument for another occasion 😛 ). I was wondering if anyone uses any of the recent technologies to detect occlusal caries such as the DIAGNOdent laser fluorescence system .

I wanted to also know what others' opinions were on these dyes (whether you are a student or dentist). I was wondering what teachers in other dental schools are telling the students in regards to this issue.

Good luck to all those starting another year of dental school...hang on...believe it or not it will fly by (just like life does, especially when you get older) and you'll be done in a blink of an eye 😉
Smilemaker,
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Dance as though no one is watching
Love as though you've never been hurt
Sing as though no one can hear you
Live as though heaven is on earth
-Souza

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[predentchick]

Interesting post. I have assisted for a long time for a doctor who uses Caries Detect. (that pink dye) I had no idea that it wasn't a "for sure" thing! How crazy! 😕

 

[Smilemaker100]

Interesting post. I have assisted for a long time for a doctor who uses Caries Detect. (that pink dye) I had no idea that it wasn't a "for sure" thing! How crazy! 😕

Get used to it, predentchick! 😀 Some things in dentistry and science are not a "for sure thing". 😕 I only realized this toward the end of my studies. You'll especially be aware of this when you're in the clinical part of your studies and different attendings/clinicians give different opinions on treatment plans or techniques. You have to try to keep yourself updated with recent literature , attend various continuing education courses given by various specialists and then judge for yourself. Also be open to change and new technology! However, don't trust all new technology- some salesmen can be pretty damn convincing!

Carie Detector doesn't only come in a pink dye ( which happens to be acid red solution). I have also seen the green dye variety ( carbolan green).
It also exists in Coomassie Blue and Lissamine Blue. In either case, these dye detectors don't seem to be caries-specific.

http://www.blackwell-synergy.com/op...05-182X&date=1999&volume=26&issue=6&spage=453

 

[trypmo]

[....]I presently use the classic methods of caries detection ( Xrays and tactility) which I think haven't really been contested ( well actually, some say that the explorer can damage the tooth...that's a whole other argument for another occasion 😛 ). I was wondering if anyone uses any of the recent technologies to detect occlusal caries such as the DIAGNOdent laser fluorescence system .[....]

I'm shadowing a (really awesome!) dentist who uses DIAGNOdent and it's really cool. From what I've seen, it detects caries in any region, not just occlusal (you do have to point the thing downward from the occlusal surface, but the light goes through the sides and works there as well).

It's a really fabulous tool (As well as a neat gadget) in part because it beeps so the pt can hear that s/he has a cavity and not just have to take your word for it! This dentist I know swears by it.

Of course, it's not a substitute for inspection by more traditional methods, but it's especially good at revealing how big a cavity is underneath that you might not be able to see or probe from the outside. "My" dentist uses it as a second sweep after traditional inspection and primarily to gauge how big the filling will need to be.

That having been said, I haven't yet seen it used during prepping a tooth for a filling, just during initial diagnostics. I'd think that would be a good idea, though, and it's very possible I could see that in future shadowing endeavors; if anyone cares, I'll keep you posted. 🙂

 

[texas_dds]

hey trypmo when are you interviewing at san antonio? im waiting to give you the tour!

I'm shadowing a (really awesome!) dentist who uses DIAGNOdent and it's a fabulous tool. From what I've seen, it detects caries in any region, not just occlusal (you do have to point the thing downward from the occlusal surface, but the light goes through the sides and works there as well).

It's a really fabulous tool (As well as a neat gadget) in part because it beeps so the pt can hear that s/he has a cavity and not just have to take your word for it! This dentist I know swears by it.

Of course, it's not a substitute for inspection by more traditional methods, but it's especially good at revealing how big a cavity is underneath that you might not be able to see or probe from the outside. "My" dentist uses it as a second sweep after traditional inspection and primarily to gauge how big the filling will need to be.

That having been said, I haven't yet seen it used during prepping a tooth for a filling, just during initial diagnostics. I'd think that would be a good idea, though, and it's very possible I could see that in future shadowing endeavors; if anyone cares, I'll keep you posted. 🙂

 

[omsres]

You are correct that the dyes come in a red and green. The red dye has the problem with masking a near pulp exposure. As most of you know, caries removal is pretty straight forward with shallow to medium depth lesions, ddye usually not required. You can just get it all out down to hard dentin (high pitched sound while scraping with your spoon). It get more tricky with those deep lesions when you want to avoid going any deeper for fear of a pulpal exposure. The green dye can help out in this situation. But if you use the red, theres know way to tell if your near the pulp. Also there are false positive results with that stuff. All in all, I'm not a fan of the dye and barely used it in dental school.

 

[Gutta Percha]

I'm just a lowly general dentist so I probably don't know as much about caries as an oral surgeon or oms resident does, but I'll give this one a shot.

Caries die stains effected and affected dentin so it is a little misleading. If a carious lesion is small to medium then it works fine with a large slow speed round bur (#6). If a lesion is so close to the pulp that you aren't sure if the dentin is carious then the best solution is endo. I have had enough of these large very deep carious lesions come back and bite me that I've finally learned endo is the best way to handle them. B/c eventually endo will have to be done. It is better to state to the patient before prepping a tooth with a deep lesion that there is a possibility of RCT so then you don't look like an idiot when you tell them its endo time. Otherwise, you will remove all carious that you can see and more than likely hit a microscopic part of the pulp in this process and then fill the tooth. Then 3 months later the patient comes to your office in pain all pissed off like you did something wrong, but you were just trying to save the tooth from endo.

 

[omsres]

I'm just a lowly general dentist so I probably don't know as much about caries as an oral surgeon or oms resident does, but I'll give this one a shot.

Caries die stains effected and affected dentin so it is a little misleading. If a carious lesion is small to medium then it works fine with a large slow speed round bur (#6). If a lesion is so close to the pulp that you aren't sure if the dentin is carious then the best solution is endo. I have had enough of these large very deep carious lesions come back and bite me that I've finally learned endo is the best way to handle them. B/c eventually endo will have to be done. It is better to state to the patient before prepping a tooth with a deep lesion that there is a possibility of RCT so then you don't look like an idiot when you tell them its endo time. Otherwise, you will remove all carious that you can see and more than likely hit a microscopic part of the pulp in this process and then fill the tooth. Then 3 months later the patient comes to your office in pain all pissed off like you did something wrong, but you were just trying to save the tooth from endo.

I think that is one way to approach the situation, but a viable alternative to the deep lesion is an indirect pulp cap or if a micro exposure a direct pulp cap. Explain to the patient that their is a chance for possible endo and give them symptoms to look for. Especially in a lower socio economic patient population. I understand that this totally differs from private practice, but also philosophies in restorative care can vary by region of the country. I'm sure their will be differences in training of someone that graduated from a california school verses a University of Tennessee graduate.

I think I am qualified to approach a dentisry question. You think I just dumped all my past training. Please. It's not like I'm giving advice on full mouth rehab and advanced cosmetic techniques. This is just caries detection dye.

 

[Gutta Percha]

You are correct that dental school training varies by the region of the country. However, my experience is not based on dental school, it is based in private practice. It is very interesting that in previous messages you have said I have no knowledge and experience to deal with oral lesions. You are correct in that statement which is the reason I said I would refer them out to the appropriate specialist. However, it is interesting that now we are discussing caries and you claim to know as much as I do. I just don't think your experience with caries in dental school is on par with my real world experience and CE I have taken in regards to endo and dentin adhesives. General dentists know more about dentistry than you ever will as an OMS, and an OMS will know more about pulling teeth and surgery than a general dentist.

The only reason I am giving you **** is b/c I remember guys like you in dental school. People who thought they new it all and if you didn't want to be an OMS then you were an idiot. Well, I never wanted to be an OMS b/c quite frankly I hate extracting teeth. You have a some more learning to do and I don't mean in regards to pulling teeth. Arrogance and a disdain for the general practicioner will lead you bankrupt.

 

[Smilemaker100]

I'm shadowing a (really awesome!) dentist who uses DIAGNOdent and it's really cool. From what I've seen, it detects caries in any region, not just occlusal (you do have to point the thing downward from the occlusal surface, but the light goes through the sides and works there as well).

It's a really fabulous tool (As well as a neat gadget) in part because it beeps so the pt can hear that s/he has a cavity and not just have to take your word for it! This dentist I know swears by it.

Of course, it's not a substitute for inspection by more traditional methods, but it's especially good at revealing how big a cavity is underneath that you might not be able to see or probe from the outside. "My" dentist uses it as a second sweep after traditional inspection and primarily to gauge how big the filling will need to be.

That having been said, I haven't yet seen it used during prepping a tooth for a filling, just during initial diagnostics. I'd think that would be a good idea, though, and it's very possible I could see that in future shadowing endeavors; if anyone cares, I'll keep you posted. 🙂

Hi trypmo,

Since the dentist you have been shadowing uses fluorescent lasers to detect carious lesions, I was wondering if he/she also uses it to detect vertical fractures. I have heard of certain beams of light that are used for this purpose. I suppose it must be impressive for the patient to hear that "beep" so they know they have a cavity.

Thanks for your post.
Smilemaker

 

[trypmo]

Hi trypmo,

Since the dentist you have been shadowing uses fluorescent lasers to detect carious lesions, I was wondering if he/she also uses it to detect vertical fractures. I have heard of certain beams of light that are used for this purpose. I suppose it must be impressive for the patient to hear that "beep" so they know they have a cavity.

Thanks for your post.
Smilemaker

I haven't yet seen the DIAGNOdent do that, but next time I'm there shadowing I'll ask about it. That would be pretty neat!

 

[DrRob]

I agree with GP - in my experience even pulp capping doesn't really work and nobody uses dycal anymore. If the carious lesion is large endo is the best solution. I've also heard from other practioners that if you can at least get clean margins then its ok to leave decay because the caries will become arrested.

My view of caries dyes are that they can cause you to over prep a tooth - I use them sometimes and even tactilly hard dentin will stain sometimes.

 

[Smilemaker100]

The only reason I am giving you **** is b/c I remember guys like you in dental school. People who thought they new it all and if you didn't want to be an OMS then you were an idiot. Well, I never wanted to be an OMS b/c quite frankly I hate extracting teeth. You have a some more learning to do and I don't mean in regards to pulling teeth. Arrogance and a disdain for the general practicioner will lead you bankrupt.

Woa! Woa! Take it easy, Gutta Percha! Whatever happened to fraternalism and brotherly love? 😍

In regards to arrogance, I wouldn't only say that that exists among the specialists but also among the generalists who resist referring cases that are better handled by specialists. Not only have I observed this arrogance between specialists and generalists because of the dental treatment my mother had ( she sought the advice of prosthodontists, oral surgeons and generalists for a few things- mostly for a # 8 crown restored on implant-which is a pretty long story in itself... 😡 ) but also on the part of dentists towards their patients. Some dentists underestimate the extent of knowledge of some of the individuals that consult them. With all the information that there is available on the internet, patients are a lot more informed these days.

And lastly, another relationship where I have witnessed arrogance is in the teacher-student relationship. A lot of teachers underestimate a student's knowledge &/ability and make all kinds of assumptions without really taking the time to listen to the student . I had that happen occasionally... it makes my blood boil when I can't defend myself so I usually keep my mouth shut and don't talk about it except with family and close friends. Sometimes, you have to let these arrogant teachers gloat in their pseudorealistic world where the teachers are "know it alls" and the students are inferior beings. There is no use arguing or even defending yourself with such people.

I think the best approach to dentistry and life in general is as Aristotle once said (my mother loved to quote this to me ), " The only thing I know, is that i know nothing." The more you study something in depth, the more you realize how much you don't know that it seems overwhelming. If you are open to new developments and novelty in your life as a child is , then your profession and your life is an exciting experience.

Ok, I'll stop here. I go overboard sometimes ( especially when I write)!

Fraternally yours,
Smilemaker

 

[predentchick]

Woa! Woa! Take it easy, Gutta Percha!

Amen to that! An attitude adjustment is in need. Just because she/he's done with school she/he wants to come around here and put us down. 🙄 Oh well. It doesn't work for me! 😀

 

[omsres]

Hey, GP, I didn't disagree with you, I just presented another option. I don't feel I'm going out on a limb when I present information I learned in dental school from my own experience, but also from seasoned faculty that have their own experiences. I'm not claiming to be an expert, but I feel like I mastered most of the concepts from dental school in theory and practice, and am still able to contribute appropriate and informative responses to the rest of the dental students on this forum. I don't see how my experience with relatively straightforward treatment and conveying that on this post can be misconstrued as "arrogant or know it all".

Even DrRob, who I've had differences with on previous posts, at least supported the validity of the indirect pulp cap as he described it in his response:

I've also heard from other practioners that if you can at least get clean margins then its ok to leave decay because the caries will become arrested.

I will not, by any stretch of the imagination, claim that I can perform restorative dentistry at the level of an experienced GP. I will not challenge you in your ability to propose a treatment plan for complicated dental restoration.

 

[north2southOMFS]

Hey omsres, why do you even care about this topic.....as far as we are concerned there is only one definitive treatment for tooth pain..........🙂

 

[ItsGavinC]

Hey omsres, why do you even care about this topic.....as far as we are concerned there is only one definitive treatment for tooth pain..........🙂

Yep, endo. 😀

 

[omsres]

The only thing I care about is the well being of my patients, and by God if that means I have to extract every asymptomatic full bony impation on every teenager in this nation, well I guess I'll just have to reluctantly shoulder that burden. And at the end of my career as I sit atop a mountain-like pile of thirds with my furrowed brow, I'll know I did my part to better humanity.

North2SouthOMS, I will take you on as my Patawan learner and show you the ways of the Force-ps. Extract or extract not, there is no endo.

 

[TX OMFS]

The only thing I care about is the well being of my patients, and by God if that means I have to extract every asymptomatic full bony impation on every teenager in this nation, well I guess I'll just have to reluctantly shoulder that burden. And at the end of my career as I sit atop a mountain-like pile of BENJAMENS with my furrowed brow, I'll know I did my part to better humanity.

North2SouthOMS, I AM A TOTAL NERD FOR QUOTING STAR WARS. I HEREBY FORFEIT MY MAN CARD AND ALL PRIVELAGES ASSOCIATED WITH IT, INCLUDING THE RIGHT TO PEE STANDING-UP.

Edited to reflect the truth