DIAGNOdent = not all its cracked up to be

[DrTacoElf]

I'm attending a class at Georgia Tech entitled dentalttechnology. Yesterday we had a lecture on dental/biophotonics and the detection of caries and we got a detailed look on how the diagnodent works based on flourescence excitation. Turns out that the wavelengths of light it uses also excite plaque, calculus, green colored food/toothpaste and several other indignent items in the mouth in addition to dental caries. So its sensitivity is pretty poor in a clinical setting (I'm sure it performs well detecting caries on teeth which have been stored in bleach for a year ). Also we got a look inside of it and the lecturer from the GT research institute said it has about $70 worth of parts inside and boy did it ever look like it. By they way it retails for $3200

Just though i'd let you guys know about what I learned (previous to this lecture I thought the DIAGNOdent was a really useful tool).

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[aphistis]

I'm attending a class at Georgia Tech entitled dentalttechnology. Yesterday we had a lecture on dental/biophotonics and the detection of caries and we got a detailed look on how the diagnodent works based on flourescence excitation. Turns out that the wavelengths of light it uses also excite plaque, calculus, green colored food/toothpaste and several other indignent items in the mouth in addition to dental caries. So its sensitivity is pretty poor in a clinical setting (I'm sure it performs well detecting caries on teeth which have been stored in bleach for a year ). Also we got a look inside of it and the lecturer from the GT research institute said it has about $70 worth of parts inside and boy did it ever look like it. By they way it retails for $3200

Just though i'd let you guys know about what I learned (previous to this lecture I thought the DIAGNOdent was a really useful tool).

A good prophy & polish before you do the caries exam will take care of most of that, Taco--plaque, calculus, and green toothpaste. It's not flawless & it's expensive, but it's better than explorer-prodding and turning incipient lesions into cavitated ones.

 

[ItsGavinC]

Good posts. Like everything else in dentistry, it isn't flawless, but it has a wonderful place if used correctly. Just like amalgam, just like composite, etc., the usefulness of the product depends on operator precision.

 

[12YearOldKid]

It is a useful tool. Yes, it has it's problems, but it is still the most effective tool we have ever had for the detection of occlusal caries. Bitewings are all but useless for occlusal caries until there are huge gaping holes. An explorer in the hands of an experienced clinician still misses approximately 50% of occlusal decay. Yes, this is all backed up by the literature.

The biggest problem with Diagnodent is an increased number of false positives due most often to teeth that have been inadequately cleaned prior to exam. If you are going to use the Diagnodent, you have to follow the instructions. This means instructing the hygienist about properly preparing the teeth for exam and not indiscriminately opening up every tooth with a reading of 30 or higher.

As for the cost - well, obscene markups are pretty much standard for dental materials.
Clorox: $1/gallon. Endodontic sodium hypochlorite solution: $1/canal.
Vaseline: $0.80 jar. Model release agent: $15.00/jar.
Dental air compressor: $5,000. Same compressor from Sears: $200
etc... etc...

 

[kenniemd]

It is a useful tool. Yes, it has it's problems, but it is still the most effective tool we have ever had for the detection of occlusal caries. Bitewings are all but useless for occlusal caries until there are huge gaping holes. An explorer in the hands of an experienced clinician still misses approximately 50% of occlusal decay. Yes, this is all backed up by the literature.

The biggest problem with Diagnodent is an increased number of false positives due most often to teeth that have been inadequately cleaned prior to exam. If you are going to use the Diagnodent, you have to follow the instructions. This means instructing the hygienist about properly preparing the teeth for exam and not indiscriminately opening up every tooth with a reading of 30 or higher.

As for the cost - well, obscene markups are pretty much standard for dental materials.
Clorox: $1/gallon. Endodontic sodium hypochlorite solution: $1/canal.
Vaseline: $0.80 jar. Model release agent: $15.00/jar.
Dental air compressor: $5,000. Same compressor from Sears: $200
etc... etc...

Speaking of markups, amalgam pins = $1-2 each
Dentists charge $20 each. Some put 4-6 pins where 2 could suffice

 

[Fullosseousflap]

Good posts. Like everything else in dentistry, it isn't flawless, but it has a wonderful place if used correctly. Just like amalgam, just like composite, etc., the usefulness of the product depends on operator precision.

Unfortunately, I have seen some multi-dentist group practices ( I won't mention them by name but they are in the Heartland of the USA) teach protocols that reward detection and intervention in false positive cases.

Diagnodent should not be used as a poor excuse for clinical judgment.

 

[Blue Tooth]

We wouldn't be referring to Heartland Dental, the nation's largest group practice, would we?

 

[KY2007]

The professors at my school say its o.k. to use it if it's used in conjunction with the other tools we have at our disposal but unethical to use it as a stand alone because of all the false positives.

 

[Fullosseousflap]

We wouldn't be referring to Heartland Dental, the nation's largest group practice, would we?

I don't believe they are the largest.

Doesn't Brite Now! have more offices?

 

[Fullosseousflap]

The professors at my school save its o.k. to use it if it's used in conjunction with the other tools we have at our disposal but unethical to use it as a stand alone because of all the false positives.

Your Professors are CORRECT!

 

[Blue Tooth]

I'm not sure. I'd heard from them when they came to present at our school that they were the biggest. Not that that really matters much anyway...

Flap, on another note, do you know of any other dentists who have regular blogs? I saw the link to Shad Lewis's blog but that hasn't been updated in a long time. I know there's quite a few physicians who have widely trafficked blogs but I don't know about many on our end.

 

[c132]

Got to use the diagnodent the other day in the clinic, and it sucks. I would not waste my money on it. Its only good on smooth surfaces, and not on interproximal or occlusal caries. I had a girl with shown radiographic caries and it gave a max reading of like 9. Not very accurate at all. Sure on one that was an obvious class V, it went into 40's. I personally will NOT waste my money on it!!! My 2 cents...

 

[Fullosseousflap]

I'm not sure. I'd heard from them when they came to present at our school that they were the biggest. Not that that really matters much anyway...

Flap, on another note, do you know of any other dentists who have regular blogs? I saw the link to Shad Lewis's blog but that hasn't been updated in a long time. I know there's quite a few physicians who have widely trafficked blogs but I don't know about many on our end.

I am the only dentist I know (besides Shad and some dental students who have their personal blogs) or I would link to them in my Blog Roll!

If there is anyone else out there please share your url and I will link to you!

In the meantime, you guys/gals are welcome to visit, read, comment and trackback.

 

[SPBest]

I'm attending a class at Georgia Tech entitled dentalttechnology. Yesterday we had a lecture on dental/biophotonics and the detection of caries and we got a detailed look on how the diagnodent works based on flourescence excitation. Turns out that the wavelengths of light it uses also excite plaque, calculus, green colored food/toothpaste and several other indignent items in the mouth in addition to dental caries. So its sensitivity is pretty poor in a clinical setting (I'm sure it performs well detecting caries on teeth which have been stored in bleach for a year ). Also we got a look inside of it and the lecturer from the GT research institute said it has about $70 worth of parts inside and boy did it ever look like it. By they way it retails for $3200

Just though i'd let you guys know about what I learned (previous to this lecture I thought the DIAGNOdent was a really useful tool).

I just attended a CRA dental update course. If you don't know what CRA is check out www.cranews.com They spoke quite highly of the DiagnoDent, but it is expensive. In fact it is now $3200 where it was about $2600 a few years ago, and they haven't made any changes. It is technique sensitive, but coupled with other diagnostic tools it is a great thing to have. The hundreds of dentists who are evaluators for CRA listed the DiagnoDent as one of ten things that a practice shouldn't be without.