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Vol. 44, No. 3, 2010
Issue release date: July 2010
Section title: Original Paper
Free Access
Caries Res 2010;44:317–322
(DOI:10.1159/000317294)

Use of ICDAS Combined with Quantitative Light-Induced Fluorescence as a Caries Detection Method

Ferreira Zandoná A.a · Santiago E.b · Eckert G.c · Fontana M.d · Ando M.a · Zero D.T.a
aDepartment of Preventive and Community Dentistry, Indiana University School of Dentistry, and bDepartment of Medicine, Indiana University School of Medicine, Indianapolis, Ind.; cDepartment of Cariology and Restorative Sciences, University of Michigan School of Dentistry, Ann Arbor, Mich.; dResearch Center, University of Puerto Rico School of Dentistry, San Juan, P.R., USA
email Corresponding Author

Abstract

The purpose of this study was to combine a standardized visually based system, the International Caries Detection and Assessment System (ICDAS), with a sensitive fluorescence-based system, quantitative light-induced fluorescence (QLF), to determine the ability to monitor caries lesion progression. This combination (QLF-I) has the potential to increase the sensitivity of the visual method without compromising specificity. A total of 460 children were enrolled and examined at baseline, 8 months and 12 months by ICDAS and QLF by a single examiner. The examiner repeatability for both methods was comparable, varying between weighted kappa of 0.70 and 0.79. The DMFT score was 6.0 (SD 5.8) at baseline and 6.4 (SD 6.3) at 12 months, and both methods were able to follow the increase in incidence. The QLF-I scored more surfaces at the early ICDAS scores (1 and 2) and score 4. Not all lesions progressed at the same rate, differing by score at baseline and surface type.

© 2010 S. Karger AG, Basel


  

Key Words

  • Dental caries
  • International Caries Detection and Assessment System
  • Longitudinal study
  • Quantitative light-induced fluorescence

References

  1. Amaechi BT, Higham SM: Quantitative light-induced fluorescence: a potential tool for general dental assessment. J Biomed Opt 2002;7:7–13.
  2. Amaechi BT, Podoleanu A, Higham SM, Jackson DA: Correlation of quantitative light- induced fluorescence and optical coherence tomography applied for detection and quantification of early dental caries. J Biomed Opt 2003;8:642–647.
  3. Ando M, Eckert GJ, Stookey GK, Zero DT: Effect of imaging geometry on evaluating natural white-spot lesions using quantitative light-induced fluorescence. Caries Res 2004a;38:39–44.
  4. Ando M, Gonzalez-Cabezas C, Isaacs RL, Eckert GJ, Stookey GK: Evaluation of several techniques for the detection of secondary caries adjacent to amalgam restorations. Caries Res 2004b;38:350–356.
  5. Ando M, Hall AF, Eckert GJ, Schemehorn BR, Analoui M, Stookey GK: Relative ability of laser fluorescence techniques to quantitate early mineral loss in vitro. Caries Res 1997;31:125–131.
  6. Ando M, van der Veen MH, Schemehorn BR, Stookey GK: Comparative study to quantify demineralized enamel in deciduous and permanent teeth using laser- and light-induced fluorescence techniques. Caries Res 2001;35:464–470.
  7. Angmar-Mansson B, ten Bosch JJ: Quantitative light-induced fluorescence (QLF): a method for assessment of incipient caries lesions. Dentomaxillofac Radiol 2001;30:298–307.
  8. Buchalla W, Lennon AM, van der Veen MH, Stookey GK: Optimal camera and illumination angulations for detection of interproximal caries using quantitative light-induced fluorescence. Caries Res 2002;36:320–326.
  9. Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W, Ismail AI: Dietary patterns related to caries in a low-income adult population. Caries Res 2006;40:473–480.
  10. Cook SL, Martinez-Mier EA, Dean JA, Weddell JA, Sanders BJ, Eggertsson H, Ofner S, Yoder K: Dental caries experience and association to risk indicators of remote rural populations. Int J Paediatr Dent 2008;18:275–283.
  11. de Josselin de Jong E, Sundström F, Westerling H, Tranaeus S, ten Bosch JJ, Angmar-Mansson B: A new method for in vivo quantification of changes in initial enamel caries with laser fluorescence. Caries Res 1995;29:2–7.
  12. Ekstrand KR, Martignon S, Ricketts DJ, Qvist V: Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 2007;32:225–235.
  13. Ferreira Zandoná AG, Stookey GK, Eggertsson H, Wefel J, Katz B, Ofner S, Eckert G: Clinical validation study of QLF at Indiana; in Stookey GK (ed): Proceedings of the 6th Annual Indiana Conference. Indiana University School of Dentistry, 2003, vol 6, pp 237–252.
  14. Finlayson TL, Siefert K, Ismail AI, Sohn W: Psychosocial factors and early childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiol 2007;35:439–448.
  15. Gonzalez-Cabezas C, Fontana M, Gomes-Moosbauer D, Stookey GK: Early detection of secondary caries using quantitative light-induced fluorescence. Oper Dent 2003;28:415–422.
  16. Heinrich-Weltzien R, Kühnisch J, Ifland S, Tranaeus S, Angmar-Mansson B, Stösser L: Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: an in vivo comparison. Eur J Oral Sci 2005;113:494–498.
  17. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB: The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 2007;35:170–178.
  18. Ismail AI, Sohn W, Tellez M, Willem JM, Betz J, Lepkowski J: Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS). Community Dent Oral Epidemiol 2008;36:55–68.
  19. Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel-Gutenbrunner M, Pieper K: Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res 2008;42:79–87.
  20. Kühnisch J, Berger S, Goddon I, Senkel H, Pitts N, Heinrich-Weltzien R: Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements. Community Dent Oral Epidemiol 2008;36:475–484.
  21. Kühnisch J, Heinrich-Weltzien R, Senkel H, Sonju Clasen AB, Stösser L: Dental health and caries topography in 8-year-old German and immigrant children. Eur J Paediatr Dent 2001;2:191–196.
  22. Pitts N: ‘ICDAS’: an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health 2004;21:193–198.

    External Resources

  23. Pretty IA: Caries detection and diagnosis: novel technologies. J Dent 2006;34:727–739.
  24. Pretty IA, Edgar WM, Higham SM: The effect of dehydration on quantitative light-induced fluorescence analysis of early enamel demineralization. J Oral Rehabil 2004;31:179–184.
  25. Pretty IA, Ellwood RP: Comparison of paired visual assessment and software analyses of changes in caries status over 6 months from fluorescence images. Caries Res 2007;41:115–120.
  26. Rodrigues JA, Hug I, Diniz MB, Lussi A: Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42:297–304.
  27. Rugarabamu PG, Poulsen S, Masalu JR: A longitudinal study of occlusal caries among schoolchildren in Dar es Salaam, Tanzania. Community Dent Oral Epidemiol 2002;30:47–51.
  28. Shi XQ, Tranaeus S, Angmar-Mansson B: Comparison of QLF and DIAGNOdent for quantification of smooth surface caries. Caries Res 2001;35:21–26.
  29. Sohn W, Ismail A, Amaya A, Lepkowski J: Determinants of dental care visits among low- income African-American children. J Am Dent Assoc 2007;138:309–318, quiz 395–396.
  30. Stookey GK: Quantitative light fluorescence: a technology for early monitoring of the caries process. Dent Clin North Am 2005;49:753–770.
  31. Tranaeus S, Al-Khateeb S, Björkman S, Twetman S, Angmar-Mansson B: Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children: a comparative study of remineralisation by fluoride varnish and professional cleaning. Eur J Oral Sci 2001;109:71–75.
  32. Varma S, Banerjee A, Bartlett D: An in vivo investigation of associations between saliva properties, caries prevalence and potential lesion activity in an adult UK population. J Dent 2008;36:294–299.
  33. Zandoná AF, Zero DT: Diagnostic tools for early caries detection. J Am Dent Assoc 2006;137:1675–1684, quiz 1730, erratum 2007;138:298.

    External Resources

  

Author Contacts

Andréa Ferreira Zandoná
415 Lansing Street, OH-144
Indianopolis, IN 46202 (USA)
Tel. +1 317 274 3409, Fax +1 317 274 5425
E-Mail azandona@iupui.edu

  

Article Information

Received: December 22, 2009
Accepted after revision: April 24, 2010
Published online: June 30, 2010
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 33

  

Publication Details

Caries Research

Vol. 44, No. 3, Year 2010 (Cover Date: July 2010)

Journal Editor: Beighton D. (London)
ISSN: 0008-6568 (Print), eISSN: 1421-976X (Online)

For additional information: http://www.karger.com/CRE


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

The purpose of this study was to combine a standardized visually based system, the International Caries Detection and Assessment System (ICDAS), with a sensitive fluorescence-based system, quantitative light-induced fluorescence (QLF), to determine the ability to monitor caries lesion progression. This combination (QLF-I) has the potential to increase the sensitivity of the visual method without compromising specificity. A total of 460 children were enrolled and examined at baseline, 8 months and 12 months by ICDAS and QLF by a single examiner. The examiner repeatability for both methods was comparable, varying between weighted kappa of 0.70 and 0.79. The DMFT score was 6.0 (SD 5.8) at baseline and 6.4 (SD 6.3) at 12 months, and both methods were able to follow the increase in incidence. The QLF-I scored more surfaces at the early ICDAS scores (1 and 2) and score 4. Not all lesions progressed at the same rate, differing by score at baseline and surface type.

© 2010 S. Karger AG, Basel


  

Author Contacts

Andréa Ferreira Zandoná
415 Lansing Street, OH-144
Indianopolis, IN 46202 (USA)
Tel. +1 317 274 3409, Fax +1 317 274 5425
E-Mail azandona@iupui.edu

  

Article Information

Received: December 22, 2009
Accepted after revision: April 24, 2010
Published online: June 30, 2010
Number of Print Pages : 6
Number of Figures : 0, Number of Tables : 3, Number of References : 33

  

Publication Details

Caries Research

Vol. 44, No. 3, Year 2010 (Cover Date: July 2010)

Journal Editor: Beighton D. (London)
ISSN: 0008-6568 (Print), eISSN: 1421-976X (Online)

For additional information: http://www.karger.com/CRE


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/22/2009
Accepted: 4/24/2010
Published online: 6/30/2010
Issue release date: July 2010

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 3

ISSN: 0008-6568 (Print)
eISSN: 1421-976X (Online)

For additional information: http://www.karger.com/CRE


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Amaechi BT, Higham SM: Quantitative light-induced fluorescence: a potential tool for general dental assessment. J Biomed Opt 2002;7:7–13.
  2. Amaechi BT, Podoleanu A, Higham SM, Jackson DA: Correlation of quantitative light- induced fluorescence and optical coherence tomography applied for detection and quantification of early dental caries. J Biomed Opt 2003;8:642–647.
  3. Ando M, Eckert GJ, Stookey GK, Zero DT: Effect of imaging geometry on evaluating natural white-spot lesions using quantitative light-induced fluorescence. Caries Res 2004a;38:39–44.
  4. Ando M, Gonzalez-Cabezas C, Isaacs RL, Eckert GJ, Stookey GK: Evaluation of several techniques for the detection of secondary caries adjacent to amalgam restorations. Caries Res 2004b;38:350–356.
  5. Ando M, Hall AF, Eckert GJ, Schemehorn BR, Analoui M, Stookey GK: Relative ability of laser fluorescence techniques to quantitate early mineral loss in vitro. Caries Res 1997;31:125–131.
  6. Ando M, van der Veen MH, Schemehorn BR, Stookey GK: Comparative study to quantify demineralized enamel in deciduous and permanent teeth using laser- and light-induced fluorescence techniques. Caries Res 2001;35:464–470.
  7. Angmar-Mansson B, ten Bosch JJ: Quantitative light-induced fluorescence (QLF): a method for assessment of incipient caries lesions. Dentomaxillofac Radiol 2001;30:298–307.
  8. Buchalla W, Lennon AM, van der Veen MH, Stookey GK: Optimal camera and illumination angulations for detection of interproximal caries using quantitative light-induced fluorescence. Caries Res 2002;36:320–326.
  9. Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W, Ismail AI: Dietary patterns related to caries in a low-income adult population. Caries Res 2006;40:473–480.
  10. Cook SL, Martinez-Mier EA, Dean JA, Weddell JA, Sanders BJ, Eggertsson H, Ofner S, Yoder K: Dental caries experience and association to risk indicators of remote rural populations. Int J Paediatr Dent 2008;18:275–283.
  11. de Josselin de Jong E, Sundström F, Westerling H, Tranaeus S, ten Bosch JJ, Angmar-Mansson B: A new method for in vivo quantification of changes in initial enamel caries with laser fluorescence. Caries Res 1995;29:2–7.
  12. Ekstrand KR, Martignon S, Ricketts DJ, Qvist V: Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent 2007;32:225–235.
  13. Ferreira Zandoná AG, Stookey GK, Eggertsson H, Wefel J, Katz B, Ofner S, Eckert G: Clinical validation study of QLF at Indiana; in Stookey GK (ed): Proceedings of the 6th Annual Indiana Conference. Indiana University School of Dentistry, 2003, vol 6, pp 237–252.
  14. Finlayson TL, Siefert K, Ismail AI, Sohn W: Psychosocial factors and early childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiol 2007;35:439–448.
  15. Gonzalez-Cabezas C, Fontana M, Gomes-Moosbauer D, Stookey GK: Early detection of secondary caries using quantitative light-induced fluorescence. Oper Dent 2003;28:415–422.
  16. Heinrich-Weltzien R, Kühnisch J, Ifland S, Tranaeus S, Angmar-Mansson B, Stösser L: Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: an in vivo comparison. Eur J Oral Sci 2005;113:494–498.
  17. Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB: The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 2007;35:170–178.
  18. Ismail AI, Sohn W, Tellez M, Willem JM, Betz J, Lepkowski J: Risk indicators for dental caries using the International Caries Detection and Assessment System (ICDAS). Community Dent Oral Epidemiol 2008;36:55–68.
  19. Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel-Gutenbrunner M, Pieper K: Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res 2008;42:79–87.
  20. Kühnisch J, Berger S, Goddon I, Senkel H, Pitts N, Heinrich-Weltzien R: Occlusal caries detection in permanent molars according to WHO basic methods, ICDAS II and laser fluorescence measurements. Community Dent Oral Epidemiol 2008;36:475–484.
  21. Kühnisch J, Heinrich-Weltzien R, Senkel H, Sonju Clasen AB, Stösser L: Dental health and caries topography in 8-year-old German and immigrant children. Eur J Paediatr Dent 2001;2:191–196.
  22. Pitts N: ‘ICDAS’: an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health 2004;21:193–198.

    External Resources

  23. Pretty IA: Caries detection and diagnosis: novel technologies. J Dent 2006;34:727–739.
  24. Pretty IA, Edgar WM, Higham SM: The effect of dehydration on quantitative light-induced fluorescence analysis of early enamel demineralization. J Oral Rehabil 2004;31:179–184.
  25. Pretty IA, Ellwood RP: Comparison of paired visual assessment and software analyses of changes in caries status over 6 months from fluorescence images. Caries Res 2007;41:115–120.
  26. Rodrigues JA, Hug I, Diniz MB, Lussi A: Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42:297–304.
  27. Rugarabamu PG, Poulsen S, Masalu JR: A longitudinal study of occlusal caries among schoolchildren in Dar es Salaam, Tanzania. Community Dent Oral Epidemiol 2002;30:47–51.
  28. Shi XQ, Tranaeus S, Angmar-Mansson B: Comparison of QLF and DIAGNOdent for quantification of smooth surface caries. Caries Res 2001;35:21–26.
  29. Sohn W, Ismail A, Amaya A, Lepkowski J: Determinants of dental care visits among low- income African-American children. J Am Dent Assoc 2007;138:309–318, quiz 395–396.
  30. Stookey GK: Quantitative light fluorescence: a technology for early monitoring of the caries process. Dent Clin North Am 2005;49:753–770.
  31. Tranaeus S, Al-Khateeb S, Björkman S, Twetman S, Angmar-Mansson B: Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children: a comparative study of remineralisation by fluoride varnish and professional cleaning. Eur J Oral Sci 2001;109:71–75.
  32. Varma S, Banerjee A, Bartlett D: An in vivo investigation of associations between saliva properties, caries prevalence and potential lesion activity in an adult UK population. J Dent 2008;36:294–299.
  33. Zandoná AF, Zero DT: Diagnostic tools for early caries detection. J Am Dent Assoc 2006;137:1675–1684, quiz 1730, erratum 2007;138:298.

    External Resources