Quantitative Light Fluorescence Research Articles

Topical fluoride treatment effectiveness: a systematic review

Relevance. The systematic review aimed to evaluate the effectiveness of topical fluoride in children based on the analysis of modern randomized clinical trial (RCT) data.Materials and methods. This review was carried out using the PRISMA checklist (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The proposed criteria determined the quality of the studies for inclusion in the review and then during the result summary. A preliminary search was conducted among articles published between 2013 and 2023 where fluoride varnishes were one of the preventive products. The search included MeSH terms, the keywords "fluorides", "fluorine varnish", "caries prevention", "remineralisation", and "children". A preliminary search found 346 studies. After excluding duplicates and irrelevant studies, two independent reviewers analysed nine RCTs based on the PRISMA criteria.Results. Children aged eight months to five years old participated in five out of nine RCTs on the fluoride varnish application included in the review, and four studies included adolescents aged 14–20 y.o. The duration of the studies ranged from 2 months to 3.5 years. Six studies described the use of fluoride varnish in children, and three studies reported on the application of calcium phosphate gels with fluoride versus fluoride varnish. Various ways determined enamel condition, namely, visual method, digitally processed photography, analysis of radiographs, QLF (quantitative light fluorescence method), and laser fluorescence analysis method (Diagnodent). The dmft, ICDAS indices, caries increment, the WSL (white spot lesion) index, and the assessment of changes in the tooth damage area evaluated the prevalence and intensity of caries. In the control groups, most studies used 1000 to 1500 ppm fluoride toothpastes according to the usual scheme. None of the studies statistically proved the additional preventive effectiveness of the fluoride varnishes.Conclusions. The analysis of RCTs did not reveal the advantages of fluoride varnishes for caries prevention in children and adolescents compared to standard oral hygiene procedures using fluoride toothpastes.

Chapter 7: Technological Aids and Coronal Caries.

In recent decades, dentistry has developed significantly in all areas. While in the past, caries was mainly treated operatively, the today's management has shifted toward noninvasive, minimal invasive, and, only if needed, invasive treatment options. Aiming at enabling the most noninvasive or conservative treatment option requires early caries detection, which, however, remains challenging. The progression of early or noncavitated caries lesions can nowadays be successfully controlled, as well as lesions arrested by oral hygiene procedures combined with the use of fluorides, sealants, or resin infiltration. Methods such as near-infrared light transillumination, fibre-optic transillumination, digital fibre-optic transillumination, laser fluorescence, or quantitative light fluorescence measurements were introduced in the dental market to provide X-ray-free caries detection, assessment, and monitoring. For approximal surfaces that are not directly visible, bitewing radiography is still the standard in detecting caries lesions. The use of artificial intelligence has become the most recent technological aid for the detection of caries lesions on bitewing radiographs and clinical images and has to be understood as an emerging technology, which requires extensive research in the future. The aim of this chapter is to give an overview of different possibilities to detect coronal caries lesions and suggestions of how to improve this process.

Clinical comparative analysis of ICDAS-2 (International Caries Detection and Assessment System-2) and QS-occlusal- quantitative light fluorescence assessment systems

Clinical comparative analysis of ICDAS-2 (International Caries Detection and Assessment System-2) and QS-occlusal- quantitative light fluorescence assessment systems

Comparative evaluation of remineralizing effect of fluoride and nonfluoride agents on artificially induced caries using different advanced imaging techniques.

Aim:The aim of the study is to evaluate and compare the in-vitro remineralization efficacy of remineralizing agents, i.e., fluoride-free toothpaste, fluoride toothpaste, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), CPP-amorphous calcium fluoride phosphate (CPP ACFP), and silver diamine fluoride (SDF) paste on dentine over time.Methodology:Seventy-five extracted human permanent molars were selected. The buccal section of these samples was shaped into a slab. Artificial caries was induced by dipping the samples into the demineralizing solution (pH 4.5) for 21 days. They were then divided into five groups (n = 15). Each experimental group underwent one of the following treatments: Group 1 – Fluoride-free toothpaste (negative control), Group 2 – Fluoride toothpaste (positive control), Group 3 – CPP-ACP, Group 4 – CPP-Amorphous Calcium fluoride Phosphate and Group 5 – SDF. Postremineralizing treatment, Scanning electron microscope, Energy dispersive X-ray and Quantitative light induced fluorescence imaging were carried out to analyze the remineralizing efficacy. The data obtained was then subjected to statistical analysis using ANOVA and Paired t-tests.Results:It was seen that SDF showed highest remineralization efficacy followed by CPP-amorphous calcium fluoride phosphate, CPP-ACP, fluoride toothpaste and fluoride-free toothpaste. The difference in mean value among the groups was statistically significant (P < 0.001).Conclusion:SDF showed the highest remineralizing potential in scanning electron microscopy and energy dispersive X-ray, followed by CPP-ACFP, CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste. Quantitative light fluorescence analysis showed more fluorescence changes in the CPP-ACFP followed by CPP-ACP, Fluoride toothpaste, and Fluoride-free toothpaste.

Multimodal hyperspectral fluorescence and spatial frequency domain imaging for tissue health diagnostics of the oral cavity.

A multimodal, hyperspectral imaging system was built for diagnostics of oral tissues. The system, termed Hyperspectral-Fluorescence-Spatial Frequency Domain Imaging (Hy-F-SFDI), combines the principles of spatial frequency domain imaging, quantitative light fluorescence, and CIELAB color measurement. Hy-F-SFDI employs a compact LED projector, excitation LED, and a 16 channel hyperspectral camera mounted on a custom platform for tissue imaging. A two layer Monte Carlo approach was used to generate a reference table for quick tissue analysis. To demonstrate the clinical capabilities of Hy-F-SFDI, we used the system to quantify gingival tissue hemoglobin volume fraction, detect caries, bacterial activity, and measure tooth color of a volunteer at different time points. Hy-F-SFDI was able to measure quantitative changes in tissue parameters.

Multispectral SWIR images of the pulp-chamber of posterior teeth in vitro.

Intraoral imaging of teeth with SWIR light provides increased contrast of dental caries and restorative materials compared to visible inspection and digital radiography. The objective of this study was to investigate the SWIR optical properties of the dental pulp-chamber floor, walls and canal orifices. We imaged in vitro extracted human posterior teeth at 1300-nm and 1500-1700-nm in reflectance and transillumination and compared the tissues properties with visible light images and quantitative light fluorescence. Transillumination of posterior teeth at both 1300-nm and 1500-1700-nm yielded significantly higher contrast between the pulp-chamber floor and walls than all other methods tested.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

BackgroundThis study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient’s mouth).MethodsA multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models.ResultsA total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up.ConclusionsAlthough a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy.Trial registrationISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.

Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center, randomized, controlled clinical trial.

To determine whether total or partial etching procedures influence the appearance of white spot lesions (WSLs). This split-mouth, double-blind, controlled, randomized study included 20 patients (mean age 16.75 years), who had class I malocclusion, mild crowding, and satisfactory oral hygiene. A total of 40 maxillary quadrants were randomly allocated to be treated using a total etching (TE) or partial etching (PE) protocol. Quantitative light fluorescence images were captured at the beginning and at 3 (T1) and 6 (T2) months after beginning orthodontic treatmen, as well as when the debonding phase of orthodontic treatment was complete (T3). The presence of pre- and posttreatment WSLs was assessed with quantitative light fluorescence software and analyzed with Student's t-test. The analyses showed that, at T2, the total etching group had significantly higher ΔQ and A scores than the partial etching group ( P < .05). The ΔF scores increased significantly at all timepoints in the TE group, but only at T1 and T3 in the PE group. However, no differences were noted at T3 between the TE and PE groups ( P > .05). The inclusion of only right-handed people may have limited the generalizability of the findings. The absence of analyses of the plaque and gingivitis scores of patients was another limitation of this study. WSL formation was observed mostly in maxillary lateral incisor teeth irrespective of the etching technique. Although PE seems to be more successful in the first 6 months, no difference was observed between PE and TE in the long term for WSL formation.

Dental Fluorosis and its Indices, what's new?

Since the description of dental fluorosis as a disease entity by Fredrick McKay and GV Black in 1916, several indices have been used to categorize the different forms of dental fluorosis. Such indices include Dean's, Thylstrup and Fejerskov's(T-F), Total Surface Index of Fluorosis(TSIF) etc. However, none of these indices that was introduced in the 20 th century is without shortcomings or limitations, which eventually led to the discovery of newer indices with continuous scale such as the Visual Analogue scale, Quantitative Light Fluorescence and Polarized white lightimages .

Comparative evaluation of remineralization potential of casein phosphopeptide-amorphous calcium phosphate and casein phosphopeptide-amorphous calcium phosphate fluoride on artificial enamel white spot lesion: An in vitro light fluorescence study

World-wide, the contribution of dental caries to the burden of oral diseases is about 10 times higher than that of periodontal disease, the other common oral condition. Owing to its globally high prevalence, dental caries is a "pandemic" disease characterized by a high percentage of untreated carious cavities causing pain, discomfort and functional limitations. Untreated carious cavities; furthermore, have a significant impact on the general health of children and on the social and economic well-being of communities. A surgical approach to the elimination of carious lesion was developed a century ago; this approach was necessary at that time, because there was no valid alternative. The focus in caries has recently shifted to the development of methodologies for the detection of the early stages of caries lesions and the non-invasive treatment of these lesions. The non-invasive treatment of early lesions by remineralization has the potential to be a major advance in the clinical management of the disease. Remineralization of white-spot lesions may be possible with a variety of currently available agents containing fluoride, bioavailable calcium and phosphate and phosphate. This concept bridges the traditional gap between prevention and surgical procedures, which is just what dentistry needs today. The aim of this in vitro study was to evaluate and to compare the remineralization potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) on artificial white spot enamel lesions using the quantitative light fluorescence (QLF). A total of 45 caries-free extracted maxillary first premolars were embedded in acrylic resin. The samples were randomly divided into three groups namely control group, CPP-ACP group and CPP-ACFP group with 15 samples in each group. The samples of each group were subjected to demineralization process for a period of 96 h. The samples were then mounted in the artificial mouth model and subjected to remineralization and pH cycling for a period of 21 days. QLF readings were recorded at the end of demineralization (1st, 7th, 14th and 21st day) and were statistically analyzed. As compared with artificial saliva both CPP-ACP and CPP-ACFP produced significant amount of remineralization of the artificial enamel white spot lesion (P < 0.001), however when the remineralizing effect of CPP-ACP was compared with the remineralizing effect of CPP-ACFP there was no significant difference. Significant amount of remineralization was produced by CPP-ACP and CPP-ACFP only after the 7th day. After the 14th day, the remineralization produced by both CPP-ACP and CPP-ACFP as compared to artificial saliva was non-significant.

Detecting Incipient Caries Using Front-illuminated Infrared Light Scattering Imaging

A new method for early caries diagnosis was proposed and tested through a home-made optical examination system that used quantitative light fluorescence (QLF) and digital imaging fiber optic transillumination (FOTI) (DIFOTI), with light sources across a wide spectral range, from 350 nm to 1,000 nm. The front-illuminated infrared light scattering image (FIR) showed similar diagnostic abilities to that of DIFOTI. The FIR method was invented based on the observation that caries lesions lose the high transmittance and low scattering properties of benign enamel tissue. There are various methods for the early diagnosis of caries, such as visual examination, exploration, X-ray radiography, QLF, FOTI, and infrared fluorescence (diagnodent). Among them, methods based on optical properties are regarded as having the most potential. A comparative study was performed between the FOTI, QLF, diagnodent, optical coherence tomography, and FIR scattering image methods, using 20 extracted teeth samples with early caries. A scale of lesion measurement based on optical image contrast was proposed. The statistical analysis showed a significant correlation between the DIFOTI and FIR methods (r

Quantitative Light Fluorescence (QLF) and Polarized White Light (PWL) assessments of dental fluorosis in an epidemiological setting

BackgroundTo determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods.MethodsSubjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean’s and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean’s and TF indices by raters and fluorescence images were automatically scored using software.ResultsData from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean’s and TF index. Agreement (measured by weighted Kappa’s) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92.ConclusionsThe study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

In situ Fluoride Response of Caries Lesions with Different Mineral Distributions at Baseline

The present in situ study investigated the fluoride response of caries lesions with similar mineral loss but two distinct mineral distributions (low- and high-‘R’, calculated as the ratio of mineral loss to lesion depth). Sixteen subjects wore eight gauze-covered enamel specimens with preformed lesions placed buccally on their mandibular partial dentures for periods up to 4 weeks. The participants brushed twice daily for 1 min with an 1,100 ppm F (as NaF) dentifrice. After 3 and 4 weeks, specimens were retrieved and analyzed microradiographically (TMR) and by quantitative light fluorescence (QLF). TMR results revealed that low- and high-R lesions showed opposite behaviors – low-R lesions further demineralized, whereas high-R lesions exhibited some remineralization. In comparison, lesion depth increased in low-R, but remained unchanged in high-R lesions; R decreased in both, but more in high-R lesions; mineral density at the lesion surface remained unchanged in low-R, but increased in high-R lesions. Differences in mineral loss between lesion types increased further between 3 and 4 weeks. QLF did not mirror TMR results as low-R lesions were found to remineralize, whereas high-R lesions remained unchanged. It is likely that low-R lesions differ from high-R lesions chemically and microstructurally; therefore rendering low-R lesion more susceptible to further dissolution. During lesion formation, low-R in contrast to high-R lesions may not lose all of the solubility-determining impurities such as magnesium and carbonate, which can reprecipitate again in different mineral phases within the lesion. In conclusion, mineral distribution at baseline directly impacts in situ lesion response to fluoride.

A Fibre Optic System for the Detection of Dental Caries

The tooth is a biological entity comprising of a hard enamel layer, encasing the softer (but still hard) dentine which conceals the much softer pulp chamber. Dental caries, commonly known as tooth decay, is the localized demineralization of enamel or dentine caused by the acidic by products of bacteria. Current methods of detection and diagnosis routinely used in the dental surgery are limited to the subjective act of visual inspection (with aide of a metal probe known as an explorer) and bitewing X-ray. Neither method provides quantitative information about the state of the disease in the tooth for accurate diagnosis and subsequent treatment planning. Such methods are also poor at detecting disease in the early (and most treatable) stages. There are, however, new technologies, generally optically based, making their way into the dental clinic, including Quantitative Light Fluorescence and the DiagnoDent tool. Both methods are able to improve the detection rates of dental caries, however, the outputs from these tools are still somewhat subjective and not quantitative, in particular providing no information on the depth of a lesion. We are reporting on work carried out using the technique of Fibre Optic Confocal Microscopy (FOCOM) in order to produce a device which can record depth profiles through the tooth and allow detection and quantification of subsurface lesions. The method has been shown to detect caries lesions and this paper concentrates on the miniaturisation of the tool for use in the oral cavity within the dental clinic. Two types of miniature lenses, GRIN and aspheric, are investigated using a computer simulation followed by experimental verification. The subsequent choice of the latter is then reported in a desktop system in the near infrared to produce depth profiles through extracted teeth with these profiles showing different characteristics between sound enamel and lesioned enamel. Results with the system used to monitor the change in surface reflection from a tooth during acid erosion of the enamel surface. The results from this new diagnostic instrument thus have applicability for both detecting and following caries lesions during a planned treatment programme of remineralization as well as to monitor the effects of acid erosion a growing dental problem caused by the consumption of acidic soft drinks.

Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries‐detection methods

The aim of this in vitro study was to evaluate whether having results available from multiple detection methods influences dentist's treatment decisions for incipient caries lesions on occlusal surfaces. The occlusal surface of 96 extracted permanent molars without frank cavitation was examined by three examiners initially by visual examination alone, following which they chose one of three treatment options: (i) no treatment, (ii) preventive or non-invasive treatment (sealants), and (iii) invasive treatment. Four weeks later the examiners again selected one of the three treatment options for the surfaces, but this time were able to refer to the results from additional caries-detection methods [bitewing radiographs, electric conductance measurement (ECM), quantitative light fluorescence (QLF), and DIAGNOdent] that had been performed in the interim time. Stereomicroscopy was used to evaluate sensitivity, specificity, accuracy, and area under the Receiver Operating Characteristic (ROC) curve (AUC) for the detection methods at the D1 diagnostic threshold. Slight improvement was obtained in the percentage of sites correctly diagnosed, and in the AUC, when referring to the results obtained from all detection methods compared with visual examination alone. However, a drastic effect on the selection of treatment options was observed by having results available from multiple methods, with the choice of invasive treatment increasing substantially. In conclusion, having data available from multiple methods did not improve the accuracy of examiners in detecting early occlusal caries lesions, but it had a great influence on the number of surfaces indicated for operative treatment. The potential decrease in overall specificity while using multiple methods of detection may be of concern in populations with a low prevalence of occlusal caries lesions.

Approximal caries development in surfaces in contact with fluoride‐releasing and non‐fluoride‐releasing restorative materials: an in situ study

This study investigated the effect of compomer on initial interproximal caries development. One-hundred and sixty cylindrical, and 40 semispherical, bovine enamel samples (control) were prepared, polished, and sterilized. Sixty semicircular samples were prepared from each of the compomer Dyract eXtra and the fluoride-free composite Spectrum TPH. Samples were stored in water and fluoridated twice daily for 28 d. A baseline quantitative light fluorescence (QLF) image was made of each cylindrical sample. Twenty volunteers received intra-oral appliances with eight sample chambers. Each wing contained 1 control sample and either 3 Dyract eXtra or 3 Spectrum TPH samples in contact with the enamel surface of a cylindrical enamel sample. Appliances were worn for 24 h a day for 28 d except during toothbrushing (twice daily) and placement in 10% sucrose solution (five times daily). A final QLF image was made after 28 d. Caries development was analyzed as the lesion area x mean fluorescence loss (DeltaQ % mm(2)) between these and the baseline images using QLF subtract software. The median DeltaQ was significantly lower in the Dyract eXtra group (-6.1% mm(2)) than in the Spectrum TPH (-13.9% mm(2), P <or= 0.001) or control (-11.4% mm(2), P=0.03) groups. Teeth in contact with the compomer developed less caries compared with controls.

The role of risk factors in the identification of appropriate subjects for caries clinical trials: design considerations.

In seeking new and more effective therapies to delay or prevent caries development, investigators must design clinical trials focused on high-risk populations with a predictable incidence of caries over a limited period of time. In children and adolescents, the strongest predictors of caries incidence appear to be baseline levels of caries activity (present caries, e.g., dmfs, DMFT, caries lesions in first molars). Other predictors of caries risk typically include oral hygiene level, counts of cariogenic micro-organisms in plaque and saliva, fluoride history, sucrose intake, and parent's socio-economic level. This paper will briefly review existing literature to address the most useful and relevant prognostic factors for predicting future caries onset. The relative merits of identifying high-risk subjects based on these factors, either singly or in combination, will be explored in terms of statistical efficiency. Particular attention will focus on the advantages of covariate adjustment in the context of survival-based methods for the analysis of caries data. Further, with the advent of more sophisticated diagnostic procedures (e.g., quantitative light fluorescence) to screen and monitor study subjects for caries activity, there is the potential for earlier states of lesion initiation and progression (or regression) to be detected, with, therefore, improved experimental sensitivity to treatment effects. The validity of risk assessment and outcome measurement on the basis of these new diagnostic tools vs. more conventional methods will be examined.

Optical methods--quantitative light fluorescence.

Considerable research during the past two decades has focused upon the development of new technologies for the detection of dental caries. Of these technologies, the method that has been most extensively studied is based upon the indirectly assessed changes in the fluorescence of enamel associated with the loss of mineral. The purpose of this presentation was to review the available information regarding the use of this technology, commonly known as quantitative light fluorescence, for caries detection, particularly early caries detection, and the potential for the routine use of this technology in clinical caries trials. This technology is unique in its ability to measure small changes in the mineral content of enamel lesions quantitatively. The results of recent small-scale clinical trials have indicated that the impact of caries-preventive measures can be determined within a six-month period. With current hardware and software refinements and the results of long-term clinical validation studies that are in progress, it may be that this technology will be the future method of choice for caries clinical trials.

The Effect of Dentine on Fluorescence Measurements of Enamel Lesions in vitro

This study aimed to determine the contribution of the underlying dentine and the enamel-dentine junction to measurements of mineral loss from enamel recorded using quantitative light fluorescence (QLF). Sixteen square blocks (5 × 5 mm) were cut from the labial surfaces of extracted bovine incisor teeth. A dental drill was used to remove dentine and the enamel-dentine junction from half of each specimen. All specimens were embedded in epoxy resin and ground to produce a smooth, flat enamel surface. Half of the enamel surface of the block, perpendicular to where the dentine had been removed, was demineralised for 72 h prior to undertaking QLF measurements from the enamel surface to compare fluorescence loss from different areas of the block. QLF readings taken from lesions with no underlying dentine or enamel-dentine junction were very similar to readings from lesions with underlying dentine. A comparison of the two data sets demonstrated a linear relationship with a gradient of 0.95 and a y intercept of –1.24 (r² = 0.936). From these data, the underlying dentine and enamel-dentine junction did not influence mineral loss in enamel measured using QLF.