Laser Caries Detection: For Children Of All Ages

By Winifred J. Booker, DDS

Non-invasive technology for accurate caries detection

Less than a decade ago, the diagnostic means for detecting decay consisted of the visual exam, probing with an explorer, or squinting to evaluate a film X-ray. Now, our new investigative tools include dynamic technologies such as digital imaging, trans-illumination, and laser caries detection.

Both pediatric dentists and general dentists do all they can to care for young patients in a nonthreatening and, above all, painless way. When confronted with a traditional explorer, the pediatric patient often feels threatened, causing the child to become uncooperative and resulting in a premature end to the visit. Further, it has been demonstrated that the traditional dental explorer can actually advance the carious process. A laser caries detector offers a welcome alternative for both the patient and the parent.

The system I invested in has a standard unit and a wireless “pen” version that is nonthreatening and even engages the child in the examination. Younger children relate the laser caries detection pen to a digital thermometer, while older kids say that it reminds them of a remote control. When I refer to the caries detector as my “magic tooth wand,” the pediatric patient transforms into a willing subject, awaiting each magic beep. When making a reassuring association with something familiar, the “tell-show-do” behavior management technique becomes a fun counting game that is a “win-win” for any dentist.

This technology is not limited to younger patients. Laser caries detection is especially valuable for adult patients with deep, dark stains in tooth enamel. It cannot be over stated that aggressive probing can risk further damage to already compromised tooth structure. The decision to “watch” the area over time can also place the tooth at risk. Now, after a quick reading from the laser detector, you can proceed with the appropriate treatment.

Quantitative results enables monitoring over time

Here is how my system works: The noninvasive handpiece uses a specialized tip that shines a laser into the occlusal subsurface. As the laser detects demineralized tooth substances and bacteria byproducts, it produces fluorescence. The harmless, high-intensity, fluorescent light interacts with the detector in the handpiece (or base unit) and displays a number on the LED screen. The amount of fluorescence, and its corresponding number, is proportional to the amount of decay. Along with the accuracy rate over 90%, this quantifying feature allows the dental professional to numerically document the progression of carious process. The doctor can choose the most ideal restorative interventions to maximize the structural integrity and preserve the involved teeth.

The use of laser detection technology in the practice of dental medicine today continues to support the profession’s commitment to prevention. Employing this technology elevates the delivery of care and helps to safeguard both the deciduous and adult dentitions.

Dr. Winifred J. Booker is a practicing pediatric dentist based in Owings Mills, Maryland. She graduated from Meharry Medical College School of Dentistry and earned her Certificate in Pediatric Dentistry from the Children’s National Medical Center in Washington, DC, where she served as chief resident. Dr. Booker was appointed to serve on the Oral Health Committee for the Surgeon General’s Commission on Oral Health in America. She is currently serving appointments to the Maryland Department of Health and Mental Hygiene’s Dental Action Committee and Medicaid Advisory Committee. She is also the acting executive director of the nonprofit Maryland Children’s Oral Health Institute. Dr. Booker can be reached at