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DENTAL DIAGNOSTICS 2015

By: Dr. Jacques Doueck



Dental checkups nowadays are not the same as they were when I graduated dental school. Although we still need to check the teeth, gums, bite and muscles, we have some new handy tools in the tool box.

As Good as it Gets?

 Let’s start with the way we check teeth. In the past, a sharp dental explorer was the only way to diagnose early cavities on the biting surface of back molars. We thought that a sharp explorer was “as good as it gets.” Not until we experience the new advances do we realize how good it could be. Today, when Joe comes in for a checkup, we check his digital X-rays and examine his teeth on the video monitor with a 40X camera. Everything looks great except for brown spots on the back molar. We then take out the diagnostic laser, and although on the surface we can’t really tell, the laser reading shows there are two big cavities. If we had waited another few months, he would have certainly needed a root canal. 

 This does not mean that explorers are outdated. Explorers are useful under crowns and in areas that X-rays and lasers cannot always read. Laser diagnostics and digital X-rays allow us to “see below the surface.” It’s the combination of the old-fashioned explorer and the hi-tech camera, laser and digital X-rays that helps us avoid missing cavities. Indeed, in a study conducted by Dr. Lussi of Berne University in Switzerland, general practitioners using only the explorer and visual inspection correctly diagnosed hidden biting surface cavities only 57 percent of the time. The same group achieved an impressive successful diagnostic rate of 90 percent when using the intraoral camera, laser and digital X-rays. 

 Why are digital X-rays better? With the old “film” X-rays, you had to sit there for 15 minutes and wait for X-ray film to develop. With digital X-rays, you can immediately see the picture of your teeth on a computer monitor while you are in the dental chair. The on-screen picture will look like a dental X-ray image – but a lot bigger! Your dentist can zoom in on a single tooth, rotate it, sharpen it and colorize it to make an accurate diagnosis. Moreover, digital X-rays use 90 percent less radiation than before. It’s the computer that allows us to raise the accuracy of the X-ray image and still reduce the radiation used. With diagnostic lasers and digital X-rays, we take much of the guesswork out of detecting tooth decay. 

Probing and Screening

 Your gums need to be measured at every checkup. Gum disease is the main cause of tooth loss among adults over the age of 30, and over 80 percent of the adult population has gum disease to some degree. Thankfully, today we can use a computerized probe, called the Florida Probe™, to measure the gums for breakdown or improvement. We can compare the measurements from one visit to the next to catch gum disease early.

 The last part of the checkup is the oral cancer screening. Oral cancer that is not caught early will kill nearly 50 percent of patients, whereas oral cancer detected early has an 80 percent survival rate. Too often, it is not detected in time, and patients end up losing part of their tongue or jaw, or even their lives. Early screening is completely painless and can save lives. We use the Velscope™, which focuses a special light on the mouth that makes healthy tissue fluoresce, and cancerous tissue look black, allowing for early detection.

 Today we understand that dental diagnosis is more complex and technically challenging than we originally thought. Thanks to technological advancements, we can stop guessing and make definitive diagnoses using the laser, digital X-rays, intraoral cameras, and high power magnification. The standard of care in dentistry has been drastically upgraded, and patients are now demanding state-of the art diagnosis and treatment.

 As a dentist, I can honestly attest that after 38 years, dentistry has become easier, faster, and much, much better!