Charles D. Samaras, DMD Private Practice Lowell, Massachusetts Director of Practice Management Tufts University School of Dental Medicine Boston, Massachusetts Board Member Contemporary Esthetics

There was a time when dentists used only a mirror and an explorer to diagnose disease, decay, and tooth breakdown. The introduction of dental x-rays has significantly increased that diagnostic ability. Now, there is much more technology available to greatly en­hance the diagnostic abilities of the entire dental team—which directly results in increased excellence and service for our patients. However, it is amazing how many dentists do not take advantage of these new and existing diagnostic tools.

These diagnostic tools fall into two categories: those that enable providers to “see better” and those that enable providers to see what can­not be seen with the naked eye.

What We Can See
Magnification
First of all, it is much easier to perform an initial or periodic oral examination when the oral cavity, or “field of examination,” is well illuminated and dry. This sounds like a no-brainer, but if your only light source is the overhead patient light, you are relying on reflected light that can be blocked by your hands or head. Not to mention that the light source is several feet away from the oral cavity, and the lack of moisture control literally “muddies the water” and decreases your diagnostic ability. Now there is a new technological tool called Isolite (Isolite Systems) that performs as a dry-field illuminator. Isolite promotes its technology as an “alternative to the rubber dam” that provides reliable isolation, illumination, and moisture control for increased visibility during restorative and other procedures. I say it provides all those properties for the examination process as well. It just makes sense that if the examination field is well lit and moisture-free, you can just plain see better. Even when using your mirror and explorer, you will be better able to diagnose disease, decay, fractured restorations, etc. Therefore, I believe this technology can and should be used when performing initial and periodic ex­ams. Another tool available for diagnostic use is ViziLite Plus (Zila Pharmaceuticals, Inc), a handheld light source that enhances your ability to detect oral abnormalities that you may not be able to see with your naked eye.

It should also be mentioned that there is head-mounted light-source technology available that provides shadow-free illumination of the oral cavity.

Eye magnification has become the standard for optimal diagnostic as well as treatment capabilities. When you can change the working distance, or magnify the area to be examined, you in­crease your ability to properly diagnose. Today, eye magnification ranges from small vision loupes mounted on conventional eyewear to large microscopes mounted to the wall, floor stand, or ceiling. Also available are microscopes that provide magnified video images on a computer screen. If you are interested in learning more about this technology, my advice is to attend one of the major dental conventions, such as the American Dental Association’s annual convention, where many eye magnification manufacturers are able to demonstrate their products.

Shade Matching
It may seem that shade matching technology would not be considered diagnostic, but I believe it is. When restoring a tooth, especially with ceramic materials, it is important to have the right color and shade match. With so many variables to consider, it is almost impossible to choose the proper ceramic shade with the naked eye. Properties such as shade, characterization, chroma, translucency, value, and hue must be evaluated as well as determining where on the tooth they exist. There are not a lot of shade-matching tools out there, but three of the most popular are Vita Easyshade (Vident), Shade­Vision (X-Rite Inc), and ShadeScan (Cynovad).

Intraoral Cameras
One of the best diagnostic technologies available today is the intraoral camera. I continue to write and say in every lecture I give that I believe the intraoral camera is the most undervalued and underused technology in dentistry. I feel that it should be used for every tooth, soft tissue, and exam. Every team member in the diagnostic process can use the intraoral camera. What is an intraoral camera? It is a camera with a light source that captures a magnified image of anything you choose to capture, and displays that magnified image on a computer screen or monitor. Because that image is illuminated and magnified, a provider can see much more than with his or her naked eye. Therefore, one’s diagnostic ability is greatly enhanced. What’s also very important is the patient’s ability to see the image as well. There are more than 25 different manufacturers of intraoral cameras, too numerous to mention them all.

What We Cannot See
One of the greatest advances in dentistry is the advent of radiology. X-rays gave the dentist the ability to see and diagnose what he or she could not see with their naked eye. Radiology has now progressed to the production of a digital radiographic image. Again, I am stunned that the majority of practicing dentists have not yet embraced this technology. In my opinion, digital radiography is far superior in its diagnostic value than conventional film x-rays. Why? First of all, a digital radiograph can be enlarged to the entire size of the viewing computer screen or monitor. Second, through the use of advanced imaging software, every image can be highlighted, contrasted, colorized, and zoomed in to enlarge certain areas. This is just not possible with conventional film x-rays. Digital radiography exponentially increases a provider’s diagnostic capabilities, which again directly results in increased excellence and service for the patient.

There are two types of digital radiography—direct and indirect. Indirect digital radiography uses phosphor plates that capture the desired image and “store” it. These plates are then scanned through a scanning device and transfer (project) the digital image onto a computer screen. Direct digital radiography uses “chip technology” by the use of a digital sensor. These sensors directly capture the desired image and immediately transfer it to a computer screen within 3 to 4 seconds. There are really only three manufacturers of indirect dental radiography. However, manufacturers of sensor, or direct digital radiography, technology are numerous. And now, there are also many manufacturers of digital panoramic and cephalometric radiography. These digital solutions are remarkably helpful with respect to enhanced diagnostic capabilities. Again, my advice is to demonstrate the different solutions in your own office, with your own team and existing technology. I believe the key is to get into the digital radiography game as soon as possible. Because, in my opinion, it’s not a matter of if you will transition, it’s when.

Caries Detection
There is also new technology to enhance one’s ability to detect caries, crown fractures, and calculus. The major players in caries detection are Difoti (Electro-Optical Sciences, Inc), which uses transilluminated light with a diagnostic imaging system, and Inspektor Pro (Omnii Oral Phar­maceuticals), which also uses a caries diagnostic imaging system with quan­titative light-induced fluorescence. Diagn­odent and the Diag­nodent pen (KaVo Dental Corpor­ation) use laser technology to measure and quantify caries. When using any of these caries detection techno­logies, you will definitely, and more accurately, diagnose existing dental caries.

Visual Probing Systems
Finally, there is a technology that assists the dentist in locating the apex of tooth roots and visualizing subgingival root surfaces. Instead of “eyeballing” where the endodontic file is in relation to the root apex, apex locators such as Endopex V (Ase­tico, Inc), ProPex (Dentsply Maillefer), Micro Apex-NRG (Endo Technic), Root ZX II (J Morita USA, Inc), Apex N.R.G. (Clinician’s Choice Dental Products Inc), Mark VI (Miltex, Inc), Endex Plus (Osada, Inc), and Foramatron D10 (Parkell, Inc) can, and will, find the apex for you.

And visual probing systems, such as the DV2 Perioscopy System (Dental View Inc), enable the dentist to use a micro fiber-optic endoscope to visualize subgingival surfaces of roots, tissue, and bone, and produce a magnified image of roots, caries, fractures, and soft tissues.

Conclusion
There are a host of technologies available today that greatly enhance dentists’ and their teams’ ability to diagnose more than ever before. This enhanced ability directly increases the excellence and service we provide for our patients. A visual exam and conventional x-rays are no longer the standard when it comes to proper diagnostic protocol. Our patients ex­pect, and deserve, our best efforts.