Pediatric Dentistry/stainless steel crowns
The Guardian, DDS wrote at 2013-09-21 07:04:45
Get your kids out of there before that guy drills unnecessary holes in your kids teeth. Poking your kids teeth with that explorer can turn early reversible decay into cavities. Your description sounds like over treatment is getting ready to start.
George Stookey, Ph.D.
USE OF AN EXPLORER CAN LEAD TO MISDIAGNOSIS AND DISRUPT REMINERALIZATION.
For at least the past 50 years, the conventional procedure for the clinical detection of dental caries has involved a visual-tactile examination of the tooth surfaces supplemented with the use of radiographs. As described in 1968 by Radike,1 a critical factor supplementing the visual inspection was the tactile feel of tackiness and force of withdrawal associated with the insertion of the dental explorer into the suspicious area. Thus, dental students were taught literally to attack the suspicious area with the sharp explorer to determine if the area had the traditional feel of a carious lesion. Since many of the suspicious areas resisted the explorer, the clinician was expected to use pressure on the probe. However, an increasing amount of research is indicating that that long-standing approach may no longer be the best.
The results of several studies indicated that use of the dental explorer was of limited value for the detection of occlusal caries.
THE EXPLORER, REMINERALIZATION AND FALSE DIAGNOSES The caries process is a known continuum beginning with demineralization beneath dental plaque and progressing through various stages that include a so-called "white spot" and eventual cavitation. Since the 1966 report by Backer Dirks2 documenting that white-spot lesions could be reversed completely and "disappear" clinically, many scientists have investigated the physicochemical dynamics of the caries process. Among the conclusions from these numerous studies is the fact that even though the white-spot lesion reflects the loss of mineral through the outer one-half of the enamel thickness, the lesion may be remineralized as long as the surface layer remains in place. Once the surface layer is broken, plaque acids diffuse into the lesion and the extent of the lesion progresses much more rapidly. Thus, an intact surface layer is considered essential to the reversal of the caries process, and penetration of this surface with an explorer converts a subsurface lesion into a frank cavity.3,4
This realization, coupled with the observation that the use of the dental explorer in the historical manner resulted in an unacceptably high proportion of false-positive diagnoses on occlusal surfaces,1,3 led a number of clinical scientists to re-examine the value of the use of the dental explorer as a probe for caries detection. The results of these studies indicated that this use of the dental explorer was of limited value for the detection of occlusal caries. For example, Lussi5 investigated the ability of faculty dentists and dental practitioners to diagnose fissure caries and determined that only 42 percent of the fissures were diagnosed correctly. In terms of reproducibility, a good level of which is expected to have a value approaching 0.75, faculty dentists had values of 0.21 using the explorer and 0.25 using only a visual examination. For dental practitioners, the values for the examinations were 0.24 and 0.23 with and without the aid of an explorer, respectively. Lussi also observed sensitivity and specificity values of 62 and 84 percent, respectively, indicating that practicing dentists were more likely to fail to treat carious fissures than to restore sound fissures.
Generally similar results of an unacceptably high number of false-negative diagnoses of fissure caries using the dental explorer have been reported by a substantial number of investigators.3,4,6����As noted by Anusavice,19 many clinical decisions to place occlusal restorations are based on the inappropriate use of the dental explorer to determine the softness or tackiness of the fissure or the amount of resistance to the removal of the explorer from the fissure. Thus, Anusavice concluded that there is strong evidence to support the elimination of the use of the dental explorer in the historical manner.
The tip of the explorer should be moved gently across the surface of any noncavitated area to determine the presence or absence of surface roughness.
However, as noted by Kidd and colleagues,20 the dental explorer continues to be an indispensable component of the caries diagnostic armamentarium. With the recognition that the caries process is a continuum and the caries process, if detected before cavitation, can be reversed or arrested with various professional and home-use fluoride measures, it is apparent that the mission of the clinical caries examination has changed from simply the identification of well-advanced lesions requiring restoration. Instead, the mission of the examination now includes the identification of lesions or demineralized areas at the precavitation stage that may be reversed or arrested if the thin surface layer covering the demineralized area remains intact. Thus, the use of the dental explorer in the traditional manner must be avoided, because it will fracture the surface layer and eliminate the possibility of reversing the caries process.
THE USES OF THE EXPLORER, PRESENT AND FUTURE The primary uses of the explorer are to remove dental plaque from the examination area and to determine the roughness of the surface of noncavitated lesions (white spots). Since dental plaque is essential for the development of dental caries, its presence is a clear indication that the area beneath the plaque needs to be examined carefully. The plaque biofilm may be removed gently with a scraping action of the explorerhaft or by the use of the explorerip in fissures to expose the underlying enamel surface.
In addition, the tip of the explorer should be moved gently across the surface of any noncavitated area (white spot, brown spot) to determine the presence or absence of surface roughness as an indication of whether the underlying demineralized area reflects an active lesion. In the absence of imaging technologies, which still are evolving, the use of the explorer in this manner coupled with the visual examination appear in several studies to be the most effective means for the diagnosis of clinical caries and the identification of the most appropriate approach for caries management.4,9,21����These studies have demonstrated clearly that the use of the dental explorer in this manner does not diminish the clinicianbility to detect accurately more advanced lesions requiring restoration on both occlusal and smooth surfaces. Moreover, this procedure permits the detection of precavitation-stage lesions and the determination of whether these areas are active. This latter assessment of the precavitated lesion or demineralized area permits the clinician to identify the appropriate professional and home-use treatments to reverse or arrest the process and to monitor the success of the treatments at subsequent examinations. Thus, while the dental explorer continues to be a critical component of the clinicianiagnostic armamentarium, its use as a probe in the historical manner for a tactile examination of the tooth surface is contraindicated.
CONCLUSION There is an increasing body of scientific data indicating that noncavitated incipient lesions may be remineralized if the surface layer covering the demineralized area or lesion (the white spot) remains intact. Because the use of the probe generally has disrupted this surface layer and prevented the possibility of reversing the noncavitated area through remineralization, the use of the probe to determine the softness or tackiness of the noncavitated lesion is contraindicated.