Shedding light on caries

July 8, 2015

Shelley Rice, RDH

Article

As hygienists, we are pretty particular about our tools. At my hygiene recare visits, I need technology that is beneficial to patient care, easy to use and portable.

The DEXIS™ CariVu™ caries detection device encompasses all of my criteria. This device sheds light on potential issues that both the dentist and I need to know on a timely basis.

CariVu™ uses transillumination technology to help identify occlusal, interproximal and recurrent carious lesions and cracks. Its patented near-infrared light makes the tooth’s enamel appear transparent, while the lesions, which trap and absorb the light, appear dark. CariVu™ images look like X-rays, and I am already familiar with reading shades of gray on X-rays every day.

At first, I thought I was only going to want to use CariVu™ on patients who were resistant to taking X-rays, children and people with certain medical conditions that precluded X-rays. But when I saw the advantages, I started integrating it into many of my hygiene recare procedures. Scanning the posteriors and capturing necessary images takes only a couple of minutes; no longer than taking bitewing X-rays. As a screening tool, I can use my CariVu™ to scan a suspicious area or one that we have been watching for a while and then compare it to previous CariVu™ images, X-rays or intraoral photographs. With all three imaging modalities giving us information, we feel we are making more succinct treatment recommendations.

I have used other caries detection devices in the past. Numerical readout caries detection devices give information regarding non-restored-areas and occlusal pits. That’s good, but I want to see more. What is happening interproximally where there’s a higher incident of caries? Has the decay broken through the dentino-enamel junction? How about decay around restorations or sealants? When a patient bites down on a tooth and it hurts, but appears fine, I use CariVu™, and I can usually expect to see a crack. I get so much more info with this device than others I’ve used in the past.

Using CariVu™ is very similar to using an intraoral camera, so it does not seem complicated or have a learning curve for me. Transillumination technology is simple for patients to understand. I tell the kids it looks like when they shine a flashlight through their hand. We use similar technology for dentistry so we can see in between the teeth. I explain that the little tip on the end will hug their tooth. When patients hear the benefits, and that they get no ionizing radiation exposure, they usually say, “Let’s do it!” As I move the CariVu™ around their mouth, I can show them the questionable areas or areas that need to be carefully monitored. This education helps them comply with instructions for home care and understand why they may have to return for a re-check or restoration.

Compiling digital data in the dental practice: Seeing is believing

Patients are more likely to accept proposed treatment after I have shown them their X-rays, intraoral photography and CariVu™ images. If CariVu™ shows incipient interproximal caries, I inform them about our practice’s fluoride program, or if they have a cavity, we can put them on the schedule to see the doctor. If we have been watching a certain area, we can follow the progress with CariVu™ and see where the decay is in relationship to the rest of the tooth. Dry mouth is a huge problem for people on antidepressant or antihypertensive medications, and those people should be having their teeth cleaned more often. If I see an area of concern, a year is too long to wait to re-X-ray them. Because they have less saliva as a buffering system to decay, what is little today may be huge in a year, so we recommend fluoride, and we can CariVu™ them every three months to monitor those teeth without worrying about radiation exposure of multiple X-rays.

Finally, CariVu™’s portability makes it very convenient to use for both the doctor and me. I like it so much that I have a tendency to “hog it” in my operatory, but the doctor often comes in and grabs it for his operatory to take a look inside a tooth to check for cracks once the filling material and decay has been removed or to check for cracks across the pulpal floor.

Webinar: How trans-infrared transillumination can change caries detection and efficiency in your practice

One last thing-cleaning it is really easy. The tips (small and large) are removable for sterilization in a STATIM® or autoclave on a regular cycle, and they dry for 10 minutes.

CariVu™ has improved the way I perform hygiene exams. Whether I am pointing out areas I have been watching to the dentist or new issues that he may want to check, I like the additional layer of documentation besides X-rays and intraoral photos. It doesn’t take a lot of time, and sets patients into the thinking mode, of what action needs to be taken-flossing, fluoride or fixing the dental issue-and when it all works together for better dental care, I feel that my job is well done.

DEXIS™ CariVu™
DEXIS™ CariVu™ is a portable caries detection device that uses patented transillumination technology to support the identification of occlusal, interproximal and recurrent carious lesions and cracks. CariVu™ hugs the tooth and bathes it in safe, near-infrared light. On the resulting images, enamel appears transparent while porous lesions trap and absorb the light and appear as dark areas. This allows the clinician to see through the tooth, exposing its structure and the actual shape and size of any carious lesions with very high accuracy.

Indications for Use: www.dexis.com/ifu

About the authorShelley Rice is a clinical hygienist working with Dr. Dennis Grabowski in Lake Elmo, Minn. You can reach her at shelley.rice.rdh@gmail.com.