Detecting Decay in People with Orthodontic Appliances

As you know any person in orthodontic appliances is at high risk for enamel disease, aka dental decay. Going by the direct CAMBRA definition of caries, one can have caries and not have decay so the first lesson is to make sure the language is spot on. Caries is a bacterial disease that promotes the oral condition – dental decay. The pH of the mouth contributes greatly to the disease and the condition. We’ve confused our patients and ourselves so that we end up treating only a manifestation of a bacterial pH driven disease with amputation and “biologically acceptable” materials.

Using light, we can detect early and late stage enamel disease (Fig. 1). Most clinicians are familiar with the late stage detection, using antique tools like the explorer; the area on the tooth exhibiting caries manifestation is soft and may cause some resistance to the removal of the explorer from the decayed area. It’s difficult to find “hidden decay” (Fig. 1) without sectioning the tooth. Using full spectrum light near the tooth helps the clinician see, and using a focused light can help the clinician detect breakdown between teeth by employing the two properties of light, reflection and refraction, known as transillumination.