Oral Health Research Institute To Use NIH Grant to Study Early Detection of Dental Decay

Primary Investigator, Dr. Andréa Ferreira Zandoná

INDIANAPOLIS – When does dental decay first begin its destructive work on a tooth? Are diagnostic clues available early enough to prevent a tooth from developing a visible lesion? Can early-detection criteria be standardized to aid practitioners and researchers around the globe?

During the next five years, researchers at the Indiana University School of Dentistry’s Oral Health Research Institute will use a $3.4 million grant from the National Institutes of Health to find answers to these questions.

Primary investigator Dr. Andréa Ferreira Zandoná and her 10-member team, including two researchers at the University of Puerto Rico, will chronicle the natural history of the progression of early dental decay (caries). They will also attempt to show that a combination of three specific methods of detecting early caries is effective in pinpointing decay at a stage early enough to stop the disease before tooth enamel is damaged and the patient requires restorative treatment.

The project, says Dr. Domenick Zero, Institute director and the IU dental school’s associate dean for Research, has the potential to become a landmark study in the field of early dental caries. “While we can detect the late stages of dental caries after cavitation (a cavity) has occurred, we know very little about how transitions occur from the very early stages,” he says. “The funding of this project will permit, for the first time, a longitudinal investigation of the natural history of dental caries using very sensitive methods of caries detection.”

The researchers will track the dental caries histories of a group of children in Puerto Rico who are at high-risk for the disease. The team will study a combination of three caries-detection methods: an experimental clinical (visual) assessment technique called the International Caries Detection and Assessment System (ICDAS) and two diagnostic imaging instruments that are among the newest being marketed to dental practitioners today – Quantitative Light-induced Fluorescence™ (QLF) and DIAGNOdent Pen,™ an instrument that uses infrared fluorescence.

ICDAS proposes a new international standard of criteria to help dentists and researchers accurately and reliably assess early caries by visual means. The system was designed in 2002 by dental researchers at Indiana and Copenhagen (Denmark) universities, and the universities of Dundee (Scotland) and Michigan.

The long-term goal of the current study is to help dentists substitute traditional diagnostic tools that typically are capable of identifying decay only in its more advanced stages, such as radiographs and dental explorers, with a combination of techniques that can spot trouble while the tooth’s surface still appears to be undamaged. By routinely detecting caries early on, dentists would have increased opportunities of not only halting the disease, but also perhaps preserving the teeth by therapeutically rebuilding, or remineralizing, the tooth structure.

Combining imaging technology with ICDAS, if successful, could provide a reliable early detection tool for practicing dentists worldwide, and could also potentially enable caries researchers to conduct smaller, briefer, and therefore less expensive clinical trials.