Diagnosis of caries by LASER fluorescent.

Technology has moved dentistry into an exciting time. Practices all over
the country are fabricating crowns using laser scanning and computer
design.LASERS are being used to control inflammation and pain in the
mouth and to help stabilize chronic periodontal infections. New
materials, tools, and equipment have made restorative dentistry more
efficient, esthetic, minimally invasive, and enjoyable to practice.
Explorer as the primary diagnostic tool for caries detection but studies
show that use of an explorer for caries detection is neither objective nor
accurate. Visual inspection of the tooth is an integral part of traditional
caries diagnosis. However it is not consistent throughout the profesion
and is very subjective to everyone.
With the application of LASER energy of a specific wavelength,
bacterial byproducts called porphyrins will fluoresce red. The intensity
of the fluorescence can then be measured as a direct correlation to the
occurrence and magnitude of the caries activity. Thus, the more acid
attack the tooth undergoes, the higher the number on the scale of the
capture device.
With the introduction of new detection devices, such as the
DIAGNOdent, along with the use of traditional instruments and
treatments, clinicians can more effectively identify the presence of
occlusal decay and properly treat the tooth structure, possible in a non-
invasive manner. The technology of the DIAGNOdent, a 655 nm diode
laser, allows for detection of noncavitated, occlusal pit-and-fissure tooth
decay, in addition to smooth surface caries at an earlier stage than visual
inspection. The DIAGNOdent measures laser fluorescence within the
mineral structure of the tooth. As the incident LASER light is
disseminated into the site, two-way handpiece optics allows the unit to
simultaneously quantify the reflected LASER light energy.

At the specific wavelength that the DIAGNOdent laser operates, healthy

tooth structure exhibits little or no fluorescence, resulting in very low
scale readings on the display. However, decayed tooth structure will
exhibit fluorescence, proportionate to the degree of lost tooth structure,
resulting in elevated scale readings on the display of the DIAGNOdent.
An audio signal allows the operator to hear changes in the scale values,
enabling focus on the patient and not solely on the device. This is
beneficial not only for detection of decay, but also for patient acceptance
of treatment plans.

However, prevention is better than cure.various mechanism suggest

LASER can prevent caries. First, it will increase acid resistance in
LASER enamel by ultrastructural alterations of enamel, as a result
of melting and resolidifying.Organic blocking theory: Partial
denaturation of organic matrix may block the diffusion
pathway in enamel, resulting in retardation of enamel demineralization.
LASER can alter the chemical composition and morphology of the
highly mineralized (96%) dental enamel. Frequencies <450 mJ/cm2,
resulted in an increased Ca/P ratio, decreased amount of carbonate and
protein and the formation of tri calcium phosphate and tetra
calcium phosphate