CLINICAL DENTAL CARIES: EARLY DETECTION AND INTERVENTION

在过去的40年里，由于氟化物在公共卫生项目中的广泛使用，如公共用水加氟、牙科实践和口腔卫生产品，儿童和成人的龋齿患病率显著下降。尽管有了显著的改善，龋齿仍然是最常见的牙病。众所周知，传统的视觉-触觉临床龋病检查方法只有在病变进展到一定程度时才能发现病变，并且涉及300-500微米的釉质。此外，这种损害很难通过氟化物和其他措施逆转，因此经常需要恢复性治疗。有理由认为，在发育的早期阶段发现的病变可能更容易逆转，最近的许多报告支持使用新的成像技术来检测牙齿哭声，比目前的临床方法更早。这些技术包括定量激光荧光法(QLF)、电导法(EC)、红外荧光法(IR)、直接数字照相法(DDR)和数字成像光纤透射法(DIFOTI)。这些技术有可能在龋齿检测和定量方面提供更高的特异性和敏感度。然而，几乎没有临床数据可以验证这些方法中的任何一种来检测早期龋齿。此外，早期龋齿检测技术的可获得性将使研究新的龋齿干预措施成为可能，这可能会进一步降低龋齿患病率。这项研究中要检验的基本假设是：(1)发展定量光或激光荧光等技术将能够比传统的视觉-触觉方法更早地准确检测牙齿哭泣；以及(2)可以确定有效逆转和控制早期龋损的创新干预措施。该项目将涉及两项临床研究：验证性研究和干预性研究。这项验证研究(1-3年)将验证QLF、IR、EC、DDR和DIFOTI在检测咬合、颊舌和近牙面之间的早期原发龋齿方面的使用，并与偏光显微镜(PLM)进行比较，偏光显微镜(PLM)是一种被接受的用于随后剥离的乳牙的“金标准”。干预研究将在临床试验中利用经过验证的方法(S)来确定项目1中确定的治疗早期乳牙龋病最有效的干预措施的有效性。拟议研究的具体目的是：1)进行临床试验，以验证QLF、IR、EC、DDR和/或DIFOTI作为早期龋齿检测手段的有效性，以及2)使用经过验证的早期检测方法(S)进行临床试验，采用项目1中确定的最有效的干预措施，以确定它们在预防或逆转早期乳牙龋病方面的有效性。

During the past 40 years has been a remarkable decline in the prevalence of dental caries in children and adults due to the widespread use of fluoride in public health programs, such as communal water fluoridation, dental practice and in oral hygiene products. In spite of this dramatic improvement, dental caries continues to be the most prevalent dental disease. It is known that the traditional visual-tactile clinical caries examination procedure cannot detect the lesions until they are well advanced and involve 300-500 microns of enamel. Further, such lesions are difficult to reverse with fluorides and other measures often resulting in the need for restorative treatment. It is reasonable to assume that lesions detected at a much earlier stage of development might be more readily reversed and numerous recent reports support the use of new imaging technologies for t he detection of dental cries much earlier than is possible with current clinical methods. These technologies include quantitative laser fluorescence (QLF), electroconductivity (EC), infra-red fluorescence (IR), direct digital radiography (DDR) and digital imaging fiber-optic transillumination (DIFOTI). These technologies have the potential to offer higher specificity and sensitivity with respect to caries detection and quantification. However, little clinical data are available to validate the use of any of these methodologies to detect early dental caries. In addition, the availability of early caries detection technologies will permit the investigation of novel caries interventions which may further reduce the prevalence of dental caries. The fundamental hypotheses to be tested in this investigation are: (1) Developing technologies such as quantitative light or laser fluorescence will permit the accurate detection of dental cries much earlier than is possible with the conventional visual-tactile method; and, (2) Innovative interventions can be identified that will effectively reverse and control early carious lesions. This project will involve two clinical studies: a validation study and an intervention study. The validation study (years 1-3) will validate the use of QLF, IR, EC, DDR, and DIFOTI for the detection of early primary dental caries on occlusal, buccal-lingual and interproximal surfaces as compared to polarized light microscopy (PLM), an accepted "gold standard", on subsequently exfoliated deciduous teeth. The intervention study will utilize the validated method(s) in a clinical trial to determine the efficacy of the most effective interventions determined from Project 1 for the treatment of early primary dental caries. The specific aims of the proposed studies are to: 1, conduct a clinical trial to validate QLF, IR, EC, DDR and/or DIFOTI as a means to detect early caries and, 2) conduct a clinical trial using the validated early detection method(s) with the most effective interventions identified in Project 1 to determine their efficacy in preventing or reversing early primary caries.