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，如公共饮水氟化、牙科实践和口腔卫生产品，儿童和成人龋齿的患病率显著下降。尽管有了这种显著的改善，但龋齿仍然是最普遍的牙科疾病。众所周知，传统的视觉-触觉临床龋齿检查程序不能检测到病变，直到病变进展良好并涉及300-500微米的牙釉质。此外，这样的病变难以用氟化物和其他措施逆转，通常导致需要恢复性治疗。可以合理地假设，在发育的早期阶段检测到的病变可能更容易逆转，并且许多最近的报告支持使用新的成像技术来检测比当前临床方法可能更早的牙疼。这些技术包括定量激光荧光（QLF）、电导率（EC）、红外荧光（IR）、直接数字X射线摄影（DDR）和数字成像光纤透照（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灵敏度。然而，很少有临床数据可用于验证使用这些方法来检测早期龋齿。此外，早期龋齿检测技术的可用性将允许研究新的龋齿干预措施，这可能进一步降低龋齿的患病率。在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允许比传统的视觉触觉方法更早地准确检测到牙齿的哭声;（2）可以确定创新的干预措施，有效地逆转和控制早期龋损。该项目将涉及两项临床研究：一项验证研究和一项干预研究。验证研究（1-3年）将验证使用QLF、IR、EC、DDR和DIFOTI检测咬合面、颊舌面和邻间面的早期原发性龋齿，并与偏振光显微镜（PLM）（公认的“金标准”）相比，对随后脱落的乳牙进行检测。干预研究将利用临床试验中经过验证的方法，以确定项目1中确定的最有效干预措施治疗早期原发性龋齿的疗效。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作为检测早期龋齿的方法，2）使用经验证的早期检测方法和项目1中确定的最有效干预措施进行临床试验，以确定其预防或逆转早期原发性龋齿的有效性。

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.