The enamel of your tooth is akin to the eggshell of an egg. A small imperfection, be it from an defective enamel formation (un-coalesced grooves in the biting surface of teeth) in conjunction with inadequate hygiene/harmful diet, will allow debris to trap in the grooves of teeth for extended periods of time during snacking and meals. This process fosters bacteria growth in the grooves where they digest the food debris, leave acidic by-products behind which slowly dissolve enamel.
After years of this ongoing process, a small perforation in the enamel will occur somewhere in the grooves, allowing bacteria to enter, grow, and feast on the inside part of your tooth all while leaving your enamel (eggshell) apparently intact. This feasting is asymptomatic when it starts, occasionally and mildly symptomatic when it has progressed significantly into the dentin (inner layer) of the tooth. Finally, as it progresses deep into dentin, the nerve tissue of a tooth will start to react erratically. Pain will tell patients there is a problem at this time. At this stage fixing the problem can become more costly.
Fluoride is beneficial in hardening enamel from chipping and dissolving in highly acidic environment such as in sugary diets, and poor hygiene situations. Prior to widely available fluoride in municipal water and toothpaste, enamel would collapse (cavities = cavitation) and it would be apparent to all what was going on. However, since fluoride is widely used in municipal water, teeth have enough strength to not collapse even if the dentin underneath is soften significantly. This allows the problem to grow undetected until either symptoms arise (pain to biting, sensitivity to temperature, spontaneous pain, etc.)
X-rays and DIAGNOdent® complement each other. X-rays are good at finding cavities in between teeth and on the roots. DIAGNOdent® is the advanced way to detect caries on the tooth’s biting surface. Poking at the grooves of teeth with “sharp” instruments is an unreliable method because the outer tooth surface often appears to be intact and even brand new “sharp” dental instruments cannot detect breaks in the enamel that are less than 0.2 mm at best. But to bacteria, 0.2mm is equivalent to a bowling ball moving down a bowling lane.
How DIAGNOdent® works is it emits an audio signal and registers a digital read-out, which identifies cavities developing below the surface. The higher the amount of fluorescence detected by the machine, the greater the degree of decay within the tooth. The DIAGNOdent® measures laser fluorescence within the tooth structure. As the incident laser light is propagated into the site, two-way hand piece optics allows the unit to simultaneously quantify the reflected laser light energy.
At the specific wavelength that the DIAGNOdent® laser operates, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display. However, carious tooth structure will exhibit fluorescence, proportionate to the degree of caries, resulting in elevated scale readings on the display. DIAGNOdent® does not work on resin (tooth-colored) restorations because they have optical fluorescing properties, prompting elevated readings. Therefore, DIAGNOdent® should not be used on these materials. Neither should it be used on Amalgam (silver) restorations for similar reasons.
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