Regarding "Early Treatment of Incipient Carious Lesions" by Dr. James C. Hamilton and colleagues (December JADA), I take issue with the conclusions drawn by the researchers.
It was determined that 44 percent of the questionable lesions had progressed into dentin in the treatment group. Yet only 14 percent of teeth in the control group were diagnosed with caries at the end of the two-year period.
This means that at least 30 percent of the teeth in the control group likely had undiagnosed caries into the dentin. There was probably more than this, since two years had elapsed between the recordings of the observation on which the two figures were based. This provides evidence to me that diagnosis by visual and explorer feel alone is not reliable, since only approximately one in three early carious lesions will be accurately diagnosed. No mention was made of the fact that carious surfaces can recalcify while actively carious beneath hard surface enamel.
This leads one to ask why additional sophisticated, objective, studied and reliable diagnostic devices, such as DIAGNOdent (Kavo America, Lake Zurich, Ill.), were not used in this study. Also, I question why data were not presented to support the reliability of the use of the diagnostic methods used. The unreliability of visual and explorer feel to diagnose caries is well-known.1
As a practicing dentist, I do not find it acceptable to allow two in three minimally decayed teeth that have caries into dentin to go undiagnosed and, therefore, untreated.
I also find it dismaying that, on a topic with such wide-ranging policy, financial and political implication, JADA would publish an article funded by Delta Dental Fund of Michigan, when they have a financial interest in the use of the data outcome. This fact, and the fact that the study was not blinded, make the results questionable at best.
For example, either subconsciously or unwittingly, preparations on the early treated group could be larger, or preparations on the control group could be under-prepared or inadequately removed of caries, or manipulation done to the surrogate PVS filling material.
Since the cost of undiagnosed caries can increase the cost of restoration by 10 to 20 times, I think this study, contrary to the authors’ purpose, provides incentive for early intervention, since the risk is minimal in comparison.
Use of DIAGNOdent significantly decreases the risk of mistaken positive diagnoses. The authors’ finding that the sealants and preventive resin restorations were performing well after two years provides additional incentive to intervene early when caries into dentin is suspected.
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