Regarding Dr. Jeffrey Trester’s April JADA letter to the editor, "Caries Into Dentin," and Dr. James Hamilton’s response, there are some basic points that might be helpful for general dentists who are deciding whether "to fill or not to fill."
As compared to 30-plus years ago, it is more common to have dentin caries be disguised by hard surface (no explorer-stick) enamel. The reason: fluoride.
I question Dr. Hamilton’s response that a 15 DIAGNOdent reading is a good candidate for sealing. When sealants microscopically loosen, dentin decay can accelerate and be impossible to diagnose until the decay has seriously compromised a tooth’s health. Careful observation or placing a fluoride containing glass ionomer in suspicious pits and fissures is preferable to a nonfluoride sealant, in my opinion.
Whether using an explorer, radiographs, a visual exam with a bright light for color change, DIAGNOdent, or all four diagnostic tools, it is very important to consider each patient’s caries-prone history when deciding whether to fill or not to fill. For a questionable pit or fissure on a healthy dental history patient, don’t fill it. Tell the patient about it, note the "watch area" on the patient’s chart and observe it over time.
I have used DIAGNOdent for months, not years. While I am impressed with the technology, it is one more tool to increase the accuracy of diagnosing decay.
On a couple of occasions, teeth have yielded high DIAGNOdent readings, and careful tooth preparation did not discover decay. Yes, we do our best to follow the manufacturer’s directions.
Consequently, I have learned to use DIAGNOdent in conjunction with our traditional diagnostic methods (explorer, tooth color and X-ray). While the DIAGNOdent technology is impressive and very helpful, it is not foolproof.
