On finishing Drs. James Bader and Dan Shugars’ October article, "A Systemic Review of the Performance of a Laser Fluorescence Device for Detecting Caries," my first thought was, "Did the authors even read the directions before vilifying such a fine diagnostic test?"
My experience with the DIAGNOdent (KaVo America, Lake Zurich, Ill.) (DD), is extensive and positive in private practice. Our office was one of the first offices in Illinois to incorporate the DD into regular preventative care modalities. It’s almost too simple to use.
Without summarizing the entire article, it was apparent to me that the authors had many concerns regarding false positives. Nothing could be truer, except that the vast majority of all the false positives I have ever witnessed have been due to operator error. I did not notice anywhere in the article where this was discussed.
Two clinicians with so much experience and depth in fluorescence research must understand the most simple and basic aspect of this diagnostic tool—that is, it does not work with conflicting fluorescing sources. I have found that most who have problems with false positives are either failing to address the use of an air slurry/power polisher (CaviJet [Dentsply, York, Pa.] or PROPHYflex [KaVo America]) type of instrument prior to diagnostic detection, have improperly used the tip(s) or failed to properly calibrate the unit.
Simply put, clinicians cannot rely on rotary-type instruments with expectations of complete removal of fluorescing mediums, such as stain, stain plugs, bacteria, etc., prior to application of the DD. Furthermore, even with proper use, tips crack routinely, and the unit must be calibrated on a per-patient basis.
Since there was no mention of this aspect of treatment during the clinical testing period, I assume it did not happen. Repeating the test after the use of a slurry polishing system will dramatically, if not exclusively, resolve false positives, so long as tips are functional and calibration is accurate.
