I am responding to Drs. James C. Hamilton and George Stookey’s November point/counterpoint article, "Should a Dental Explorer Be Used to Probe Suspected Carious Lesions?" (
JADA 2005;136:1526–32[Free Full Text]
). My 51 years of general practice have convinced me that over 99 percent of pits and fissures that engage a probe on adults open into extensively decayed dentin. I use a sharpened jacquet, which is stiffer and more penetrating than an explorer, to probe. In the course of a year, I may find one or two teeth that probe and do not have dentin decay.
Fifty years ago, before the use of topical fluoride in tooth-paste, pit and fissure decay was more obvious, and the extent of dentin decay was more consistent with the quantity of enamel decay. Now, enamel decay is usually quite limited, but the associated dentin decay is usually advanced.
I believe that topical fluoride, especially in toothpaste, has immunized the enamel. However, when decay penetrates it, it goes relatively wild. The dentin is not protected by the topical fluoride.
X-rays, in my opinion, are rapidly becoming less relevant in caries detection (and I have the board in radiology). Class II lesions tend to be small and hard to see. The decayed dentin becomes soft, but it maintains its density. Logic suggests that the tiny holes prevent fluid exchange.
