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Cavities: Laser device helps find them when they're smaller, easier to treat

Tuesday, September 05, 2000

By Deborah Weisberg

A Regent Square dentist is using laser light to diagnose tooth decay before it develops into full-blown cavities.

David Sultanov purchased the DIAGNOdent, a $2,600 cavity detection device, after it received Food and Drug Administration approval in February, and now makes it part of every dental exam. He is one of 2,000 dentists in America who own one of the machines, which have been available in Europe for more than two years.

The methods dentists have always used -- manually probing teeth with a fine pick and taking X-rays every year or two -- are effective in finding only 57 percent of minute areas of decay, Sultanov said. The laser is 90 percent accurate in finding cavities or suspicious areas, he said.

Most decay isn't evident to dentists until it is one-third the width of the tooth, Sultanov said. By then it requires a large filling that can weaken tooth structure and possibly cause problems years later.

The battery-powered DIAGNOdent, about twice the size of a videocasette, allows dentists to beam a laser light onto teeth with a pen-like instrument, illuminating grooves where cavities the size of pinpricks may be forming.

While light passes easily through healthy teeth, it has difficulty penetrating decay. When the laser encounters a suspicious spot, a digital readout registers an increased wavelength of light. In addition, an auditory signal alerts the dentist to a possible problem.

"It can find vulnerable areas so dentists can prescribe aggressive preventive measures like high doses of fluoride, or special mouth rinses," said Jeff Thibadeau, director of education for the laser's manufacturer, KaVo America Corp.

The device is 90 percent accurate, said Sultanov, "and is absolutely safe."

The first time he used the procedure on Vaughn Busch, 48, of Edgewood, he discovered a cavity.

"I've always had problems with my teeth," Busch said. "I've had to have crowns put in because I've had such problems with decay in certain teeth, so it was nice to have a cavity discovered before it got out of hand.

"It's an easy, comfortable procedure. Only took 10 minutes. You hear a monotone, and when [DIAGNOdent] hits a cavity, it's higher pitched."

Busch's cavity was in a lower right molar, a common area for decay because the deeply ridged chewing surface is an ideal harbor for plaque. Plaque is the sticky white substance that forms when components in saliva mix with bacteria. It's the acid produced by the bacteria in plaque that gradually destroys tooth enamel, Sultanov said. Fluoride found in most toothpastes and drinking water helps slow the breakdown of enamel, but it cannot totally prevent decay.

If a cavity is found before it invades the tooth's dentin -- the softer tissue below surface enamel -- a sealant is sometimes enough to treat the tooth, Sultanov said. Otherwise, a filling may be required.

The advantage of treating cavities when they are just beginning is that repairs can leave most of the tooth structure intact, said Sultanov. Small fillings minimize the prospect of complications, such having to eventually crown or replace teeth. And simple procedures are less expensive.

The DIAGNOdent doesn't increase the cost of a dental exam, said Sultanov, who uses the device on both children and adults. DIAGNOdent's manufacturer could not say whether area dentists other than Sultanov incorporate the device into their practices.

While fluoride treatments are commonly performed on children and sometimes given to adults, they are effective only against decay, not against gum disease, which is the leading cause of tooth loss among adults.

If decay is allowed to progress, it not only can destroy tooth structure, it can enter the root of a tooth and cause an abscess.

A spokeswoman for KaVo said it has not yet sought the American Dental Association's Seal of Acceptance for DIAGNOdent because the device is marketed to dentists and not the general public.

"The ADA seal has more meaning when it comes to toothpaste and mouthwash," the spokeswoman said.

Deborah Weisberg is a free-lance writer who lives in the East End.

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