Black and White: Diagnosing Doesn’t Have to be Gray Area by Jeffrey B. Dalin, DDS

With all the different types of patients that come through our doors each day, it’s practical to have different types of examination tools that aid in diagnosis. While bitewing X-rays are a standard modality for detecting caries, as we all know, there are many times when the patient is not able to tolerate or even refuses radiographs. We can often feel as if our hands are tied as we try to make determinations based on just our visual exams. This is when it’s good to have another way to “look inside” our patient’s teeth.

Earlier this year I started using the DEXIS CariVu caries detection device. This new portable unit helps me easily detect a range of carious lesions (occlusal, interproximal, recurrent) and cracks using transillumination technology—without radiation. The infrared light source is in the unit’s handpiece, and you can capture images from this handpiece directly into the DEXIS software.

CariVu lets me verify what I see in visual exams or on radiographs. In the images that CariVu captures, the natural tooth looks transparent, and caries is dark, similar to radiographs. This view is familiar and easy to read. Another great benefit of CariVu is that it identifies the carious lesion’s location, shape and its relative size to the tooth under review.

I’ve used DEXIS products for well over 15 years and appreciate having all my X-ray and camera images centralized. CariVu images are captured and stored with the patient’s intra-oral Xrays and camera images. When I select a tooth number, these images appear at the top of the screen. I can easily compare them side-by-side to make a diagnosis and decide on a course of treatment. My patients find these images easy to understand as well, and that means they can better understand the need for preventive or restorative care.

We have all faced the patient who is very insistent about not having any X-rays. They may go year after year after year without letting us take any radiographs on them. This system has been a godsend for these patients. It takes about the same amount of time to scan all the posterior occlusal surfaces as it does to take bitewings, so no time is lost in the appointment. The amount of information gathered can help give me the patient the best clinical diagnosis under their imposed constraints.

Another situation where the system can be of value is when we are monitoring areas between routine exams. While decay may spread before it’s time to take bitewings again, capturing a quick CariVu image of the area lets me know if it’s OK to wait to take radiographs until the next recall visit or begin treatment.

I have found it to be very useful for children with small mouths where it is very difficult to take any radiographs— regardless if sensor- or film-based—due to their cavity size, gag reflex, behavioral problems, etc. I can comfortably capture CariVu images of their posterior teeth, and they love watching their images appear on the screen.

Lastly, the system is simple to use; just plug-and-play. Everyone in the office was up and running with it within the first few minutes of plugging it in. I see CariVu as a very valuable adjunct to exams and radiographs for the identification of tooth decay and cracks in every dental office—it’s a great diagnostic choice.

  Author's Bio
A second-generation dentist, Dr. Jeffrey Dalin received his BS in Chemistry from Emory University and his DDS from Indiana University School of Dentistry. He has earned a fellowship in Geriatric Dentistry from the University of Missouri-Kansas City School of Dentistry and fellowships from the American College of Dentists, the Academy of General Dentistry, the International College of Dentists and the Academy of Dentistry International. Dr. Dalin is the co-founder of the Give Kids A Smile (GKAS) program, which has now been adopted by the American Dental Association. He currently is chairperson of the National Advisory Board of the GKAS program. Dr. Dalin maintains a private practice in St. Louis, MO. Dr. Dalin evaluated CariVu for DEXIS; he has no financial interests in DEXIS, LLC.

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