JKAOH Journal of Korean Academy of Oral Health J Korean Acad Oral Health 1225-388X 2093-7784 Journal of Korean Academy of Oral Health 10.11149/jkaoh.2014.38.2.105 jkaoh-38-105 Original Article In vitro quantification of occlusal caries lesion using QLF-D, ICDAS, and DIAGNOdent KangSi-mook3 MinJi-Hyun3 KimHan-Na1 KimBaek-Il3 KimJin-Bom12 JeongSeung-Hwa12 Department of Preventive and Community Dentistry, Pusan National University School of Dentistry, Yangsan, Korea Institute of Translational Dental Sciences, Pusan National University, Yangsan, Korea Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, Seoul, Korea Corresponding Author: Seung-Hwa Jeong Department of Preventive and Community Dentistry, School of Dentistry, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea Tel: +82-51-510-8222 Fax: +82-51-510-8221 E-mail: jsh0917@pusan.ac.kr 062014 12062014 38 2 105 110 29052014 19062014 21062014 Copyright © 2014 Journal of Korean Academy of Oral Health 2014 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives

To compare the QLF-D method and the ICDAS and DIAGNOdent techniques for in vitro quantification of occlusal caries and to assess the histological features of the caries.

 Methods

One hundred and twenty-two extracted permanent teeth were selected, and the site of interest on the occlusal surface was examined using each detection method. The occlusal sites were classified according to the ICDAS II criteria based on the decision taken by two investigators, who have taken the ICDAS E-learning course. The examined site was then measured using the DIAGNOdent, and the peak value was recorded. In addition, by using the QLF-D, the occlusal site was photographed to obtain the ΔFmax value. After all assessments were performed, the occlusal sites were vertically sectioned in order to assess the histological features. This was considered the gold standard. The histological criteria were graded using a 4-point scale as follows: S=sound (n=21), E1=limited enamel caries (n=27), E2=caries extending to the dento-enamel junction (n=49), D=caries involving the dentine (n=25).

 Results

An ICDAS code between 0 and 4 was assigned to all the occlusal sites, and this revealed the QLF-D value, which was between ―95 to 0. The DIAGNOdent value was between 8 and 99. The correlation values of QLF-D, ICDAS, and DIAGNOdent with the histological features were 0.68, 0.58, and 0.46, respectively (P<0.01). A highly significant correlation was observed between QLF-D and the gold standard, which showed a moderate correlation and an acceptable correlation was observed with ICDAS (r=0.75, P<0.01). A statistically significant difference was observed in the average QLF-D values of each histological grade i.e., ―28.5 (S), ―53.7 (E1), ―68.1 (E2), and ―84.4 (D).

 Conclusions

The QLF-D showed a significant correlation with the ICDAS and histological features. Therefore, visual inspection with QLF-D would improve the detection accuracy and ensure early diagnosis of dental caries.

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Site of interest of each occulsal surface. the site was selected by one examiner.

An example of lesion analysis procedure using QLF-D.

ICDAS and histological criteria used in this study.

Cross-tabulation of ICDAS compared to Histology

Histology ICDAS Total
0 1 2 3 4
S 20 (41.7%) 1 (2.8%) 0 0 0 21
E1 14 (29.2%) 8 (22.2%) 5 (19.2%) 0 0 27
E2 13 (27.1%) 18 (50.0%) 13 (50.0%) 4 (50%) 1 (25%) 49
D 1 (2.1%) 9 (25.0%) 8 (30.8%) 4 (50%) 3 (75%) 25
Total 48 (100%) 36 (100%) 26 (100%) 8 (100%) 4 (100%) 122

S: sound, E1: demineralization limited in Enamel, E2: demineralization into DEJ, D: demineralization involving dentin.

QLF-D ΔFmax value and DIAGNOdent peak value (mean±SE) in each ICDAS score

ICDAS N QLF-D ΔFmax value DIAGNOdent peak value
0 48 ―34.5±2.1a 26.1±3.5a
1 36 ―73.4±2.5b 52.5±4.0b
2 26 ―82.3±2.9bc 68.1±4.8bc
3 8 ―87.5±5.2c 83.6±8.6cd
4 4 ―90.5±7.4c 97.2±12.1d

bcdThe same character indicates no significant different at a=0.05 by one way ANOVA with Duncan's post hoc test.

QLF-D ΔFmax value and DIAGNOdent peak value (mean±SE) in each Histological feature

Histology N QLF-D ΔFmax value DIAGNOdent peak value
S 21 ―28.5±4.3a 22.3±6.2a
E1 27 ―53.7±3.8b 41.1±5.5b
E2 49 ―68.1±2.8c 56.0±4.1bc
D 25 ―84.4±3.9d 66.1±5.7c

bcdThe same character indicates no significant different at a=0.05 by one way ANOVA with Duncan's post hoc test.

Pearson’s Correlation coefficient between Histology and ICDAS and QLF-D and DIAGNOdent value

Histology ICDAS QLF-D DIAGNOdent
Histology 1
ICDAS 0.58** 1
QLF-D ―0.68** ―0.75** 1
DIAGNOdent 0.46** 0.65** ―0.59** 1

**P<0.01.