Joel Berg

Vital Pulp Therapy

Vital pulp therapy is performed to preserve the health status of the tooth and its ultimate position in the arch. These procedures are performed routinely in primary and permanent teeth. This review is divided into 2 parts: the first aims to illustrate the basic biology of the pulp and the effects on the pulp due to various procedures; the second focuses on the clinical aspects of treatment and the use of various dental materials during different vital pulp therapy procedures performed in the primary and permanent teeth.

Trimodal detection of early childhood caries using laser light scanning and fluorescence spectroscopy: clinical prototype

Abstract. There is currently a need for a safe and effective way to detect and diagnose early stages of childhood caries. A multimodal optical clinical prototype for diagnosing caries demineralization in vivo has been developed. The device can be used to quickly image and screen for any signs of demineralized enamel by obtaining high-resolution and high-contrast surface images using a 405-nm laser as the illumination source, as well as obtaining autofluorescence and bacterial fluorescence images. When a suspicious region of demineralization is located, the device also performs dual laser fluorescence spectroscopy using 405- and 532-nm laser excitation. An autofluorescence ratio of the two excitation lasers is computed and used to quantitatively diagnose enamel health. The device was tested on five patients in vivo as well as on 28 extracted teeth with clinically diagnosed carious lesions. The device was able to provide detailed images that highlighted the lesions identified by the clinicians. The autofluorescence spectroscopic ratios obtained from the extracted teeth successfully quantitatively discriminated between sound and demineralized enamel.

Physician and Dentist New Initiatives to Jointly Mitigate Early Childhood Oral Disease

Current research findings for early childhood caries (ECC) disease in the United States point to an urgent need for physicians and dentists to partner and intervene on behalf of children considered most at risk, aged birth to 3 years. ECC disease is multifactorial and multidisciplinary as well as social, behavioral, and most of all, preventable. The estimated annual dental bill in the United States to restore children’s decayed teeth exceeds US

Optical Measure of Enamel Health: Ability to Triage High Risk Children in Communities without Dental Practitioners

2 billion, making it one of the single most expensive, uncontrolled diseases of childhood. Today, technological, educational, and even philosophical barriers exist making a collaborative, patient centric alliance between medical professionals and dentists challenging. And yet, research findings and real-world working models of joint care point to exactly this type of alliance as pivotal in helping mitigate ECC disease. As well, the cost-benefits to society for early disease discovery and intervention are well documented. This article reviews the current state of affairs in the United States for the ECC disease epidemic, reports barriers prohibiting more urgent development of a nationwide system of allied care, and illuminates current and successful models of joint care already working in different states. Also presented are recent initiative goals set forth in a July 2011 inaugural symposium in Seattle titled, “Physician and Dentist: Together Managing Early Childhood Oral Health.” Symposium speakers, including Institute of Medicine’s (IOM) chair, Dr Fred Rivara, covered ECC-related outcomes from the IOM July 2011 report titled, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations.” As well, Dr Marcia Brand, deputy administrator of the US Health Resources and Services Administration (HRSA) and symposium speaker, expressed HRSA endorsement of a core IOM recommendation that to effectively combat ECC disease in the United States, oral health services can and should be delivered in a variety of settings by a diverse and expanded array of providers, including collaborative and interprofessional teams working across the health care spectrum. Furthermore, Brand appealed for increased efforts to reach children most at risk for developing ECC disease, birth to age 3 years. Methods

Spectrally enhanced image resolution of tooth enamel surfaces

As prevalence of dental caries in children rises worldwide, there is an increasing need for a safe, easy to use and cost-effective technique to detect and identify childhood caries at an early stage where remineralization of the tooth is possible and damage may be reversed. We have developed a simple and robust autofluorescence (AF) laboratory device that uses the dental AF spectra from 405 nm and 532 nm laser excitation and computes a ratio of the integrated areas of the spectra. Ten human extracted teeth with early stage natural caries lesions and an additional 8 human extracted teeth with artificially created erosion lesions were used for the study. The 405/532 nm AF ratio was obtained from healthy as well as unhealthy enamel regions for all teeth. A clear distinction between the ratios for healthy enamel and unhealthy enamel was seen. A percent change in 405/532 nm AF ratio of 62% was seen between natural white spot lesions and healthy enamel, with progressively more severe lesions leading to greater percent changes in AF ratios. The 405/532 nm AF ratio is a promising technique that may be used to detect the presence of early stage dental caries and triage high risk children. A cost effective clinical device can be developed which utilizes the proposed technique to screen children in underserved communities.

Guided fluorescence diagnosis of childhood caries: preliminary measures correlate with depth of carious decay

Short-wavelength 405 nm laser illumination of surface dental enamel using an ultrathin scanning fiber endoscope (SFE) produced enhanced detail of dental topography. The surfaces of human extracted teeth and artificial erosions were imaged with 405 nm, 444 nm, 532 nm, or 635 nm illumination lasers. The obtained images were then processed offline to compensate for any differences in the illumination beam diameters between the different lasers. Scattering and absorption coefficients for a Monte Carlo model of light propagation in dental enamel for 405 nm were scaled from published data at 532 nm and 633 nm. The value of the scattering coefficient used in the model was scaled from the coefficients at 532 nm and 633 nm by the inverse third power of wavelength. Simulations showed that the penetration depth of short-wavelength illumination is localized close to the enamel surface, while long-wavelength illumination travels much further and is backscattered from greater depths. Therefore, images obtained using short wavelength laser are not contaminated by the superposition of light reflected from enamel tissue at greater depths. Hence, the SFE with short-wavelength illumination may make it possible to visualize surface manifestations of phenomena such as demineralization, thus better aiding the clinician in the detection of early caries.

Multimodal optical device for early childhood caries: a clinical prototype

The current rise in childhood caries worldwide has increased the demand for portable technologies that can quickly and accurately detect and diagnose early stage carious lesions. These lesions, if identified at an early stage, can be reversed with remineralization treatments, education, and improvements in home care. A multi-modal optical prototype for detecting and diagnosing occlusal caries demineralization in vivo has been developed and pilot tested. The device uses a 405-nm laser as a scanned illumination source to obtain high resolution and high surface contrast reflectance images, which allows the user to quickly image and screen for any signs of demineralized enamel. When a suspicious region is located, the device can be switched to perform dual laser fluorescence spectroscopy using 405-nm and 532-nm laser excitations. These spectra are used to compute an auto-fluorescence (AF) ratio of the suspicious region and the percent difference of AF ratios from a healthy region of the same tooth. The device was tested on 7 children’s teeth in vivo with clinically diagnosed carious lesions. Lesion depth was then visually estimated from the video image using the 405-nm scanned light source, and within a month the maximum drill depth was assessed by a clinician. The researcher and clinicians were masked from previous measurements in a blinded study protocol. Preliminary results show that the ratiometric percent difference measurement of the AF spectrum of the tooth correlates with the severity of the demineralization as assessed by the clinician after drilling.

Laser scanning dental probe for endodontic root canal treatment

There is currently a need for a safe and effective way to detect and diagnose early childhood caries. We have developed a multimodal optical clinical prototype for testing in vivo. The device can be used to quickly image and screen for any signs of demineralized enamel by obtaining high-resolution and highcontrast surface images using a 405-nm laser as the illumination source, as well as obtaining autofluorescence and bacterial fluorescence images. Then, when a suspicious region is located, the device can perform dual laser fluorescence spectroscopy using 405-nm and 532-nm laser excitation which is used to compute an autofluorescence ratio. This ratio can be used to quantitatively diagnose enamel health. The device is tested on four in vivo test subjects as well as 17 extracted teeth with clinically diagnosed carious lesions. The device was able to provide detailed images which served to screen for suspected early caries. The autofluorescence ratios obtained from the extracted teeth were able to discriminate between healthy and unhealthy enamel. Therefore, the clinical prototype demonstrates feasibility in screening for and in quantitatively diagnosing healthy from demineralized enamel.

Developing laser-based therapy monitoring of early caries in pediatric dental settings

Complications that arise during endodontic procedures pose serious threats to the long-term integrity and health of the tooth. Potential complexities of root canals include residual pulpal tissue, cracks, mesial-buccal 2 and accessory canals. In the case of a failed root canal, a successful apicoectomy can be jeopardized by isthmuses, accessory canals, and root microfracture. Confirming diagnosis using a small imaging probe would allow proper treatment and prevent retreatment of endodontic procedures. An ultrathin and flexible laser scanning endoscope of 1.2 to 1.6mm outer diameter was used in vitro to image extracted teeth with varied root configurations. Teeth were opened using a conventional bur and high speed drill. Imaging within the opened access cavity clarified the location of the roots where canal filing would initiate. Although radiographs are commonly used to determine the root canal size, position, and shape, the limited 2D image perspective leaves ambiguity that could be clarified if used in conjunction with a direct visual imaging tool. Direct visualization may avoid difficulties in locating the root canal and reduce the number of radiographs needed. A transillumination imaging device with the separated illumination and light collection functions rendered cracks visible in the prepared teeth that were otherwise indiscernible using reflected visible light. Our work demonstrates that a small diameter endoscope with high spatial resolution may significantly increase the efficiency and success of endodontic procedures.

Special Section on Optical Imaging, Sensing, and Light Interactions in Cells and Tissues: Trimodal detection of early childhood caries using laser light scanning and fluorescence spectroscopy: clinical prototype

Optical imaging modalities and therapy monitoring protocols are required for the emergence of non-surgical interventions for treating infections in teeth to remineralize the enamel. Current standard of visual inspection, tactile probing and radiograph for caries detection is not highly sensitive, quantitative, and safe. Furthermore, the latter two are not viable options for interproximal caries. We present preliminary results of multimodal laser-based imaging and uorescence spectroscopy in a blinded clinical study comparing two topical therapies of early interproximal caries in children. With a spacer placed interproximally both at baseline and followup examinations, the 405-nm excited red porphyrin uorescence imaging with green auto uorescence is measured and compared to a 12-month follow-up. 405-nm laser-induced uorescence spectroscopy is also measured from the center of selected multimodal video imaging frames. These results of three subjects are analyzed both qualitatively by comparing spectra and quantitatively based on uorescence region segmentation, and then are compared to the standard of care(visual examination and radiograph interpretation). Furthermore, this study points out challenges associated with optically monitoring non-surgical dental interventions over long periods of time in clinical practice and also indicates future direction for improvement on the protocol.