Lin-P’ing Choo-Smith

Detection of early dental caries using polarized Raman spectroscopy

A new technique based on polarized Raman spectroscopy is demonstrated for detecting early dental caries on extracted human teeth. Sound tooth enamel exhibited strong Raman polarization anisotropy whereas early caries consistently showed a lower degree of Raman polarization anisotropy. In particular, for sound enamel, the Raman peak arising from the symmetric nu1 vibration of PO(4) (3-) at 959 cm(-1) is strongly polarized. This is in contrast to the spectra of carious lesions that displayed weaker polarization dependence at 959 cm(-1). Such difference in the degree of Raman polarization anisotropy allows for discrimination between early dental caries and sound enamel.

Vibrational spectroscopy and medicine: an alliance in the making

Both infrared (IR) and Raman spectroscopy are emerging as powerful probes of biomedically relevant properties of tissue and biological fluids. From tentative first steps, this field of endeavor is now beginning to mature as the central conceptual and technical issues come into focus. Using representative examples mainly from our own research, the aim of the present article is to provide the reader with a brief overview of progress to date.

Assessment of early demineralization in teeth using the signal attenuation in optical coherence tomography images

Optical coherence tomography imaging is used to improve the detection of incipient carious lesions in dental enamel. Measurements of signal attenuation in images acquired with an 850-nm light source were performed on 21 extracted molars from eight human volunteers. Stronger attenuation was observed for the optical coherence tomography (OCT) signal in healthy enamel than in carious lesions. The measured attenuation coefficients from the two groups form distinct statistical populations. The coefficients obtained from sound enamel fall within the range of 0.70 to 2.14 mm(-1) with a mean value of 1.35 mm(-1), while those in carious regions range from 0.47 to 1.88 mm(-1), with a mean value of 0.77 mm(-1). Three values are selected as the lower threshold for signal attenuation in sound enamel: 0.99, 0.94, and 0.88 mm(-1). These thresholds were selected to provide detection of sound enamel with fixed specificities of 90%, 95%, and 97.5%, respectively. The corresponding sensitivities for the detection of carious lesions are 92.8%, 90.4%, and 87%, respectively, for the sample population used in this study. These findings suggest that attenuation of OCT signal at 850 nm could be an indicator of tooth demineralization and could be used as a marker for early caries detection.

Early dental caries detection using a fibre-optic coupled polarization-resolved Raman spectroscopic system

A new fibre-optic coupled polarization-resolved Raman spectroscopic system was developed for simultaneous collection of orthogonally polarized Raman spectra in a single measurement. An application of detecting incipient dental caries based on changes observed in Raman polarization anisotropy was also demonstrated using the developed fibre-optic Raman spectroscopic system. The predicted reduction of polarization anisotropy in the Raman spectra of caries lesions was observed and the results were consistent with those reported previously with Raman microspectroscopy. The capability of simultaneous collection of parallel- and cross-polarized Raman spectra of tooth enamel in a single measurement and the improved laser excitation delivery through fibre-optics demonstrated in this new design illustrates its future clinical potential.

Optical coherence tomography: fundamental principles, instrumental designs and biomedical applications

The advances made in the last two decades in interference technologies, optical instrumentation, catheter technology, optical detectors, speed of data acquisition and processing as well as light sources have facilitated the transformation of optical coherence tomography from an optical method used mainly in research laboratories into a valuable tool applied in various areas of medicine and health sciences. This review paper highlights the place occupied by optical coherence tomography in relation to other imaging methods that are used in medical and life science areas such as ophthalmology, cardiology, dentistry and gastrointestinal endoscopy. Together with the basic principles that lay behind the imaging method itself, this review provides a summary of the functional differences between time-domain, spectral-domain and full-field optical coherence tomography, a presentation of specific methods for processing the data acquired by these systems, an introduction to the noise sources that plague the detected signal and the progress made in optical coherence tomography catheter technology over the last decade.

Determining the Effect of Calculus, Hypocalcification, and Stain on Using Optical Coherence Tomography and Polarized Raman Spectroscopy for Detecting White Spot Lesions

Optical coherence tomography (OCT) and polarized Raman spectroscopy (PRS) have been shown as useful methods for distinguishing sound enamel from carious lesions ex vivo. However, factors in the oral environment such as calculus, hypocalcification, and stain could lead to false-positive results. OCT and PRS were used to investigate extracted human teeth clinically examined for sound enamel, white spot lesion (WSL), calculus, hypocalcification, and stain to determine whether these factors would confound WSL detection with these optical methods. Results indicate that OCT allowed differentiating caries from sound enamel, hypocalcification, and stain, with calculus deposits recognizable on OCT images. ANOVA and post-hoc unequal N HSD analyses to compare the mean Raman depolarization ratios from the various groups showed that the mean values were statistically significant at P < .05, except for several comparison pairs. With the current PRS analysis method, the mean depolarization ratios of stained enamel and caries are not significantly different due to the sloping background in the stained enamel spectra. Overall, calculus and hypocalcification are not confounding factors affecting WSL detection using OCT and PRS. Stain does not influence WSL detection with OCT. Improved PRS analysis methods are needed to differentiate carious from stained enamel.

Towards early dental caries detection with OCT and polarized Raman spectroscopy

In recent years, we have been developing optical coherence tomography (OCT) and polarized Raman spectroscopy (PRS) for the detection of early non-cavitated dental caries. OCT provides high resolution morphological depth imaging of incipient caries. With OCT, early lesions can be readily identified as regions of high light backscattering with depth into the enamel as compared to health sound enamel. From the OCT images, the lesion depth can be approximated to provide clinically useful information to guide treatment decisions. In addition, we have derived a parameter known as the optical attenuation coefficient in order to distinguish sound from carious enamel non-subjectively. OCT is being combined with PRS since regions of high light backscattering not related to caries development can lead to false-positive results. PRS provides biochemical specificity along with molecular structural/orientational information. With PRS, the Raman depolarization ratio calculated from the main phosphate vibration at ~959 cm-1 from parallel- and cross-polarized Raman spectra allows discrimination between sound and early developing caries. Early studies on lab bench instrumentation are now being translated into fibre-optic based devices for intra-oral use in patient volunteers for clinical validation. In combination, OCT and PRS have potential for detecting and monitoring early lesions with high sensitivity and high specificity.

Emerging Dental Applications of Raman Spectroscopy

Until recently, the application of Raman spectroscopy to investigate dental tissues has primarily focused on using microspectroscopy to characterize dentin and enamel structures as well as to understand the adhesive interface of various resin and bonding agents used in restorative procedures. With the advent of improved laser, imaging/mapping and fibre optic technologies, the applications have expanded to investigate various biomedical problems ranging from oral cancer, bacterial identification and early dental caries detection. The overall aim of these applications is to develop Raman spectroscopy into a tool for use in the dental clinic. This chapter presents the recent dental applications of Raman spectroscopy as well as discusses the potential, strengths and limitations of the technology in comparison with alternative techniques. In addition, a discussion and rationale about combining Raman spectroscopy with other optical techniques will be included.

Ex vivo imaging of early dental caries within the interproximal space

Optical coherence tomography (OCT) is emerging as a technology that can potentially be used for the detection and monitoring of early dental enamel caries since it can provide high-resolution depth imaging of early lesions. To date, most caries detection optical technologies are well suited for examining caries at facial, lingual, incisal and occlusal surfaces. The approximal surfaces between adjacent teeth are difficult to examine due to lack of visual access and limited space for these new caries detection tools. Using a catheter-style probe developed at the NRC-Industrial Materials Institute, the probe was inserted into the interproximal space to examine the approximal surfaces with OCT imaging at 1310 nm. The probe was rotated continuously and translated axially to generate depth images in a spiral fashion. The probe was used in a mock tooth arch model consisting of extracted human teeth mounted with dental rope wax in their anatomically correct positions. With this ex vivo model, the probe provided images of the approximal surfaces revealing morphological structural details, regions of calculus, and especially regions of early dental caries (white spot lesions). Results were compared with those obtained from OCT imaging of individual samples where the approximal surfaces of extracted teeth are accessible on a lab-bench. Issues regarding access, regions of interest, and factors to be considered in an in vivo setting will be discussed. Future studies are aimed at using the probe in vivo with patient volunteers.