A new method for the in vivo assessment of changes in initial enamel caries lesions was developed and tested. A CCD camera equipped with a high-pass filter (λ > 520 nm) collects the fluorescence image of carious teeth, illuminated intraorally with diffuse laser light (λ=488 nm). Incipient lesions show a loss in fluorescence to be expressed as a percentage of fluorescence radiance of sound tissue. A PC program (Inspektor, model QLF 1.0) is used for display, storage, and subsequent analysis of images. To enable the calculation of fluorescence loss, the fluorescence of sound tissue at the lesion site is reconstructed from the radiances of sound tissue bordering the lesion. This method was tested on 19 visually sound buccal surfaces in vivo. The differences between actual and reconstructed radiance was -1.6 ± (SD) 1.1%, over areas varying between 8 and 14 mm2. The repeatability of the caries quantification was tested by measuring one arrested initial caries lesion 25 times in vivo. The lesion area was 0.56 ± 0.20 mm², and the loss of fluorescence was 17.6 ± 0.7%, corresponding to a lesion depth of 17 ± 2 μm. The new quantitative method was applied for the testing of an in vivo caries model using plaque-accumulating brackets on premolars scheduled for extraction. Videoimages were recorded in vivo before bracketing and 0, 2, 3, and 5 weeks after debracketing. Clear changes between the different time points were recorded for both lesion size and mineral content. Thus, the method seems suitable for in vivo measurement of mineral changes in natural enamel lesions on smooth surfaces and might be useful for clinical trials and evaluation of preventive measures.

Quantitative light induced fluorescence (QLF) is a nondestructive diagnostic method for the longitudinal assessment of early caries lesions in time. When a tooth becomes carious the fluorescence radiance at the location of the caries lesion decreases. The fluorescence image of enamel with incipient lesions can be digitized and then the fluorescence loss in the lesion can be quantified in comparison to the fluorescence radiance level of sound enamel. Changes in fluorescence radiance and lesion area can be followed in time to measure lesion development. The amount of fluorescence radiance loss is related to the mineral loss in the lesion. The technique can be used in vitro, in situ and in vivo to monitor mineral changes in lesions. Applications of QLF are found in the testing of products designed to inhibit demineralization and promote remineralization of caries. The method has been successfully applied to smooth surfaces as well as occlusal surfaces, but application on approximal lesions is not yet possible.

A new quantitative, non-destructive method using laser-induced fluorescence (LAP) was compared with longitudinal microradiography (LMR) for assessment of mineral changes in enamel slices using an in vitro caries model. Ten enamel slices, cut longitudinally from sound natural smooth surfaces of human teeth, were exposed to de- and remineralization in a pH-cycling model. The enamel slices were subjected to LAF and LMR measurements before and at 2, 4, 7, and 9 days of demineralization. For LAF, the average fluorescence radiance decreased during the demineralization period with 11% by day 2 and 49% by day 9. For LMR, the corresponding average loss of mineral content changed with 0.01 and 0.10 kg m^––2 over the same time period. The mineral losses in each individual enamel slice measured with the two techniques were strongly correlated, r = 0.97. The Spearman rank correlation coefficient for all LAF and LMR demineralization results was 0.86. The precision (coefficient of variation) for LAF was 3.1%, corresponding to 0.005 kg m^––2, and the repeatability error for LMR was 0.02 kg m^-2 indicating a lower discrimination threshold for LAF compared to LMR. It was concluded that the new, sensitive, nondestructive LAF method provides possibilities for further improvement in the quantification of initial caries lesions in natural smooth enamel surfaces for use in in vitro studies. Furthermore, it offers potential in in situ caries studies as well as a tool in the diagnosis of early enamel caries in vivo.

Quantitative laser fluorescence has been reported as a useful method for the non-destructive in vitro and in vivo diagnosis of early enamel caries. A portable system for intraoral use has been developed with a new light source and filter system replacing the laser light to facilitate clinical application. This new device was validated with microradiographic and chemical analyses for assessment of mineral changes in enamel during lesion formation and remineralization in vitro and compared with the laser light equipment. A significant correlation was found between fluorescence changes and mineral loss: r = 0.79 (laser system) and r = 0.84 (portable lamp system). The correlation between the two fluorescence methods was r = 0.93. The portable fluorescence device seemed to be a promising new tool for reproducible and sensitive assessment of the severity of incipient enamel lesions.

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