Effects of Dental Probing on Occlusal Surfaces – A Scanning Electron Microscopy Evaluation

Abstract

The aim of this clinical-morphological study was to investigate the effects of dental probing on occlusal surfaces by scanning electron microscopy (SEM). Twenty sound occlusal surfaces of third molars and 20 teeth with initial carious lesions of 17- to 26-year-old patients (n = 18) were involved. Ten molars of each group were probed with a sharp dental probe (No. 23) before extraction; the other molars served as negative controls. After extraction of the teeth, the crowns were separated and prepared for the SEM study. Probing-related surface defects, enlargements and break-offs of occlusal pits and fissures were observed on all occlusal surfaces with initial carious lesions and on 2 sound surfaces, respectively. No traumatic defects whatsoever were visible on unprobed occlusal surfaces. This investigation confirms findings of light-microscopic studies that using a sharp dental probe for occlusal caries detection causes enamel defects. Therefore, dental probing should be considered as an inappropriate procedure and should be replaced by a meticulous visual inspection. Critical views of tactile caries detection methods with a sharp dental probe as a diagnostic tool seem to be inevitable in undergraduate and postgraduate dental education programmes.

Factors Affecting the Detection and Treatment of Occlusal Caries Using the International Caries Detection and Assessment System

“…7,8 Studies that have been previously conducted to assess the reproducibility and accuracy of this system relied on examiners who were trained using the ICDAS-II criteria. 10,16,17 In our study, the participants did not have any previous training on the system prior to their participation in the study. The criteria were presented to them without any further detail or any additive verbal explanation.…”

Diagnosis of the early carious lesion

“…15 It has been recommended for at least two decades that this technique be limited or replaced for detection of fissural or smooth surface caries. 9,15,16 This is due to the limited amount of extra information tactile examination provides in addition to what can be gained by using other detection techniques, and also the possible damage that may be done to demineralized enamel during the 'probing' procedure. 9,15,17,18 It is recommended that only a ball-ended probe is used, especially to check enamel surface integrity/roughness.…”

Occlusal Caries Depth Measurements Obtained by Five Different Imaging Modalities

“…In order to overcome difficulties during diagnosis and enable better detection of occlusal caries, authors have recommended that traditional methods like visual examination and probing [3] that may cause enamel defects [4] be combined with other diagnostic aids such as radiography, laser or light fluorescence-based methods, or electrical impedance measurements [5][6][7][8][9]. Conventional intraoral film, solid-state detectors and photostimulable phosphor plates are the most commonly preferred and available modalities for diagnosing occlusal caries in conjunction with visual and clinical examination in routine dental practice.…”