Early caries detection tools.

FOTI and DIFOTI

Visual methods.
A. Conventional methods.

1. Tactile examination

2. Visual examination.

B. Advances in visual methods.

1. Illumination (FOTI and DIFOTI)

2. Dyes.
Fibre optic transilluminatio and digital imaging fibre optic transillumination:

1. Help differentiate between sound tooth structure and carious tooth.

2. Promote detection of small carious lesions.

This is possible because, microporosity of enamel structure will alter the

transmission of light therefore defects and colour changes will be visible
throughout enamel and dentin.
Fibre optic transilluminatio a.k.a. FOTI
Depends on the propagation of light from the source to the non illuminated tooth
surface; source being the fibre optic handpiece.

No shadow➡➡➡high index of light transmission ➡➡➡no lesion.

Dark shadow ➡➡➡low index of light transmission ➡➡➡ carious lesion.

Mechanism of action
It is based on the changes in the scattering and absorption phenomenon of light
photons that increases the contrast between sound and enamel caries. In other
words, results from a local decrease of transillumination owing to the
characteristics of the carious lesion. The illumination is delivered via fiber-optics
from a light source to a tooth surface. The light propagates from the fiber
illuminator across tooth tissue to non-illuminated surfaces. The resulting images of
light distribution are then used for diagnosis. Its transmission can be observed
either in the opposite side or in the occlusal surfaces, when molars and premolars
are analyzed. As light scattering is higher in the demineralized enamel, it is
possible to see the lesion as a dark area or a shadow. Besides, carious dentin
appears orange, brown or grey underneath the enamel. This can help on the
differentiation between enamel and dentin lesions.
Evaluation of caries using FOTI
Evaluating for Anterior Caries

For both maxillary and mandibular anterior teeth, in order to visualize anterior
proximal caries the probe should be placed on the labio-cervical region of the
tooth, and the surface should be examined from the lingual aspect with a mouth
mirror (Figure 1). In some cases, because of the thinness of mandibular incisors,
the light guide can be placed on the lingual surface.
Evaluating for Posterior Interproximal Caries

To visualize posterior proximal caries using a conventional light guide, the probe is
placed on the cervical area of the tooth, buccally or lingually. Light passes into the
cervical tooth structure and then radiates occlusally. Caries can appear as a dark
shadow on the occlusal surface
Setbacks and shortcomings of FOTI
it has been show that FOTI diagnosis by naked eye can be subject to great inter-
and intra-examiner variation,
 Digital imaging fibre optic transilluminatio a.k.a.
DIFOTI

Digital imaging fiber-optic transillumination (DIFOTI) was developed in an attempt to reduce the perceived
shortcomings of FOTI, by combining FOTI with a digital CCD camera. DIFOTI has elevated traditional
transillumination to more sophisticated diagnostic levels

Mechanism of action:

When the teeth are transilluminated, areas of demineralized enamel or dentin scatter
light and incipient caries appear darker in the resultant image. Images taken during
different examinations can be compared for clinical changes between several images of
the same tooth over time.