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Schweizerische Zahnrzte-
Gesellschaft SSO
Socit Suisse
dOdonto-Stomatologie
CH-3000 Bern 7
Prof.Adrian Lussi
Klinik fr Zahnerhaltung,
Prventiv- und
Kinderzahnmedizin
Freiburgstrasse 7
3010 Bern
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Ich bedanke mich bei den unten aufgefhrten Kolleginnen und Kollegen fr ihre wertvolle Mitarbeit, die sie in den vergangenen drei Jahren geleistet haben.
Adrian Lussi
M.Altenburger, Freiburg
N.Arweiler, Marburg
T.Attin, Zrich
M.E.Barbour, Bristol
C.E.Besimo, Brunnen
U.Blunck, Berlin
M.M.Bornstein, Bern
T.S.Carvalho, Bern
V.Chappuis, Bern
B.Cvikl, Wien und Bern
D.Dagassan-Berndt, Basel
K.Dula, Bern
S.Eick, Bern
T.Eliades, Zrich
N.Enkling, Bern
A.Filippi, Basel
S.Flury, Bern
A.Franz, Wien
A.Friedmann, Witten
K.W.Grtz, Zrich
S.Hnni, Bern
H.Hecker, Basel
E.Hellwig, Freiburg
I.Hitz Lindenmller, Basel
T.Imfeld, Zrich
R.Jacobs, Leuven
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T.Joda, Bern
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J.Katsoulis, Bern
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S.Kiliaridis, Genve
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G.Krastl, Wrzburg
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J.T.Lambrecht, Basel
O.Lieger, Bern
H.T.Lbbers, Zrich
H.-U.Luder, Mnnedorf
R.Mnnchen, Winterthur
C.Marinello, Basel
G.Menghini, Zrich
A.Mombelli, Genve
F.Mller, Genve
K.Neuhaus, Bern
I.Nitschke, Zrich
C.Ramseier, Bern
M.Rcker, Zrich
S.Ruf, Giessen
G.Salvi, Bern
M.Schtzle, Luzern
S.Scherrer, Genve
M.Schimmel, Bern
R.Schmelzeisen, Freiburg
P.R.Schmidlin, Zrich
A.Sculean, Bern
R.Seemann, Bern
P.R.Shellis, Bristol
V.Suter, Bern
U.Ther, Meikirch
J.Trp, Basel
H.van Waes, Zrich
C.Verna, Basel
T.von Arx, Bern
C.Walter, Basel
T.Waltimo, Basel
R.Weiger, Basel
M.Zehnder, Zrich
B.Zimmerli, Bern
N.U.Zitzmann, Basel
1074
KEYWORDS
autofluorescence,
tongue coating,
tongue coating index
SUMMARY
evaluation with
VELscope.
hygiene.
VELscope 0.672).
Introduction
During routine examinations of oral mucosa using an autofluorescence device at the School of Dental Medicine/University of
Basel, fluorescent orange areas were observed particularly on
the tongue dorsum. Based on certain publications (De Veld et
al. 2005, Poh et al. 2007), it was postulated that the orange color
may be indicative of areas densely colonized by bacteria. A Masters thesis was thus performed in which tongue dorsa were
clinically inspected and evaluated with the Winkel Tongue
Coating Index (WTCI) as well as irradiated with the autofluoresSWISS DENTAL JOURNAL SSO VOL 125 10 2015
P
Results
With both techniques, more tongue coating was found in the
posterior than anterior tongue area (Fig.5). The evaluation of
coating distribution with and without VELscope demonstrated that tongue coating and orange color were chiefly located on
Figs1 and 2 Dividing the tongue dorsum into sextants without (Fig.1;
Winkel et al. 2003) and with the VELscope (Fig.2).
SWISS DENTAL JOURNAL SSO VOL 125 10 2015
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Score 0
Score 1
Score 2
No coating
Sparse coating
Dense coating
Fig.3 Winkel Tongue Coating Index (Winkel et al. 2003). Each of the sextants (see Figs 1 and 2) is evaluated according to the following scores: no coating
(0,left-hand image), sparse coating (1, center), dense coating (2, right-hand image). The summed scores yield the index (minimum 0, maximum 12 points).
Score 0
Score 1
Score 2
Fig.4 The VELscope Index, developed for the study. The summed scores yield the index (minimum 0, maximum 12 points).
SWISS DENTAL JOURNAL SSO VOL 125 10 2015
P
Score 0
ing age, but this increase in older vs younger patients was not
significant (p=0.20).
No significant difference between men and women was found
either with the WTCI (p=0.12) or the VELscope Index (p=0.22).
Discussion
In some cases, the evaluation of tongue coating using the WTCI
was not unambiguous: with a WTC score of1, the question arose
as to whether the finding was actually tongue coating; if instead
it was hyperkeratosis of the filiform tongue papillae, this resulted in a false positive result. Lundgren et al. (2007) studied the
reproducibility of the WTCI and found it conducive to eliminate
score1. Where only scores of0 (no coating) and2 (dense coating) were employed, the reproducibility was better. It proved
simple to detect dense tongue coating with the VELscope device. In this study, a VELscope score of1 or2 corresponded to
a Winkel Tongue Coating score of2. A VELscope score of0
correlated with Winkel Tongue Coating scores of0 or1. Evaluation was easier even for inexperienced examiners if the two
methods were combined.
Dividing the tongues dorsum into sextants enabled even inexperienced examiners to describe the distribution of the coating. Statistical analysis demonstrated good agreement between
the experienced examiner and those lacking experience.
Score 1
Score 0
Score 2
Score 1
Score 2
Fig.6 Comparison of the two tongue coating indices per sextant. Scores 0 or 1 of the Winkel Tongue Coating Index (top) correspond to score 0 of the
VELscope Index (bottom), while score 2 of the Winkel Tongue Coating Index corresponds to scores 1 or 2 of the VELscope Index.
SWISS DENTAL JOURNAL SSO VOL 125 10 2015
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Tab.I Kappa coefficients of the two examination methods compared between the experienced examiner and the inexperienced
examiners (dentists 13, students 1 and 2).
Clinical manifestation
Comparison
Kappa
lower 95%CI
upper 95%CI
0.68
0.59
0.77
0.64
0.55
0.73
0.74
0.65
0.84
0.64
0.55
0.74
0.57
0.48
0.66
Comparison
Kappa
lower 95%CI
upper 95%CI
0.64
0.58
0.70
0.77
0.70
0.84
0.55
0.48
0.61
0.65
0.58
0.72
0.75
0.69
0.82
VELscope
vs: versus
Thus, further studies are necessary to identify micro-organisms which show fluorescence and are associated with
halitosis.
Conclusion
The VELscope device is a suitable instrument for detecting
tongue coating and can complement tongue coating examinations as part of halitosis diagnostics. Thanks to the orange color
of tongue coating illuminated by the VELscope, dentists can
graphically impress upon patients the importance of optimizing
their tongue hygiene. Due to the presently high acquisition
costs (about 4000), chiefly patients at university clinics will
benefit from tongue coating examinations using an autofluorescence device.
Rsum
Dans la prsente enqute, le dpt sur la langue a t examin
dune part laide de lindice dit Winkel Tongue Coating
Index et dautre part il a t complt avec le dispositif dautofluorescence VELscope, pour lequel un indice a t cr.
Lautofluorescence permet de visualiser clairement la coloration
orange de la langue et ainsi, lavenir, montrer distinctement
aux patients souffrant dhalitose les zones de la langue contamines, avec pour but de les encourager optimiser leur hygine
buccale.
La surface de la langue de 100patients (35h, 65f, moyenne
dge 51ans) a t photographie laide de ce dispositif dautofluorescence et sans celui-ci. Toutes ces images ont t dcoupes en six zones lordinateur sous forme de quadrillage.
six personnes (5novices et le directeur du service) ont analys
les images de manire alatoire.
1079
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