journal of dentistry 36 (2008) 1041–1047

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Clinical evaluation of polypropylene glycol-based caries

detecting dyes for primary and permanent carious dentin

Y. Hosoya a,*, T. Taguchi b, S. Arita c, F.R. Tay d

a
Nagasaki University Graduate School of Biomedical Sciences, Medical and Dental Sciences, Unit of Translational Medicine,
Department of Pediatric Dentistry, 1-7-1, Sakamoto, Nagasaki, 852-8588, Japan
b
Taguchi Pediatric Dental Clinic, 4-1, Doza-machi, Nagasaki, 850-0841, Japan
c
Arita Pediatric Dental Clinic, 14-8, Nagasaki, 852-8016, Japan
d
Department of Endodontics, School of Dentistry, Medical College of Georgia, Augusta, GA 30912-1129, USA

article info abstract

Article history: Objective: The aim of this study was to compare the clinical efficacy of new caries detecting
Received 18 June 2008 dye Caries Check Blue (CCB) with Caries Check (CC) and Caries Detector (CD) using a laser
Received in revised form fluorescence device (DIAGNOdent).
29 August 2008 Method: Primary and permanent teeth with dentin caries were stained with polypropylene
Accepted 29 August 2008 glycol (MW = 300) based new caries detecting dyes CCB, CC, or propylene glycol (MW = 76)
based CD. In the CCB and CC groups, stained dentin was completely removed. In the CD
groups, pink-stained dentin was retained according to the manufacturers’ instructions.
Keywords: Cavities before and after caries removal were measured with the DIAGNOdent. Data were
Caries detecting dye analyzed using ANOVA and Fisher’s PLSD multiple comparison test at a = 0.05. Regression
Polypropylene glycol analyses were performed between DIAGNOdent readings and scores obtained from the
Acid red clinical parameters.
Brilliant blue FCF Results: The DIAGNOdent readings after caries removal were: primary-CCB (13.2  10.4),
Infected dentin primary-CC (14.3  16.7), primary-CD (9.0  5.2), permanent-CCB (22.7  13.4), permanent-
Affected dentin CC (10.6  6.8) and permanent-CD (9.7  9.0). Significant differences were identified between
Laser fluorescence caries detector the permanent-CCB and all other groups. Correlation coefficients between DIAGNOdent
Primary teeth readings and clinical parameters were low.
Young permanent teeth Conclusions: When dentin stained with Caries Check Blue or Caries Check was completely
removed, the DIAGNOdent readings were higher than those recorded when palely-stained
pink dentin was retained with the Caries Detector, with significant difference observed for
the permanent-CCB group. Caries Check Blue may be used clinically to avoid excessive
removal of caries-affected or sound dentin in permanent teeth but not in primary teeth.
# 2008 Elsevier Ltd. All rights reserved.

1. Introduction substantially degraded and cannot be remineralized, this

A carious dentinal lesion has been described as one
consisting of two distinct layers with different ultrastruc-
tural and chemical characteristics. The outer layer is
contaminated with bacteria. As the organic matrix is
layer of caries-infected dentin must be removed. The inner
layer is partially demineralized but not contaminated with
bacteria. As there is only limited collagen degradation, the
inner layer of caries-affected dentin can be remineralized
and should be preserved.1 The primary object of cavity

* Corresponding author. Tel.: +81 95 819 7673; fax: +81 95 819 7675.
E-mail address: hosoya@nagasaki-u.ac.jp (Y. Hosoya).
0300-5712/$ – see front matter # 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2008.08.010
1042 journal of dentistry 36 (2008) 1041–1047
preparation is the removal of all caries-infected dentin prior
to restoration.2
Color and hardness have been used as criteria for the
clinical assessment of carious dentin. Estimation of hardness
of the remaining dentin by tactile procedures, however, may
not be a reliable guide for the clinical removal of caries.3
Discoloration is considered reliable only in chronic caries
where it is usually marked, and that the extent of bacterial
invasion follows closely the discoloration front. In acute
caries, the zones of discoloration are less evident, and
bacterial invasion is usually diffuse and extends beyond the
discoloration front.3,4 Thus, discoloration is also not a reliable
guide for the removal of caries-infected dentin.
Caries detecting dyes such as Caries Detector (Kuraray
Medical Inc., Tokyo, Japan) contain 1% acid red in propylene
glycol5 have been used to facilitate clinical discrimination of
carious dentin from sound dentin during caries removal.6,7
The use of these dyes, however, does not provide a completely
objective method for assessment of caries removal. Excessive
removal of dentin8 or incomplete removal of bacteria9 has
been reported when these dyes were used to remove caries.
The extent of bacterial infection in dentin that remains after
the use of caries detecting dyes has also been challenged,10–12
as these dyes appear to stain demineralized collagen matrices
instead of bacteria.9 There is also concern that the routine use
of these dyes would result in excessive removal of tooth
structures.8,9,13 For Caries Detector (CD), no microbial invasion
was found when palely-stained dentin was left behind along
the cavity floor.11 It is generally recommended to leave dentin
stained light pink with Caries Detector. However, it is
ambiguous which color means light pink.
Recently, a new caries detecting dye (Caries Check, Nippon
Shika Yakuhin, Shimonoseki, Japan) was developed to prevent
excessive dentin removal. This product contains 1% acid red in
polypropylene glycol instead of propylene glycol. The mole-
cular weights of the glycol components employed in Caries
Check and Caries Detector are 300 and 76, respectively. It has
been shown that dyes that were dispensed in higher molecular
weight carriers exhibited reduced diffusional properties in
porous tissues.14,15 Thus, it was hypothesized that caries
detecting dyes prepared with higher molecular weight poly-
propylene glycols might prevent over-staining and excessive
removal of caries-affected or sound dentin. In a previous
study,16 when dentin stained with Caries Check was com-
pletely removed, the DIAGNOdent readings were higher than
those recorded when palely-stained pink dentin was retained
with the Caries Detector, with significant difference observed
for the permanent teeth. Thus, Caries Check may be used
clinically to avoid excessive removal of caries-affected or
sound dentin in permanent teeth but not in primary teeth. In
the previous study,16 the number of the experimental teeth
especially for the Caries Detector groups was low. Thus,
reassessment of the clinical efficacy of these caries detecting
dyes with a larger number of teeth is preferable. As the color of
the dentin between the infected and affected regions often
appears reddish-brown, it is difficult to distinguish between
these two types of dentin using a red caries detecting dye.
Hence, a new blue-colored caries detecting dye (Caries Check
Blue, Nippon Shika Yakuhin) has been developed to tackle this
problem. This product contains 1% brilliant blue FCF in
polypropylene glycol. It is envisaged that the use of this blue
caries detecting dye may improve the detection of the reddish-
brown caries-infected dentin and prevent over-staining and
excessive removal of caries-affected or sound dentin.
The laser fluorescence device, DIAGNOdent (KaVo Co.,
Biberach, Germany), has been developed for objective caries
diagnosis.17–19 The principle behind the use of this device is
that the laser fluorescence emitted from carious dentin
surfaces is greater than that emitted from sound dentin
surfaces.20 The fluorescence emitted from a test surface is
displayed as numerical values ranging from 0 to 99, with
deeper carious lesions producing higher values.18,19,21,22
DIAGNOdent exhibited greater sensitivity than caries detect-
ing dyes in caries detection.23 Thus, apart from the use of
caries detecting dyes, the DIAGNOdent may be used to
evaluate the extent of demineralization of dentin during
caries removal.24 However, a number of potential factors may
complicate the interpretation of DIAGNOdent readings.
Staining of dentin has been reported as one of the confounding
factors that affect the accuracy of caries diagnosis.25 In
addition, significant correlations between DIAGNOdent read-
ings and the color of natural dentin caries lesions, as well as
between DIAGNOdent readings and the hardness of decayed
dentin have been reported, with darker and harder decayed
dentin exhibiting higher values.21 However, there is limited
information about the relationship between the clinical
parameters for determining acute (light-colored and soft) or
chronic (dark-colored and hard) carious dentin and DIAG-
NOdent readings.16
The purpose of this study were (1) to compare the clinical
efficacy of the blue-colored new caries detecting dye contain-
ing polypropylene glycol with the red-colored caries detecting
dyes containing polypropylene glycol or propylene glycol
using the DIAGNOdent device, and (2) to analyze the
correlations between DIAGNOdent readings and the color
and hardness of carious dentin. The null hypotheses tested
were that (1) there are no differences in the clinical efficacy
among caries detecting dyes with the same dye concentration
but dispensed in different molecular weight carriers or with
different kinds of dye but dispensed in the same molecular
weight carrier, and (2) there are no correlations between
DIAGNOdent readings and the clinical parameters for deter-
mining dentinal caries.
2. Materials and methods
2.1. Human subjects
Patients who visited the pediatric dental clinic of Nagasaki
University Medical and Dental Hospital or two private
pediatric dental clinics for tooth-caries treatment were
recruited under a protocol approved by the Institutional
Review Board of the Nagasaki University. The total number of
the patients recruited for primary teeth and permanent teeth
were 69 and 62, respectively. Ninety-eight primary teeth (9
primary incisors, 9 primary canines and 80 primary molars)
and 82 permanent teeth (16 incisors, 1 canine, 1 premolar and
64 molars) with dentin caries were selected. The location of
the caries and (the number of teeth) for the primary teeth were
 journal of dentistry 36 (2008) 1041–1047
occlusal (62), disto-proximal or mesio-proximal (23) and
buccal or lingual (13); and that for the permanent teeth were
occlusal (51), disto-proximal or mesio-proximal (24) and
buccal or lingual (7). The means (standard deviations) of the
age of the patients were 5 years 7 months (2 years 1 month) for
the primary teeth and 10 years (3 years 11 months) for the
permanent teeth.
2.2. Caries detecting dyes
The three caries detecting dyes used in this study were two
new caries detecting dyes Caries Check Blue (CCB) and Caries
Check (CC), and a conventional caries detecting dye (Caries
Detector). The composition of these caries detecting dyes are
polypropylene glycol (molecular weight: 300) and 1% brilliant
blue FCF for CCB, polypropylene glycol and 1% acid red for CC,
and propylene glycol (molecular weight: 76) and 1% acid red for
CD. All of these products are supplied in syringes.
Experimental groups and (number of teeth) were primary-
CCB (34), primary-CC (33), primary-CD (31), permanent-CCB
(33), permanent-CC (23) and permanent-CD (26). For primary-
CC, primary-CD, permanent-CC and permanent-CD groups,
each of 28, 19, 21 and 18 teeth were the same used in the
previous study.16 Dyes and teeth were randomly assigned.
2.3. DIAGNOdent readings
All DIAGNOdent readings and dental treatments in this study
were performed by three experienced pediatric dentists who
were well-versed with the DIAGNOdent system and had
combined exercises before the study. After confirmation of
accurate unit setting, the device was first calibrated using a
ceramic plate according to the manufacturer’s instructions.
The fluorescence of a sound spot on the smooth surface of the
tooth was measured in order to provide a baseline reading for
each tooth (second calibration). This value was then sub-
tracted electronically from the fluorescence of the site under
study. The highest values were selected for the test sites. The
tip of the laser device was placed on the test site and rotated
around a vertical axis until the highest fluorescence reading
was obtained. The same location was measured five times
with a small type-A detector, and the mean value for each
location was obtained.
Acid red in CC and CD, and brilliant blue FCF in CCB do not
affect the DIAGNOdent readings and the DIAGNOdent read-
ings for CC, CD and CCB are 0.
2.4. Caries removal
The teeth were anesthetized, isolated with rubber dam,
cleaned with air-water spray, and the DIAGNOdent readings
taken prior to caries removal. Each cavity was accessed with a
water-cooled high-speed diamond bur. The soft, caries-
infected dentin was removed with a water-cooled low-speed
round steel bur and hand instruments. One of the caries
detecting dyes was applied on the soft dentin for 10 s and then
rinsed off by air-water spray. This procedure was repeated
until all caries-infected dentin was removed. For CC and CCB,
all the stained dentin was removed. For CD, only the red-
stained dentin was removed, leaving behind the pale, pink-
1043
stained dentin according to the manufacturer’s instructions.
After removal of the caries-infected dentin, DIAGNOdent
readings were retaken. The teeth were subsequently restored
with resin composites or metal inlays.
The DIAGNOdent readings obtained for both primary and
permanent teeth using the three caries detecting dyes were
statistically analyzed using one-way ANOVA and Fisher’s
PLSD multiple comparison tests. Statistical significance were
set at a = 0.05.
2.5. Clinical characteristics of caries-infected dentin
The characteristics of the caries-infected dentin were clini-
cally assessed using two parameters: color and hardness. Each
parameter was classified into three qualitative categories, so
that a score of 1–3 could be designated to the respective
parameter.
For color, the three categories were: 1; black-colored group
(black or dark brown), 2; brown-colored group (brown or
yellow brown), 3; yellow-colored group (yellow or light yellow).
Color charts of the six-colored caries-infected dentin were
used for in vivo classification of the dentin color categories.
After cavity access, the caries-infected dentin of all experi-
mental teeth was photographed using digital cameras (D100,
Nikon Co., Tokyo, Japan), and the color category of each tooth
was identified and agreed upon by three dentists.
For hardness, the three categories were: 1; hard, 2; medium,
3; soft. If the caries-infected dentin was easily removed with
hand instruments, the dentin was classified as 3 (soft). If the
carious dentin required the use of both burs and hand
instruments for removal, it was classified as 1 (hard). If the
hardness of the carious dentin fell between the aforemen-
tioned categories, it was classified as 2 (medium). Prior to the
commencement of the clinical study, category selection was
standardized between the three examiners using extracted
primary and permanent teeth with either acute or chronic
dentinal caries.
After the training for evaluations of color and hardness, the
three examiners worked at different dental clinic using
different DIAGNOdent instruments that showed no significant
data difference among the three instruments in a previously
reported pilot study.16
When these subjective clinical scores were examined
together, lower scores would represent the characteristics of
chronic dentinal caries. Conversely, higher scores would
represent the characteristics of acute dentinal caries. The
correlations between these clinically subjective parameters
and the DIAGNOdent readings were statistically analyzed
using linear regression analyses with a = 0.05.
3. Results
Table 1 depicts the age of the patients, the DIAGNOdent
readings before treatment, and after removal of the carious
dentin in the CD, CC and CCB groups. For both primary and
permanent teeth, there were no significant differences in the
age of patients among the CD, CC and CCB groups. For the
mean DIAGNOdent readings before treatment, the reading in
the primary-CCB subgroup was significantly higher than those
1044 journal of dentistry 36 (2008) 1041–1047

Table 1 – Comparison of age of patients, and DIAGNOdent readings before treatment and after removal of the carious
dentin among caries detecting dyes
Caries detecting dye Age of patients (months) DIAGNOdent reading before DIAGNOdent reading after
treatment carious dentin removal

Primary Permanent Primary Permanent Primary Permanent

teeth teeth teeth teeth teeth teeth

Caries Detector (CD) 66.5  24.6 a 120.9  52.2 b 37.7  15.0 c 43.6  19.7 c 9.0  5.2 d 9.7  9.0 d
Caries Check (CC) 76.3  30.7 a 130.0  53.0 b 39.0  13.4 c 40.8  19.5 c 14.3  16.7 d 10.6  6.8 d
Caries Check Blue (CCB) 59.9  15.8 a 113.0  36.2 b 25.9  13.1 42.3  10.2 c 13.2  10.4 d 22.7  13.4

Groups with the same letter superscripts (a–d) are not significantly different ( p > 0.05).

obtained from primary-CD, permanent-CD, primary-CC, per-

manent-CC and permanent-CCB subgroups ( p < 0.05). For the
mean DIAGNOdent reading after caries removal, the perma-
nent-CCB subgroup was significantly higher than those
obtained from the primary-CD, permanent-CD, primary-CC,
permanent-CC and primary-CCB subgroups ( p < 0.05).
When the mean DIAGNOdent readings among the three
dentists were compared, there were no significant differences
in the readings obtained before treatment for the permanent
teeth. However, the readings obtained by dentist A from
primary dentition before caries removal was significantly
higher than those by dentists B and C ( p < 0.01). For the mean
DIAGNOdent readings after caries removal, the readings
obtained by dentist A from both dentitions were significantly
higher than those obtained by dentists B and C ( p < 0.05). The
readings obtained by dentist B from the permanent dentition
was also significantly higher than those obtained by dentist C
( p < 0.05).
Fig. 1A and B summarize the respective clinical scores
obtained for color and hardness of the carious dentin. Table 2
shows the scores for color and hardness of carious dentin
among the CD, CC and CCB groups. There were no significant
differences in the scores for color among the CD, CC and CCB
groups, and the primary-CD, primary-CC, primary-CCB,
permanent-CD, permanent-CC and permanent-CCB sub-
groups. However, for the hardness scores, the score of
permanent-CCB was significantly higher than those of Fig. 1 – Clinical parameters of the carious dentin. (A)
primary-CC and permanent-CD ( p < 0.05). Both the color Numbers of teeth classified into three color parameters:
and dentin hardness scores obtained by dentist B were black, brown and yellow. (B) Numbers of teeth classified
significantly lower than those obtained by dentists A and C into three hardness parameters: hard, medium and soft.
( p < 0.01).
Table 3 shows the correlation coefficients between the
DIAGNOdent readings and the subjective clinical character- coefficients, except for the hardness of primary teeth before
istics of the carious dentin. For both before treatment and after treatment, and color and hardness of permanent teeth after
removal of the caries-infected dentin, all the correlation infected dentin removal, exhibited negative correlations

Table 2 – Comparison of the clinical scores obtained for color, and hardness conditions of caries-infected dentin for caries
detecting dyes
Caries detecting dye Color Hardness

Primary teeth Permanent teeth Primary teeth Permanent teeth

a a b,c
Caries Detector (CD) 2.07  0.74 1.85  0.83 2.00  0.74 1.85  0.83 b
Caries Check (CC) 1.91  0.72 a 1.74  0.75 a 1.85  0.71 b 1.91  0.67b,c
Caries Check Blue (CCB) 2.03  0.53 a 1.97  0.64 a 2.03  0.64b,c 2.30  0.85 c

For each clinical parameter, groups with the same letter superscripts (a–c) are not statistically significant ( p > 0.05).
 journal of dentistry 36 (2008) 1041–1047
Table 3 – Correlation coefficients between DIAGNOdent
readings and the clinical parameters employed for
evaluating the characteristics of caries-infected dentin
Color Hardness
DIAGNOdent readings vs. carious dentin before treatment
Primary teeth 0.023 (0.828) 0.082 (0.426)
Permanent teeth 0.214 (0.053) 0.084 (0.456)
DIAGNOdent readings vs. dentin after infected dentin removal
Primary teeth 0.205 (0.045) 0.128 (0.215)
Permanent teeth 0.065 (0.562) 0.239 (0.030)*
The data represent r-values ( p-values).
* DIAGNOdent is a diode laser fluorescence (LF) device. It has
Significant correlation ( p < 0.05).
between the DIAGNOdent readings and conditions of the
carious dentin. For the primary teeth, the correlation
coefficients were all very low and there was no significant
difference between the DIAGNOdent readings and the clinical
parameters used for defining the characteristics of the carious
dentin. For the permanent teeth, the correlation coefficients
were low before treatment and after caries-infected dentin
removal. However, significant difference was identified
between the DIAGNOdent values and the dentin hardness
following removal of the caries-infected dentin ( p < 0.05).
4. Discussion
The original rationale in using caries detecting dyes for
identifying caries-infected dentin was based on preferential
staining of demineralized dentin collagen matrices that have
been irreversibly denatured by breakdown of the intermole-
cular cross-links.26 Such a mechanism has been refuted and it is
now known that the dye solution penetrates the more porous
carious dentin, with the acid red simply staining the organic
matrices or collagen fibrils,8,13 irrespective of whether they have
been denatured. This revised mechanism provides a plausible
explanation for the staining of dentinoenamel junctions and
sound, deep dentin even after complete caries removal, as these
dentin substrates are considerably more porous.13 Thus, the use
of conventional caries detecting dyes may result in inadvertent
removal of dentin that is partially demineralized but devoid of
bacterial infection. Likewise, it has been suggested that the less
mineralized and more porous nature of the mantle dentin
subjacent to the dentinoenamel junction would render these
sites more susceptible to dye staining.8 The new caries detecting
dye (Caries Check and Caries Check Blue), consisting of higher
molecular weight polypropylene glycol, was developed to
minimize over-staining of uninfected porous dentin by restrict-
ing the diffusion of the dye through tissue porosities.
Unpublished in vitro test by the manufacturer of Caries Check
using extracted carious teeth showed that the diffusion of
polypropylene glycol (MW = 300) into carious dentin was lower
than that of propylene glycol (MW = 76). Propylene glycol is a
dihydric alcohol that allows the safranin 0 dye, which is a bias
aniline dye but not an acid red dye, to penetrate faster and
deeper into root dentin than distilled water (MW = 18).27 The
low surface tension and higher diffusional nature of propylene
glycol may result in over-staining of the caries-affected or
sound dentin underneath the soft caries-infected dentin.
1045
Many studies reported that the use of caries detecting dyes
reduced the propensity of microorganisms in tooth cavities
but did not completely eliminate them.5,9,28 A previous study
also suggested that occlusal dental caries may be arrested for
up to 10 years by resin sealing.29 It is uncertain whether the
entrapment of bacteria under fillings influences the prognosis
of the restored teeth. Although it is dubious that carious dentin
may be truly arrested by resin seals without complete removal
of the overlying infected dentin, it is possible that the bacteria
in the dentinal tubules may not be cariogenic after the tubules
are sealed with current restorative materials.
been observed that LF does not adequately measure small
mineral changes.16,18 In comparison with the quantitative
laser/light induced fluorescence (QLF) methods, LF showed
lower correlation with mineral loss and lesion depth in
smooth-surface carious lesions in permanent teeth.18 Others
reported that the LF readings reflect changes in the organic
matrix, rather than in the inorganic content of the teeth,17,18,22
and that the increase in fluorescence of carious lesions is
probably caused by the presence of porphyrins, mainly the
protoporphyrin IX.30,31 Previous studies observed higher
correlation between the DIAGNOdent readings and lesion
depth than with mineral loss when the carious lesions were
evaluated with transverse microradiography in smooth-sur-
face caries lesions in permanent teeth.17,32 Another study22
compared the efficacy of DIAGNOdent caries detection in
primary molars using three thresholds: D1, caries limited to
the outer half of enamel; D2, caries extending into the inner
half of the enamel, but not to the dentinoenamel junction; and
D3, caries limited to the outer half of the dentin. Using
histopathological and microhardness evaluation criteria, the
results of that study showed that the best DIAGNOdent
performance was obtained at the D3 threshold. It has been
shown that the DIAGNOdent readings were useful to facilitate
accurate removal of the caries-infected dentin.21 Thus, in this
study, we used DIAGNOdent readings to observe the condition
of the dentin after removal of the caries-infected dentin
tissues that were stained with different caries detecting dyes.
A previous study reported that the DIAGNOdent cut-off point
for dentin caries was 18.33 Conversely, other previous clinical
study showed that the DIAGNOdent cut-off point for both
cavitated enamel and dentin caries was over 20.21 In that
study, carious dentin was removed without the use of caries
detecting dye. Differentiation of the caries-infected dentin
from the underlying caries-affected dentin was based entirely
on the hardness of remaining dentin. In that study, the
DIAGNOdent readings before and after caries removal were
28.3  26.8 and 6.3  7.7, respectively for primary teeth, and
22.5  19.3 and 6.4  5.8, respectively for permanent teeth.
There was no significant difference between primary and
permanent teeth.21 In the present and previous16 studies, the
DIAGNOdent readings after caries removal in the Caries
Detector group (Table 1) were very similar to the results
obtained without the use of any caries detecting dye in the
previous study.20 For the CC and CCB groups, the DIAGNOdent
readings obtained following complete removal of all stained
dentin in both the primary and permanent teeth were higher
than those obtained in the CD group. In the previous study,16
the value of the permanent-CC group was significantly higher
1046 journal of dentistry 36 (2008) 1041–1047
than that of the permanent-CD group. In the present study,
there was no significant difference of the value between the
permanent-CD and permanent-CC groups. However, the value
of the permanent-CCB group was significantly higher than
those values obtained from all other groups (Table 1). Thus, the
results of this study demonstrated that one of the new Caries
Detector dye Caries Check Blue might be useful, especially in
adult patients to circumvent the problem of inadvertent
removal of caries-affected dentin.
It has been reported that typical acute (or active) caries stains
easily with the caries detecting dyes, while typical chronic (or
arrested) caries stains very weakly.1 Generally, clinicians
distinguish the acute or chronic caries status by color and
hardness of the decayed dentin. Thus we classified the carious
teeth involved in this clinical study with these parameters
(Fig. 1A and B). These figures revealed that the primary and
permanent teeth treated in this study included both acute and
chronic dentin caries. That may be one of the reasons why high
standard deviations of the DIAGNOdent readings were obtained
after removal of the caries-infected dentin (Table 1). It can also
be expected that blue-colored caries-infected dentin stained
with Caries Check Blue is more easily discerned clinically than
the red-colored caries-infected dentin stained with Caries
Check and Caries Detector. Thus Caries Check Blue may be
more effective for removing caries-infected dentin and in
avoiding excessive removal of the caries-affected or sound
dentin, especially for permanent teeth.
Compared to permanent dentin, the mechanical properties
of primary dentin were found to be lower. Primary dentin was
more porous, especially for the dentin close to pulp.32–36 Thus,
deeper penetration of Caries Check and Caries Check Blue in the
caries-affected dentin and excessive dentin removal may still
occur when these new polypropylene glycol-based caries
detecting dyes are employed in primary teeth. In the present
study, both before and after caries removal, the correlation
coefficients between DIAGNOdent readings and color and
hardness clinical parameters were low (Table 3). The small
number of teeth with typical acute or chronic dentin (Fig. 1A and
B) may be one of the reasons that account for such low
correlations. Additional study for typical chronic decays, and
acute caries decays that might be porous and easily occur
excessive dentin removal is required. From the results of this
study and previous studies,16,21 it appears that the accuracy of
DIAGNOdent readings to detect completeness of dentin caries
excavation is lower in primary teeth than in permanent teeth.
Thus, for primary teeth, it may be necessary to use both a caries
detecting dye and the DIAGNOdent device to assess the extent
of caries removal. However, as DIAGNOdent readings were
reported to be influenced by tooth-polishing pastes, sealants
and restorative materials,37 the application of the DIAGNOdent
system for the detection of secondary caries is questionable.
Further ultrastructural and bacteriological studies should be
performed to determine the completeness of bacteria elimina-
tion for the newly developed caries detecting dyes.
5. Conclusions
Compared with a conventional caries detecting dye that
contains 1% acid red in propylene glycol (MW = 76) newly
developed caries detecting dyes that contain 1% acid red
(Caries Check) or 1% brilliant blue (Caries Check Blue) in
polypropylene glycol (MW = 300), especially for Caries Check
Blue in permanent teeth, may be more effective to remove
caries-infected dentin and avoid excessive removal of the
caries-affected or sound dentin.
The correlation coefficients between the DIAGNOdent
reading and the clinical parameters of color and hardness
of the caries-infected dentin were low both in primary and
young permanent teeth.
Acknowledgement
The authors acknowledge to the donation of products by
Nippon Shika Yakuhin KK.
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