Modern prospective caries studies require the measurement of small changes in tooth mineral content. Quantitative measurements of changes in mineral content in a single caries lesion is desirable. Quantitative methods can be either destructive or non-destructive. The latter type permits longitudinal studies to be conducted. Various methods available for the analysis of lesion parameters are reviewed. The basic principle of each method is summarized, and its characteristics are discussed. For each method, the correlation between the measured parameter and mineral loss, the useful range of mineral loss, the discrimination threshold, and the repeatability, are presented. Where such quantities were not available in the original papers, they were calculated from literature data. A comprehensive table of specifications of all methods is given.
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References
1.
Almqvist, H.; Wefel, J.S.; Lagerlof, F.; Ekstrand, J.; and Henrikson, C.O. (1988): In vitro Root Caries Progression Measured by 125I Absorptiometry: Comparison with Chemical Analysis, J Dent Res67:1217-1220.
2.
Angmar, B.; Carlstrom, D.; and Glas, J.E. (1963): Studies on the Ultrastructure of Dental Enamel. IV. The Mineralization of Normal Human Enamel, J Ultrastruct Res8:12-23.
3.
Angmar-Mansson, B. and Ten Bosch, J.J. (1987): Optical Methods for the Detection and Quantification of Caries, Adv Dent Res1:14-20.
4.
Arends, J. and Christoffersen, J. (1986): The Nature of Early Caries Lesions in Enamel, J Dent Res65:2-11.
5.
Arends, J.; Ruben, J.; and Jongebloed, W.L. (1989): Dentine Caries in vivo. Combined Scanning Electron Microscopic and Microradiographic Investigation , Caries Res23:36-41.
6.
Arends, J.; Schuthof, J.; and Jongebloed, W.L. (1979): Microhardness Indentations on Artificial White Spot Lesions, Caries Res13:290-297.
7.
Arnold, F.A.; Likins, R.C.; Russell, A.L.; and Scott, D.B. (1962): Fifteenth Year of the Grand Rapids Fluoridation Study, J Am Dent Assoc65:780-785.
8.
Bakhos, Y. and Brudevold, F. (1982): Effect of Initial Demineralization on the Permeability of Human Tooth Enamel to Iodide, Arch Oral Biol27:193-196.
9.
Bakhos, Y.; Brudevold, F.; and Aasenden, R. (1977): In vivo Estimation of the Permeability of Surface Human Enamel, Arch Oral Biol22:599-603.
10.
Bear, R.S.; Schmitt, F.O.; and Young, J.Z. (1937): The Ultrastructure of Nerve Axoplasm, Proc R Soc Lond B123:505-519.
11.
Bjelkhagen, H.; Sundstrom, F.; Angmar-Mansson, B.; and Ryden, H. (1982): Early Detection of Enamel Caries by the Luminescence Excited by Visible Laser Light, Swed Dent J6:1-7.
12.
Borsboom, P.C.F. and Ten Bosch, J.J. (1982): Fiber-optic Scattering Monitor for Use with Bulk Opaque Material, Appl Opt21:3531-3535.
13.
Borsboom, P.C.F. and Ten Bosch, J.J. (1983): Fiber-optic Scattering Monitor for Application on Bulk Biological Tissue, Paper, and Plastic. In: SPIE, Vol. 369, Bellingham, WA, USA: Soc. Photo-optical Instr. Engs., pp. 417-421.
14.
Borsboom, P.C.F.; Wolfs, B.H.J.; Leydsman, H.; Doorn, N.; Ten Bosch, J.J.; and Liem, K.G. (1987): A Machine for Sawing 80-Micrometer Slices of Carious Enamel, Stain Technol62:119-125.
15.
Brinkman, J.; Ten Bosch, J.J.; and Borsboom, P.C.F. (1988): Optical Quantitation of Natural Caries in Smooth Surfaces of Extracted Teeth, Caries Res22:257-262.
16.
Bromley, B.C.; Moreno, E.C.; and Margolis, H.C. (1987): Image Analysis in Enamel Mineral Content Assessment , J Dent Res66:218, Abst. No. 893.
17.
Brudevold, F.; Attarzadeh, F.; Tehrani, A.; Van Houte, J.; and Russo, J. (1984): Development of a New Intraoral Demineralization Test, Caries Res18:421-429.
18.
Carlstrom, D. (1964): Polarization Microscopy of Dental Enamel with Reference to Incipient Caries Lesions. In: Advances in Oral Biology, Vol. 1, P.H. Staple, Ed., London: Academic Press, pp. 255-296.
19.
Crawford, A.W. and De Bruin, H.J. (1983): Concentration Changes in Surface Ca, P, F, Zn, Fe, and Sr During White Spot Formation, J Dent Res62:964-968.
20.
Darling, A.I. (1958): Studies of the Early Lesion of Enamel Caries, Br Dent J105:119-135.
21.
Davidson, C.L.; Hoekstra, I.S.; and Arends, J. (1974): Microhardness of Sound, Decalcified and Etched Tooth Enamel related to the Calcium Content, Caries Res8:135-144.
22.
Dean, H.T.; Arnold, F.A.; and Elvove, E. (1942): Domestic Water and Dental Caries. V. Additional Studies of the Relation of Fluoride in Domestic Waters to Dental Caries Experience in 4,425 White Children, aged 12 to 14 Years, of 13 Cities in 4 States, Publ Health Rep57:1155-1179.
23.
De Josselin De Jong, E.; Angmar-Mansson, B.; Ten Bosch, J.J.; and Sundstrom, F. (1990): Comparison of White-light Scattering and Light-induced Fluorescence from Sound and Carious Tooth Enamel, Caries Res (in press).
24.
De Josselin DEJong, E. and Ten Bosch, J.J. (1985a): Measurement and Optimalization of the MTF's of the Microradiographic Method and its Subsystems. In: SPIE, Vol. 492, Bellingham, WA, USA: Soc. of Photo-optical Instr. Engs., pp. 486-492.
25.
De Josselin DEJong, E. and Ten Bosch, J.J. (1985b): Error Analysis of the Microradiographic Determination of Mineral Content in Mineralized Tissue Slices, Phys Med Biol30:1067-1075.
26.
De Josselin DEJong, E.; Ten Bosch, J.J.; and Noordmans, J. (1987a): Optimized Microcomputer-guided Quantitative Microradiography on Dental Mineralised Tissue Slices, Phys Med Biol32:887-899.
27.
De Josselin DEJong, E.; Van Der Linden, A.H.I.M.; Borsboom, P.C.F.; and Ten Bosch, J.J. (1988): Determination of Mineral Changes in Human Dental Enamel by Longitudinal Microradiography and Scanning Optical Monitoring and their Correlation with Chemical Analysis, Caries Res22:153-159.
28.
De Josselin DEJong, E.; Van Der Linden, A.H.I.M.; and Ten Bosch, J.J. (1987b): Longitudinal Microradiography: a Non-destructive Automated Quantitative Method to Follow Mineral Changes in Mineralised Tissue Slices, Phys Med Biol32 :1209-1220.
29.
Elliott, J.C.; Bromage, T.G.; Anderson, P.; Davis, G.; and Dover, S.D. (1990): Application of X-ray Microtomography to the Study of Dental Hard Tissues. In: Tooth Enamel V, R.W. Feamhead, Ed., Tsuzumi, Japan: Florence Publ., pp. 429-433.
30.
Elliott, J.C. and Dover, S.D. (1984): Three-Dimensional Distribution of Mineral in Bone at a Resolution of 15 μm Determined by x-ray Microtomography, Metab Bone Dis Rel Res5:219-221.
31.
Featherstone, J.D.B. (1986): Demineralization/Remineralization - Working Group Consensus Report, J Dent Res65 :1532-1536.
32.
Featherstone, J.D.B. and Fu, J. (1987): Fluoride Effect on Remineralization of Caries-like Lesions in Human Tooth Roots, Caries Res21:181, Abst. No. 62.
33.
Featherstone, J.D.B.; Rodgers, B.E.; and Smith, M.W. (1981): Physicochemical Requirements for Rapid Remineralization of Early Carious Lesions, Caries Res15:221-235.
34.
Featherstone, J.D.B.; Ten Cate, J.M.; Shariati, M.; and Arends, J. (1983): Comparison of Artificial Caries-like Lesions by Quantitative Microradiography and Microhardness Profiles, Caries Res17:385-391.
35.
Flaitz, C.M.; Hicks, M.J.; and Silverstone, L.M. (1986): Radiographic, Histologic, and Electronic Comparison of Occlusal Caries: an in vitro Study, PediatrDent 8:24-28.
36.
Fosse, G.; Rosengren, B.; Skaale, S.; Leknes, K.; and Wulff, L. (1986): An in vivo Method for Microhardness Measurements on Human Teeth, Scand J Dent Res94:27-37.
37.
Frank, R.M. and.Leach, S.A. (Eds.) (1982): Surface and Colloid Phenomena in the Oral Cavity: Methodological Aspects, London: IRL Press.
38.
Gelhard, T.B.F.M. and Arends, J. (1984): Microradiography of in vivo Remineralized Lesions in Human Enamel II, J Biol Buccale12:59-65.
39.
Graves, C.N. and Feagin, F.F. (1988): A Method of Semi-quantitative Microradiographic Analysis of Root Surface Lesion Remineralization, J Oral Pathol17:241-249.
40.
Groenhuis, R.A.J.; Webber, R.L.; and Ruttimann, U.E. (1983): Computerized Tomosynthesis of Dental Tissues, Oral Surg Oral Med Oral Pathol56:206-214.
41.
Grøn, P. (1978): Inorganic and Structural Aspects of Oral Mineralized Tissues. In: Textbook of Oral Biology, J.H. Shaw, E.A. Sweeney, C.C. Cappuccino, and S.M. Meller, Eds., Philadelphia: Saunders, pp. 484-507.
42.
Grondahl, H.-G.; Grondahl, K.; Okano, T.; and Webber, R.L. (1982): Statistical Contrast Enhancement of Subtraction Images for Radiographic Caries Diagnosis, Oral Surg Oral Med Oral Pathol53:219-223.
43.
Hallsworth, A.S.; Robinson, C.; and Weatherell, J.A. (1972): Mineral and Magnesium Distribution within the Approximal Carious Lesion of Dental Enamel, Caries Res6:156-168.
44.
Hals, E.; Tveit, A.B.; and Totdal, B. (1988): X-ray Microanalysis of Dentin: A Review, Scanning Microsc2:357-369.
45.
Heaven, T.J.; Firestone, A.R.; and Feagin, F.F. (1990): Microradiographic Density Measurements on Natural Caries Lesions, J Dent Res69:345, Abst. No. 1890.
46.
Henrikson, C.O. and Linden, L.A. (1974): Quantitative Longitudinal Study of Enamel Decalcification in vitro, Sven Tandläk Tidskz67:69-79.
47.
Herkstroter, F.M.; Witjes, M.; Ruben, J.; and Arends, J. (1989): Time Dependency of Microhardness Indentations in Human and Bovine Dentin Compared with Human Enamel, Caries Res23:342-344.
48.
Herkstroter, F.M.; Noordmans, J.; and Ten Bosch, J.J. (1990): Wavelength-independent Microradiography: Its Use to Measure Mineral Changes in Curved and Thick Samples, Caries Res (in press).
49.
Herr, P.; Holz, J.; and Baume, L.J. (1986): Mantle Dentine in Man - A Quantitative Microradiographic Study, J Biol Buccale14:139-146.
50.
ISO (1984): International Vocabulary of Basic and General Terms in Metrology, Geneva : International Bureau of Weights and Measures, pp. 24-28.
51.
Kashket, S. and Ahern, J.M. (1989): Correlation between Physical Changes in Tooth Enamel and Changes in Iodide Penetrability Following in vitro or Intraoral Demineralization, Caries Res23 :232-237.
52.
Koulourides, T.; Phantumvanit, P.; Munksgaard, E.C.; and Housch, T. (1974): An Intraoral Model used for Studies of Fluoride Incorporation in Enamel, J Oral Pathol3 :185-196.
53.
Koulourides, T. and Reed, J.L., Jr. (1964): Effects of Calcium, Phosphate, and Fluoride Ions on the Rate of Softening and Dissolution of Tooth Enamel , Arch Oral Biol9:585-594.
54.
Kwant, G.W.; Houwink, B.; Backer Dirks, O.; Groeneveld, A.; and De Jager, W.O.R. (1972): Fluoridetoevoeging aan Drinkwater, IV. Resultaten van het onderzoek Tiel-Culemborg na 16½ jaar, Ned Tijdschr Tandheelkd79:316-327.
55.
Lindh, U. and Tveit, A.B. (1980): Proton Microprobe Determination of Fluorine Depth Distributions and Surface Multielement Characterization in Dental Enamel, J Radioanal Chem59:167-191.
56.
Lipshutz, G.S.; Webber, R.L.; Zeichner, S.J.; Ruttimann, U.E.; and Bolander, M.E. (1987): Quantification of Incipient Interproximal Caries by Digital Subtraction Radiography, J Dent Res66:248, Abst. No. 1135.
57.
Mallon, D.E. and Mellberg, J.R. (1985): Analysis of Dental Hard Tissue by Computerized Microdensitometry, J Dent Res64:112-116.
58.
Matsumoto, H. (1981): Some Problems Involved in Measurement of Electrical Impedance of Carious Teeth, J Dent9:43-52.
59.
Mellberg, J.R.; Castrovince, L.A.; and Rotsides, I.D. (1986): In vivo Remineralization by a Monofluorophosphate Dentifrice as Determined with a Thin-section Sandwich Method, J Dent Res65:1078-1083.
60.
Mellberg, J.R. and Sanchez, M. (1986): Remineralization by a Monofluorophosphate Dentifrice in vitro of Root Dentin Softened by Artificial Caries, J Dent Res65:959-962.
61.
Nyvad, B.; Ten Cate, J.M.; and Fejerskov, 0. ( 1989): Microradiography of Experimental Root Surface Caries in Man, Caries Res23:218-224.
62.
O'Brien, W.J.; Vazquez, L.; and Johnston, W.M. (1989): The Detection of Incipient Caries with Tracer Dyes, J Dent Res68:157-158.
63.
Øgaard, B.; Arends, J.; Schuthof, J.; Rlla, G.; Ekstrand, J.; and Oliveby, A. (1986): Action of Fluoride on Initiation of Early Enamel Caries in vivo, Caries Res20:270-277.
64.
Øgaard, B.; Ten Bosch, J.J.; and Jongebloed, W.L. (1989): Quantitative Longitudinal Study of the Remineralization of Induced Lesions in Vital Teeth, Caries Res23:436, Abst. No. 37.
65.
Patterson, C.M.; Weatherell, J.A.; and Robinson, C. (1984): Sampling of Porous Hard Tissues in vitro by Acid Etching, Caries Res18:231-236.
66.
Pitts, N.B. and Renson, C.E. (1985): Reproducibility of Computer-aided Image-analysis-derived Estimates of the Depth and Area of Radiolucencies in Approximal Enamel, J Dent Res64:1221-1224.
67.
Pitts, N.B. and Renson, C.E. (1986a): Further Development of a Computer-aided Image Analysis Method of Quantifying Radiolucencies in Approximal Enamel, Caries Res20:361-370.
68.
Pitts, N.B. and Renson, C.E. (1986b): Image Analysis of Bitewing Radiographs. A Histologically Validated Comparison with Visual Assessments of Radiolucency Depth in Enamel , Br Dent J160:205-209.
69.
Pitts, N.B. and Renson, C.E. (1987): Monitoring the Behaviour of Posterior Approximal Carious Lesions by Image Analysis of Serial Standardized Bitewing Radiographs , Br Dent J162:15-21.
70.
Purdell-Lewis, D.J.; Groeneveld, A.; and Arends, J. (1976): Hardness Tests on Sound Enamel and Artificially Demineralized White Spot Lesions, Caries Res10:201-215.
71.
Rawls, H.R. and Owen, W.D. (1978): Demonstration of Dye-uptake as a Potential Aid in Early Diagnosis of Incipient Caries, Caries Res12:69-75.
72.
Rentsch, H.; Merte, K.; Zschau, H.-E.; Plier, F.; Otto, G.; and Vogt, J. (1990): Fluoride and Mineral Redeposition in Outermost Layers of Bovine Enamel during Surface Softening, Caries Res24:97-100.
73.
Robinson, C.; Weatherell, J.A.; and Hallsworth, A.S. (1983): Alterations in the Composition of Permanent Human Enamel During Carious Attack. In: Demineralisation and Remineralisation of the Teeth, S.A. Leach and W.M. Edgar, Eds., Oxford: IRL Press, pp. 209-223.
74.
Rock, W.P. and Kidd, E.A.M. (1988): The Electronic Detection of Demineralisation in Occlusal Fissures, Br Dent J164:243-247.
75.
Sakkab, N.Y.; Cilley, W.A.; and Haberman, J.P. (1984): Fluoride in Deciduous Teeth from an Anti-caries Clinical Study, J Dent Res63:1201-1205.
76.
Saloman, E.B.; Hubbell, J.H.; and Scofield, J.H. (1988): X-ray Attenuation Coefficients (Total Cross Sections) for Energies between 0.1-100 keV, At Data and Nucl Data Tables38:1-197.
77.
Shellis, R.P. and Poole, D.F.G. (1985): Modified Procedure for the Quantitative Estimation of Pore Volumes in Carious Dental Enamel by Polarizing Microscopy, Arch Oral Biol30:865-868.
78.
Silverstone, L.M. and Taylor, R. (1981): Preparation of Thin, Undemineralized, Unembedded Sections of Human Enamel: The Silverstone-Taylor Hard Tissue Microtome, J Dent Res60:311, Abst. No. 2.
79.
Spitzer, D. and Ten Bosch, J.J. (1975): The Absorption and Scattering of Light in Bovine and Human Dental Enamel, Calcif Tissue Res17:129-137.
80.
Strang, R.; Damato, F.A.; and Stephen, K.W. (1988): Comparison of in vitro Demineralization of Enamel Sections and Slabs, Caries Res22:348-349.
81.
Tavares, M.; De Paola, P.F.; Soparkar, P.M.; Van Houte, J.; and Alman, J.E. (1985): The Reliability of the Iodide Permeability Test Applied to the Natural Dentition, J Dent Res64:1257-1260.
82.
Tehrani, A.; Goulet, D.; Brudevold, F.; and Attarzadeh, F. (1986): Enamel Demineralization and the Length of Intra-oral Exposure to Different Concentrations of Glucose or Sucrose, J Dent Res65:139-145.
83.
Ten Bosch, J.J.; Almqvist, H.; Noordmans, J.; and Lag-Erlöf, F. (1988): Comparisons of Methods to Determine Enamel Mineral Loss, J Dent Res67:257, Abst. No. 1159.
84.
Ten Bosch, J.J.; Van Der Mei, H.C.; and Borsboom, P.C.F. (1984): Optical Monitor of in vitro Caries, Caries Res18:540-547.
85.
Ten Cate, J.M. and Exterkate, R.A.M. (1986): Use of the Single-Section Technique in Caries Research, Caries Res20 :525-528.
86.
Thewlis, J. (1940): The Structure of Teeth as Shown by x-ray Examination , Med Res Coun Sp Rep Ser London, No. 238, pp. 5-82.
87.
Trautz, O.R. (1967): Crystalline Organization of Dental Mineral. In: The Structural and Chemical Organization of Teeth, Vol. 2, A.E.W. Miles, Ed., New York: Academic Press, pp. 165-200.
88.
Van De Hulst, H.C. (1980): Multiple Light Scattering. Tables, Formulas and Applications, Vol. 2, New York: Academic Press, pp. 699-703.
89.
Van De Rijke, J.W. and Ten Bosch, J.J. (1990): Optical Quantification of Caries-like Lesions in vitro by Use of a Fluorescent Dye, J Dent Res69:1184-1187.
90.
Van Der Linden, A.H.I.M.; Meiring, H.D.; Ten Bosch, J.J.; and Arends, J. (1986): Inorganic Phosphate Assay with the Ascorbic Acid or Stannous Chloride Method: Influence of Fluoride, Caries Res20:17-23.
91.
Van Der Stelt, P.F.; Ruttimann, U.E.; and Webber, R.L. (1986): Enhancement of Tomosynthetic Images in Dental Radiology, J Dent Res65:967-973.
92.
Weatherell, J.A.; Robinson, C.; Strong, M.; and Naka-Gaki, H. (1985): Micro-Sampling by Abrasion, Caries Res19 :97-102.
93.
Wefel, J.S.; Clarkson, B.H.; and Heilman, J.R. (1985): Natural Root Caries: a Histologic and Microradiographic Evaluation, J Oral Pathol14:615-623.
94.
Wefel, J.S.; Maharry, G.J.; Jensen, M.E.; and Harless, J.D. (1987): Development of an Intra-oral Single-section Remineralization Model, J Dent Res66:1485-1489.
95.
White, D.J. (1987): Reactivity of Fluoride Dentifrices with Artificial Caries I. Effects on Early Lesions: F Uptake, Surface Hardening and Remineralization, Caries Res21:126-140.
96.
Young, R.A. and Brown, W.E. (1982): Structures of Biological Minerals. In: Biological Mineralization and Demineralization, G.H. Nancollas, Ed., New York: Springer, pp. 101-141.
97.
Zero, D.T.; Van Houte, J.; and Russo, J. (1986): Enamel Demineralization by Acid Produced from Endogenous Substrate in Oral Streptococci, Arch Oral Biol31:229-234.
98.
Zero, D.T.; Rahbek, I.; Fu, J.; Proskin, H.M.; and Featherstone, J.D.B. (1990): Comparison of the Iodide Permeability Test, the Surface Microhardness Test and Mineral Dissolution of Bovine Enamel Following Acid Challenge, Caries Res24:181-188.
