- How ECD Works
- Early Detection
- The Science
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode, this week brought to you by Basic Bites.
That’s a 10. Ope. That’s a 33. Hmm. And it looks like you have a little fracture line there. Yep. Still consistent with a 33.
Patient: What number?
Michelle Strange: So this is, uh, this is pretty interesting.
Patient: What number is that?
Michelle Strange: This is — Oh, and was this five? Nope. Yeah. 5 was a 33.
Michelle Strange: Um, 3 was a — I mean, you can see a little of the darkness there.
Michelle Strange: That’s — you want to see the other side?
Michelle Strange: Hey, y’all. I thought I would share a little clip of me using the new Ortek-ECD unit for detecting early caries. You know I’ve been super perio focused my entire career. Of course I can detect obvious carious lesions, but I have never really been into sticking pits and fissures with an explorer. So I am happy to have devices to help guide me in my caries detection, especially if these devices allow me to detect early cavitated lesions so they don’t progress.
The new FDA-cleared ECD measures the conductivity of enamel at the bottom of pits and fissures. The ECD can instantly identify these very prevalent lesions usually before xray, visual, or even tactile evaluations, which is great since I’m not great at that anyway.
And my experience is that it’s fast and easy to use. And the ECD was developed and tested at a leading US dental school. And, in a published peer-reviewed clinical study, the ECD demonstrated 100 percent sensitivity and 93 percent specificity in diagnosing and detecting early occlusal lesions.
We know dental caries remains the most common chronic disease in the world in both children and adults. It’s been estimated that in most industrialized countries, 60 to 90 percent of school-aged children are affected, and nearly 100 percent of adult population is affected by tooth decay.
A major goal of current caries management is to detect dental carious lesions as early as possible. This is particularly true for occlusal caries where significant tooth damage and even tooth loss can occur due to the late caries detection. Until now, early occlusal caries detection has really been limited, and it creates a diagnostic challenge for dental professionals like me because it is difficult to determine if a suspicious lesion has penetrated into the dentin or is non-cavitated.
And various methods of diagnosing occlusal caries have been described, but usually visual, clinical examinations, and radiographs are the common ones used in dental practices. Studies do suggest that traditional mirror and probe and xray examinations fail to detect about 75 percent of pit and fissure lesions that have penetrated through the enamel and reached into the underlying dentin.
When an occlusal lesion is detected on a bitewing radiograph, the progression of decay may have already reached far into the dentin. Xrays often cannot distinguish between non-cavitated and cavitated lesions, and I certainly don’t have the eye for this. Mucogingival defects? Yes. Carious lesions on radiographs? Neh. Not so much.
And I know there’s been several caries detection systems in our dental world for years. I don’t have experience for all of them, but I understand that they range from transillumination to fluorescence. And electrical methods for caries detection has been proposed for a number of years as a means of detecting the presence of occlusal carious lesions, but it’s been an issue. You know, I’m assuming that whole, like, “sending a continuous electrical current when saliva is present” probably has been a bit of an issue, but the ECD has figured it out and solved those technical hurdles.
Here is the science that I learned from people a little smarter than me: So, from what I understand, electrically, enamel is a good insulator because of the high calcium phosphate content, whereas dentin is not. And, if the dentin-enamel junction at the bottom of the pit or fissure is breached by demineralization, hydrostatic pressure that exists within that dentinal tubule will allow this miniscule amount of conductive dentinal fluid to enter the breached enamel site. This is what allows the ECD to complete that electrical circuit. This is an — such a great example of how sometimes I just turn on pieces of equipment and I forget how cool the technology is behind it. I now explain this to my patients, and it makes me sound super smart.
So, as this demineralization increases, more dentinal fluid enters the breached site, and the more fluid detected by the ECD results in a lower resistance, a higher current, and an increasing digital caries score that is displayed on the screen anywhere to 01 to 100.
And, at the beginning, you heard me calling out numbers after the machine beeped at me. And so, when the enamel at the bottom of the pit and fissure is intact, the circuit path is open, and no current can flow, indicating no cavitated lesions and a zero score. The higher the number, the more concern I have. And, when I used this, I was getting a number in the 30s, which tells me that the lesion has advanced into the dentin. Definitely time to take action.
And, y’all, it is super fast and easy to use. Literally, it’s small and compact and takes me no amount of time to use it. It has a 9-volt battery, so I’m not connected to an outlet, which makes it portable for the office. I know it’s just a matter of time before I have to go searching for it because somebody wanted to use it on their patient, and they took it from my room. But I tell all of the people in the office it’s incredibly affordable and has an extremely rapid return on investment, so it’s a real win-win for our patients and your practice. So, you know, go get your own. Don’t take it from my room.
One thing I do want to tell you is that there is a lip hook. So the ECD has a lip hook that’s very similar to lip hooks used with an electronic apex locator. You know the ones used in endodontics? It allows that ECD to complete an electrical circuit if there is that cavitated lesion.
And so it’s, like I said, super simple, y’all. All I have to do is isolate the tooth. I used my saliva ejector to help control any saliva issues, and then I place the lip hook on the patient’s mouth. Very simple. It just kind of hangs at the corner of the mouth. I use the air/water syringe to dry the tooth for, like, four to five seconds. Then, I just put the tip of the unit on the pit or fissure very gently, and if it beeps, I look at the number, and I record it. The patient feels no sensation. The tips are single use, so they can be disposed of, and they only cost about $1 each.
With the ECD, there is really no gray area in detecting a cavitated lesion. A zero score indicates a non-cavitated lesion, and a score of 1 or higher indicates initial dentin involvement or progression into the dentin. Very easy and super cool.
You can learn more at ecddetect.com. And, if you’re like me and don’t necessarily have the eye for identifying carious lesions on radiographs or, you know, early carious lesions clinically, then you may just love this device. Visit ecddetect.com to check it out.
I hope you enjoyed this week’s TIPisode. Bye, y’all.
Thanks for listening to another TIPisode, and thank you to Basic Bites for sponsoring this week’s episode. You can find more about their products at basicbites.com. Professionals can go to basicbites.com/professional. And don’t forget to hit the “subscribe” button in your podcast app, follow us on Facebook or Instagram, and head over to our website, ataleoftwohygienists.com, to sign up for our newsletter. We always appreciate ratings and reviews. Thanks for listening to your unofficial dental hygiene podcast.