Do Caries Explorers Transmit Infections within Persons?

Abstract

Dental caries explorers may become contaminated during routine caries examinations with pathogenic organisms and thereby potentially transmit infections from one tooth to another within a patient. The purpose of this study was to test the hypothesis that the contamination status of explorers influenced the caries risk of second molars. Two explorer contamination statuses were defined: (1) contamination status 1 – explorers which had probed a carious molar just prior to examining the second molar versus explorers which had probed a sound molar prior to examining the second molar, and (2) contamination status 2 – sterile explorers versus explorers which had probed several teeth. Caries examinations were performed by 4 dentists on a cohort of 4th grade students in Belize City. The examination dates and sample sizes (n) were: September-October 1989 (n = 1,277), January 1991 (n = 1,111), and January 1992 (n = 961), and January-February 1993 (n = 861). Within this cohort, there were 221 subjects who (1) had at least one pit and fissure carious onset on a caries-free second molar, (2) had no evidence of dental treatments, and (3) were examined by the same examiner during the entire study. After adjusting for confounding variables, the examination of a second molar with a dental caries explorer in either contamination status 1 or 2 had no substantial effect on the caries risk (rate ratio 0.95, 95% confidence interval: 0.77–1.18, and rate ratio 1.18,95% confidence interval: 0.89–1.56, respectively). If a true rate ratio of 1.7 or greater was associated with the contamination status 1 and 2, these analyses had more than 99 and 80% probability of detecting it, respectively. Conclusions: Examining a sound second molar with a contaminated dental explorer either does not affect the caries risk, or results in such a small increase in caries risk that it can only be reliably identified in studies where the exposure of sound teeth to contaminated dental explorers is randomized.

Avaliação clinica de quatro metodos de diagnostico de lesões de carie oclusal

“…Para pesquisa clínica, aplica-se a alguns usos, desde que com seus devidos cuidados, enfatizando o treínamento e a calibração dos examínadores como forma de aumentar a efetividade do exame visual. HUJOEL et al (1995) tiveram por objetivo testar a hipótese de estabelecimento da doença cárie num sítio sadio de segundos molares, devido à inoculação de microorganismos por meio de uma sonda exploradora contaminada. Concluíram que esta possibilidade é pequena ou mesmo inexistente, mostrando que esses dentes não se tornam mais susceptíveis ao desenvolvimento de lesões, quando comparados com dentes examinados com exploradores estéreis.…”