The effect of airflow on site-specific electrical conductance measurements used in the diagnosis of pit and fissure caries in vitro

There has been renewed interest in the electronic diagnosis of occlusal caries using measurement of conductance or impedance. One of two previously manufactured electronic caries detectors (the Vanguard electronic caries detector, Massachusetts Manufacturing Corporation, Cambridge, Mass., USA) had a probe tip with an integral air supply. Airflow is essential for removing superficial moisture and preventing surface conduction to the gingival margin. The aim of this study was to determine the effect of airflow on electronic diagnosis of occlusal caries using a prototype electronic caries meter (ECM II. LODE, Groningen, The Netherlands) fitted with a flow meter. Stable conductance readings were taken at 76 discrete sites on 32 extracted teeth with no visible signs of cavitation, at 3 airflows: 5, 7.5 and 10 litres/min. The stable conductance scale was a continuous scale from -0.45 to 13.25 and set by the manufacturer. Histological validation was carried out on macroradiographs of sections cut to include each sample site. The histological picture was compared with the stable conductance readings taken at various airflows. Sensitivity and specificity were calculated using different conductance readings to differentiate sound and carious sites, and receiver operating characteristic (ROC) curves constructed. Of the sites, 32% had enamel and dentine caries and 33% had enamel caries. The ROC curves showed airflow to be highly relevant. An airflow of 5 litres/min was shown to be inadequate and led to large numbers of false-positive diagnoses. A minimum airflow of 7.5 litres/min was required to achieve optimum sensitivity (92%) and specificity (87%) for dentine caries diagnosis.