Explorer unethical?

[letsconnect]

I came across a position paper for the Idaho State University Department of Dental Hygiene entitled "The Science and Practice of caries prevention, risk assessment and management". A really interesting read actually, if anyone's interested (it's a PDF file):

www.isu.edu/departments/dentalhy/pdf_files/science_and_practice_of.pdf

In the last paragraph on page 2, it says that "The use of a sharp explorer to probe occlusal pits and fissures is no longer recommended" (true). Then it goes on to say that "In Europe, this technique is considered unethical because of the evidence of damage caused to the surface enamel layer. "

Is the use of an explorer really considered unethical, though? Just wondering I've never heard this mentioned anywhere else.

[Mike]

The idea is that if a tooth has an early lesion it may be possible to reverse the demineralisation and prevent the need for a filling. By probing it with an explorer, it is possible that the tooth structure at the early lesion is compromised and a filling would then certainly be needed. The probe or explorer can still be used gently to feel for any 'tackiness' of the tooth structure which indicates decay.
Problem is that for years the 'gold standard' for checking for decay was to stick the probe in and give it a good shove. (And sometimes with certain holes in teeth this still remains the only way of knowing for sure if a hole is starting). The paper mentions the importance of xray in diagnosing decay- this is certainly true, especially for interproximal caries (ie which starts between the teeth cos you've not been flossing!). However occlusal (biting surface of the tooth) caries is notoriously difficult to see on xrays (a point not considered by the paper). Therefore despite what the paper says, it may still sometimes be neccessary, and I would argue ethical, to probe the tooth gently to decide if there is a problem with decay starting on the biting surface.
So my opinion is that the probe should still be used, it just should not be used with much as much force as we used to use it in the old days- which is good news for anxious patients anyway!
Mike

[Gordon]

Totally agree with Mike on this.
But just to make it less of a "Me Too" post

I've been playing with a KaVo Diagnodent for the last couple of years, it's a laser system which can (it's claimed) detect early decay more reliably than a probe does. It's certainly better for dental phobics, since nobody enjoys the feeling of a probe poking about on their molars, but I still find myself lifting the probe regularly. ;D
I'd say it's unethical not to use a probe since you'd miss lots of decay...