title: The use of QLF-DTM (Quantitative Light-induced Fluorescence-DigitalTM) as an oral hygiene evaluation tool to assess plaque accumulation and enamel demineralisation in pre orthodontic patients with suboptimal oral hygiene
Creators: name: Raphy, Puthri
Publisher: name: University of Liverpool Repository
Year: 2023

description: Aim: To assess the use of the Quantitative Light-induced Fluorescence-Digital Biluminator TM (QLF-DTM) as an oral hygiene evaluation tool to assess plaque accumulation and demineralisation in patients with poor oral hygiene. Design: Randomised clinical trial Settings: Liverpool University Dental Hospital Subjects: 60 patients (32 females, 28 males) with inadequate oral hygiene referred to dentists or hygienists for oral hygiene reinforcement before the start of orthodontic treatment were recruited for the trial. The median age of patients was 13.8 years with an IQR range from 11.1 to 26.7 years. Methods: The patients were randomly allocated at baseline (T1) to receive oral hygiene reinforcement (OHR) at three consecutive appointments (T1-T3) using the White light (WL) or Quantitative Light-induced Fluorescence (QLF) images, taken with the QLF-DTM device (Inspektor Research Systems BV, Amsterdam, The Netherlands), as visual aids. The standard of oral hygiene was assessed on the QLF images using customised software to provide quantitative scoring of fluorescence loss (ΔF) and plaque coverage (ΔR30) at each appointment. Inter-examiner reliability assessments were conducted by four examiners using QLF and WL images from 35 images of 7 patients. One examiner assessed the images on a second occasion two months later to ascertain the intra-examiner reliability. A debriefing questionnaire, distributed on completion of the study, was used to ascertain the patients’ perspectives of the QLF-DTM images. Results: There were no significant differences in plaque accumulation (p=0.81) or demineralisation (P=0.69) between the WL and QLF groups. There was no significant change in demineralisation over the three visits in either group. However, there was a significant reduction in plaque in both groups (P&lt;0.001) with a mean percentage change in R30 of 51.8% and 95% CI of 40.36% to 63.26%. All of the participants in the QLF group found being shown the images helpful and were able to see areas of demineralisation and plaque accumulation. 92.5% of the QLF group and 76.7% of the WL group expressed it would be useful to receive such OHR for the full duration of orthodontic treatment. The inter-examiner reliability of QLF image assessment, using ICC, was 0.987 and 0.773 for ΔR30 and ΔF respectively. The inter-examiner reliability of WL image assessment, using kappa, ranged from -0.0932 to 0.447. The intra-examiner reliability scores were excellent with an ICC of 1.0 and 0.995 for ΔR30 and ΔF respectively on the QLF images. The kappa score of demineralisation assessment on the WL images was 1.0. Conclusion: QLF-DTM can be used as an effective tool to assess plaque accumulation and detect and monitor demineralisation in patients with suboptimal oral hygiene to start orthodontic treatment. The image analysis demonstrated high levels of inter- and intra-examiner reliability. OHR using WL or QLF images as visual aids was effective in reducing plaque coverage in patients with suboptimal oral hygiene. There was no difference in the level of demineralisation or plaque coverage between the QLF and WL groups. More patients reported that the QLF images were useful than patients shown WL images. Summary: OHR using WL or QLF images was an effective tool in reducing plaque in poor OH patients and reported QLF images were informative.