Is Caries Detector Dye BS? – PDP138

Jaz’s Introduction:
Is there actually any sign or useful applications because caries, as some colleagues would say, I just use my high magnification, my good lighting and my probe.

I don’t need a fancy dye to tell me if I got caries or not. I’m experienced enough to know that I’ve removed caries. Now, you know what? I kind of felt that way. I was like, do I really need a dye? I’m think I’m pretty good at moving caries and too fair. Since I’ve been using it, it’s kind of confirmed that I’m pretty good at removing caries.

Okay. I’m happy to say that I’m proud enough to say that. However, one in five, one in six times I see a pink haze where it shouldn’t be. You’ll find out what that pink haze means in this episode, but it’s really useful objective data. So we’ll speak to Dr. Germán Dorgan, all about caries deck to die, how to actually use it properly. What is the evidence space behind it, and how to interpret the data that you get by using it.

Hello, Protruserati. I’m Jaz Gulati and welcome back to the Protrusive Dental Podcast. If you’re new to the podcast, welcome, it’s great to have you.

Protrusive Dental Pearl:
Every episode, every main episode, I do a Protrusive Dental Pearl, some good tip, often clinical, sometimes non-Clinical that’s gonna help you in practice tomorrow.

The one I have for you today is very much linked to the theme of this episode. Ie how not to expose, how to remove the appropriate amount of caries to get the best bond strengths possible without risking, removing too much dentin and causing a pulp of exposure. So how do you do that? You use some landmarks, use your perio probe and some landmarks and the zone that should be ultra-clean.

The zone where you should be aggressive in caries removal, if that’s a fair enough term to use, is if you measure from the cusp tip down five millimeters. In that zone, you’re not gonna hit the pulp, so please remove the caries and from the adjacent tooth. So let’s say you’re doing a first molar, you can measure from the second molar.

The marginal ridge of the second molar, three millimeters into the first molar distal, then that is your zone that you should keep super clean. And in those ranges, in those five millimeters from the cusp tip and three millimeters from the adjacent marginal ridge, you’re not gonna risk exposing. And so therefore you should try to get this really lovely, clean peripheral zone.

But you’ll hear more about that in the main episode with German. So next time you’re wondering, should I remove some more? Should I not, will I expose? Maybe you can use a perio probe. Just be sure to warn your nurse first because the first time you ever do this, you are sort of a perio probe out of nowhere randomly in the middle of caries removal you’re about to expose and your nurse be like, wait, why are we now suddenly doing a BPE or something? Right? So, make sure you maybe tell your nurse what you’re doing first.

We’ll go ahead and join the main podcast now. This episode is suitable for 50 minutes of CPD. It’s via the Protrusive app. If you’re not on the app already, do download it. It’s on iOS and Android. Even on the web, you can just go to protrusive.app as a website and that will load the app as a web app so you can access it there as well. And for premium members, you can answer a few questions at the end and get your CPD as well as a transcript in pdf. And the premium notes that you see on the side will be given to you as a pdf. I’ll catch you in the outro.

Main Episode:
Germán Dorgan, welcome to the Protrusive Dental Podcast, my friend. How are you?

[German]
Very well, thank you, Jaz. Very excited and ready to go.

[Jaz]
Mate, you are. I know you’re buzzing. We had a little chat earlier about the, you’re still buzzing from that World Cup win. I can sense the energy. I was enjoying your social media sort of banter about you and how Argentina was doing. I was happy. I won 150 pounds. I had Argentina as one of my teams in the sweepstakes. So, I won and so I treated my practice to pizza. So I threw everyone a pizza party. So everyone was happy that Argentina won.

[German]
That was really fair. I only won eight heart attacks in the finals, so.

[Jaz]
Now that was, Epic. An epic final. I don’t think we’ll ever see a final like that again, so that’s amazing. But Germán, you are very active on social media. Uh, we’ve been connected for a few years now. What I see you do in terms of your passion for Biomimetic dentistry is amazing.

And you got me hooked to caries detection dye. I love this stuff. Absolutely love it. When I first got the bottle, I was like, I have no idea how to use this. Read the instructions. And now when I use it, I’m like, wow, I was missing so much of it. And I guess we’ll talk about my experiences and your experiences with it.

But for those of you who don’t know you, who don’t yet follow you, tell us a little about yourself, your journey when you came over to the UK from Argentina. Was that after qualifying or?

[German]
No, so I was born in Argentina, but I was raised in Spain. At the age of five, my parents moved, to Spain, to Madrid. And that’s where I grew up. And then I’ve got grandfather, dentist, mom, dentist father, dentist sister, dentist. So I had to follow the steps of everybody. So graduated in 2010, in Madrid after a couple of years of- 2010 was a very, very hard time in terms of economical crisis, and I wasn’t very happy working in Spain, so I decided to just like move to the UK.

I actually came for a couple of years to try to make some money and improve my parents’ practice, but that was 2012 and I’m still here, start working on the NHS and then after a few years, as I was learning, I was finding a few struggles, unfortunately, in terms of use of certain materials. I’m providing certain treatments to my patients.

That all started after doing Tipton’s, Paul Tipton, training. Luckily, I managed to increase my private work to provide this to most of my patients and I focus in restorative and adhesive dentistry with a big background of Biomimetics. 2019, I got in into Matt Nejad’s course when he came to London. That hooked me into Alleman’s mastership over a year.

Then I had the opportunity to train with emulate, but also help them teaching a little bit. And currently I’m taking part of get bonded and step bonded with Sami Sherif . Great course.

[Jaz]
I mean, now, you’re teaching with these guys, right? You’re an educator with them, which is amazing man. Well done.

[German]
Yeah, that’s a great step. We’re doing a good job. We’re actually bringing David Alleman in March for a session, couple of days of Biomimetics and then taking also part of the Mimétika, long, it’s a one-year program. It’s a European program with three huge guides, in my opinion. Filip Keulemans, Hugh Byrne, and one of my great greatest friends and probably mentors, Raphael Wymann, which are helping me to understand adhesive dentistry, like what element will call, get bonded and stay bonded, if that makes sense.

[Jaz]
Amazing. And from speaking to Taylor Paton, the previous episode, it is really, you know, get bonded, stay bonded is such a great way to summarize the field of Biomimetic dentistry and part of achieving those great bond strength is actually your caries management, your caries removal. Because if you’re gonna bond the caries, it ain’t gonna stick. You’re gonna be disappointed. And we spoke on social media. You recommended caries detector dye I asked you about it and you told me which one to get.

So let’s start with that. You know, what is caries detection dye? It looks pretty on social media, but is it BS? Is it any good? I know you have a bias, but the bias is led by literature and it’s led by some time of you using it and your mentors using it. So, just start from the very basics. What actually is it?

[German]
So, yeah, it’s a very good point, what you said. You cannot bond if you foundation is not good. Okay. So imagine building a house and the base is really soft. The house is gonna crumble down, so we really have to find a way to see what we have underneath. And caries detector dye is a disclosing agent, red fuschin on a glycol solution.

The main purpose is to stain DENATURALISED COLLAGEN. Okay? And this is a very important point because it’s not a staining bacteria, okay? We’re not looking for bacteria. We’re looking for the naturalized collagen, okay? We know that the bond strength-

[Jaz]
So to make it clear, Germán, it is not a plaque indicator. It’s completely different from plaque indicator.

[German]
Correct. Exactly. So we know that if we have the neutralized collagen, the quality and the bond strength of that dentin is not gonna be as good as if we have sound dentin. So, the caries detector dye, basically it’s the excavation of the outer decalcified and infected dentin.

Okay. And that basically allows us to have an optimal caries removal. Okay, so if we have a good caries removal, we are gonna achieve good seal and more important prevent issues like losing pulp vitality. So it could be a problem because if we are not sealing the caries properly, it will keep going down and eventually we’re gonna end up with irreversible pulpitis or farther problems.

[Jaz]
Yeah. Some people who are not very open-minded and me as a practitioner, I’d never been taught about caries, the use of caries detection dye. I’d only ever seen other people using it, and I’m quite an open-minded clinician. I tend to, I’m happy to try new things, as long as got a scientific rationale behind it, which obviously is caries detection dye does.

I was very open to using it and I love it. But the same thoughts that go into my mind, go into other people’s mind, but I still give it a go. I still wanna give things a go. Other people are like, well, I have my probe. I’ve been using my probe for years. I can feel the dentin. I know that this is soft and this is hard.

Why do I need some color to tell me that? Now, obviously I’ve been using it so I can answer that, but you are in a better place to answer that. What do you think?

[German]
Yeah. Okay, so, we are talking about how to be objective and subjective in this matter. Okay, so it’s perfect, that’s a good way to do the description.

If we can see what we’re treating and we can identify the substrate by different colors, we’re gonna be able to know what is there, however, let’s say you use the probe. The first point I will have is like, how can you measure every millimeter square of the surface of the cavity that you’re doing?

Good luck with that. You know, I’m not saying that you are not wrong by trusting, and I think it’s part of the clinical judgment that you’re gonna have. You have to feel what you are treating and that will be part of the guidance. But I think, it’s not completely accurate and I believe that you will get surprised.

If you finish a caries removal just with your bur and testing with a probe, eventually if you try with a drop of caries detector dye things will change and they will blow your mind somehow showing that you probably left tissues there that are not gonna provide appropriate bonding and proper seal of the surface.

And especially when we’re talking nowadays that the contemporary concepts are saying that we can leave caries behind, as long as we seal it properly to starve the bacteria and then kill it. Okay, so if you are having a leak, that’s not gonna work, and then it’s gonna bite you back eventually. I think another point is like, how subjective is hard for me.

How is, like, I think, I explained this with in a talk with Ash is a very, very simple thing. You, me, go to the gym, but I believe that I go only twice a month. But you go every day. Okay.

[Jaz]
I wish.

[German]
Okay. Yeah. Well, I’m putting just an example, but 10 kilos for you. If you’re going every day, it’s not gonna be heavy. 10 kilos for me that I go twice a month might be super heavy. So we really cannot have always, all of us the same feeling.

[Jaz]
Tactile feedback. And it’s the same as perio probing, Germán, perio probing. You’re supposed to use 25 grams, I believe of weight when you’re doing perio probing. But when you actually get the test at alga meters, whatever they use, everyone’s actually usually a bit too much. But when everyone’s different and to achieve the Optimum is difficult.

[German]
How do you screw an implant? What do you use? Torque wrench.

[Jaz]
I don’t, I use a referral pad.

[German]
Okay. Fair enough. No, but it’s a good way to think it. No, but if you think about it, when we’re doing implants, for example, if we need to know how much torque we have to give to screw, we need something to measure it. And that’s why we use a torque wrench, for example. Okay. And if we want to be even more accurate, we’re gonna use probably a digital one. Okay. So I think having, especially when the main thing that we’re doing as general dentist is remove caries every day.

We sure have a systematic or a way that we can really kind of standardize the way that we’re removing caries to achieve proper results. And I think it’s an important thing, and I don’t believe the tactile feedback, it’s not accurate. And there are papers from Fusayama that are even more important when we’re getting closer to the pulp, the closer that we’re getting.

Okay. Acute and chronic decay. There is no difference in the elasticity and the hardness of that surface. So if we are dealing with the cavities and we want to prevent pulp exposure, the best way to address it will be helping yourself with something to visualize what you’re removing and having a little bit of knowledge of the anatomy of the tooth.

[Jaz]
Well, we’ll talk about that in terms of, once you do use the caries detector, I had to interpret that data. But I think, it’s a good first point. The data is good because it turns something subjective. You know, one of the first things I learnt was the color is unreliable. You know, we used to chase everything until it was yellow.

We then know that, okay, it’s okay to leave brown and black based on amalgam staining, et cetera. And so that was fine. Yeah, I think people still struggle to believe that your probe and the softness even that can fool you because that is subjective data, and I completely agree. So, to give you my experience of using caries detection dye so far, In the last six months, I’m usually, now I’m using it. It’s validating, it’s giving me peace of mind. Okay, yeah. This is what I expected. I thought this was caries free and my caries detector dye is confirming that. However, the odd time, one in six times I’ve done it has like, oh wow, I’ve actually missed a bit there and I should go back.

And it’s just, it made me feel really good. And it also gives me a zone that I know that, okay, this zone, and we’ll talk about these zones. I can be a little bit more aggressive here. I can lead a little bit more behind here, and it gives that nice zone, which I know we’ll get into. So, I’m so far, very much converted.

I’m a big fan of it and odd timing, it has surprised me. I thought, thank goodness I’ve got this as objective data. So I totally agree that more people should use it. When should you use it? Should you use it for, do you use it for every restoration, every caries restoration, or is it only for the deep ones?

[German]
Everything. First of all, not disrespecting anyone, but if I’m replacing any restoration, I need to find out why. Okay, so let’s say there’s a recurring carries and we’re removing a fill-in. The first thing I wanna check if okay, it could be C factor, it could be something that, poor bonding protocol.

Not enough light cure. Something has happened, but the first thing I’m gonna probably try to check and this is where I respect how open-minded you are. Cause as soon as you heard that, it was like, okay, I’m gonna try it. I’m gonna give it a go. And you clearly notice the difference when I started my Biomimetics and most of my adhesive restorative dentistry, it was because things were not going well in many of my treatments.

So I had that curiosity to find out why. So I’m replacing a filling. Let’s say a patient is coming with some sort of sensitivity, there is a fill-in. The first thing I’m gonna do is an investigation. And the first step is as soon as I remove my fill-in, check with the caries detector dye and will say that in very, very, very high percentage of those cases, I’m finding effective dentin or even infected dentin in areas that shouldn’t be.

So what we are basically saying here is there are areas that are not bonding properly. So therefore, that restoration is starting to fail, causing problems to the patient.

[Jaz]
So, that is, just to make it really clear for someone who might have missed, or you said that this is, as soon as you remove the restoration, you haven’t even now started to remove any caries yet, because I guess the point you’re trying to prove is, why did it fail? And if you use it straight after removing restoration, you can see that there is still caries near the sort of external margin it was leaking.

[German]
Correct, exactly. So, it could be probably the thickness of the caries, it could be the C factor, but definitely I want to check if there is upper peak caries removal.

Okay. So because I’m taking over this treatment, so I need to sleep well, like you said, and I need to make sure that I’m gonna achieve high born strength. And therefore, longer prognosis of my restoration. Whenever I’m gonna do any caries, even if it’s like something that is a deep caries, definitely it will help me to prevent public exposure because I will have knowledge of my landmarks and I will know where I have to stop.

But more important, how to create the famous peripheral seal zone that helps to seal the bacteria. I’m preventing them from going deeper. And in those cases, what I will probably do is as soon as I remove kind of like the dirty area, we will call it like that. And I’m starting to have my cavity. So I know that I’m starting to go a little bit deep then is when I’m gonna start using my first few drops.

And I’m saying drops because it’s not one drop. Okay? Most of the people will say, oh yeah, I do one first drop clean, but they don’t check. So we will talk probably when we go into how to use it-

[Jaz]
Well, let’s just talk about that now or what is, how much did you, so I could tell you what I’ve been doing and I’m happy to say it out, you know, live on air if you like.

I might be doing it wrong and feel free to tell me is at the moment, and I didn’t read the instructions in terms of the way it’s delivered. I just, I know it’s supposed to leave it for 10 seconds and that’s what I remember and that’s what I do before I wash it away. But, I have it in a dappen spot and I’ve got maybe like 2, 3, 4 drops in there and I’m mixing my microbrush inside there, and then I’m rubbing my microbrush into the cavity. Am I doing it wrong? Am I doing it right?

[German]
No, absolutely perfect. I probably, I use maybe a couple of drops in the brush, and that’s more than you know, or in the dappen. But what I’m doing is constantly trying, constantly try and so I clean and I try, I clean and I try. I always test it. Because one thing is a staining-

[Jaz]
So you’re talking about reapplication. So you’re applying it waiting 10 seconds, you’re washing it away, then you’re reapplying it.

[German]
I clean my surface. Okay? And then I will test myself if I clean it properly. Okay. It doesn’t have enough penetration sometimes, so we really have to do reapplications in the different steps that we’re going through the removal of the caries.

[Jaz]
Got it, got it. Okay. But in terms of the actual procedure of how I’m applying with a microbrush and just rubbing it all way around, uh, yeah. Okay. Right. Yeah. Leave it for 10 seconds. Wash it away. Perfect. Fine. So before we talk about how to interpret that data, which I think is so key, and we’ll talk about the peripheral zone and using your landmarks, what does the evidence say?

Is there much evidence in terms of how reliable the data is that you, this objective data that you’re getting from the color, from the caries detector dye, how reliable is it?

[German]
This has been studied since 70’s, 80’s. Okay. And the most important thing, and especially I think, this is something that for me, it clicks a lot in a way of we’re measuring infected affected dentin so we know the bacteria’s going through, there is acid attack, and that’s producing denaturalization of the collagen, which is what create the good and the bad bond on the surface of the tooth.

And studies are from late 70’s, 80’s, and actually showing that even without complete removal, so leaving infected areas, we’re getting high bond strength. Well, high bond strength, if we’re talking about infected dentin, we’re getting around 10, 15.

But if we’re leaving affected dentin, we’re around 20’s. Okay, so 25. If we think about bonding to enamel, we’re getting 31. Okay. So even not complete removal is showing us that it’s high bond strength. Okay. And then if we are actually have sound dentin, we’re achieving up to fifties, how do you achieve it is a different thing.

And I think it’s what you spoke with my previous colleague about how to bond to dentin and more the principle of Biomimetics. And it’s all about a matter of time allowing the bond to mature properly in order to achieve high bond strength. Okay, so obviously there is several papers that are shown that we’re able to bond to caries.

And how effective is the fact that we can visualize what we’re bonding. How do you describe infected or affecting denting without having anything that is showing you? You know, it doesn’t go into my mind. It’s like infected dentin. We know that by discoloration we cannot differentiate the difference surfaces. So it has to be something. And in this case, it’s a caries detector what helps you.

[Jaz]
When you seeing the different colors. Now, let’s say you’ve got an large cavity. You removed the caries to the what you think should be removed. So, you know, you’ve gone by your usual subjective data and now you’re gonna rub in the caries detector dye.

Then you wash it away after 10 seconds and you see what’s left behind. Does the color gradient, does the pink versus red tell you something? Assuming using a red one I’ve used you use a green one is different, but let’s go with the red cause that’s the one I have.

[German]
So yeah, the have a look to the first papers that are coming around the 80’s. What they’re saying is that the infected dentin stains, whereas the uninfected dentin or affected dentin, doesn’t sustain. Okay. The acid attack on the affected dentin has been more aggressive. Okay, so everything has collapsed and it allows the dye to penetrate. That’s why it will get darker. It’s not that-

[Jaz]
Wait, on the infected dentin. It’s been more attacked, right?

[German]
Exactly. Whereas the affected, the demineralisation is not so aggressive. So let’s think about the progression of the decay. There is acid at the front. Yeah. That acid attack hasn’t been so strong. Okay. That dentin still has the ability to remineralize, which is the important thing, why we can’t preserve it, and why we have a higher bond strength.

Okay. If we are trying to penetrate with the Caries detector, it’s not gonna be so easy. So that is when you’re gonna get a lighter pink. Okay. So the red will be the affected dentin. Completely unmineralized, okay.

[Jaz]
The red is the infected.

[German]
Infected and the pink is affected.

[Jaz]
So the pink is affected. And then obviously if you get no staining at all, that’s obviously completely healthy. And, and that’s fine. Well, give us some guidelines now in terms of, if you have some pink, when is it okay to leave the pink? And what position in the cavity? Is it okay to leave the pink? I think that’s important as well.

So we’ll come to the red in terms of when you’re getting near the pulp and stuff, but, let’s start with the pink. If I see some pink, which is the affected dentin, but it’s near the ADJ. It’s near the DEJ, then that’s affected dentin. Now we can bond to affected dentin better than infected dentin. But is it safe to leave it at the ADJ?

[German]
So that will be basically losing a 30 to 50% bond strength. Yes. Because we said we’re gonna go around 20’s, 25, 30. Okay. If I am not gonna expose pulp why will I leave it? I want to increase my bond strength for a more successful restoration. So therefore it’s basically, the idea will be to lift it around two millimeters inside of the DEJ of sound dentin, okay. So there shouldn’t be any pink haze near the DEJ.

[Jaz]
Perfect. And then when we get closer to the pulp, at what point can you leave red?

[German]
Okay. So the red, this is a bit of, If we go to that paper, the Pascal and David Alleman released in 2012, there are some landmarks that is letting us, I will share you the little pictures with the probe.

I think, having a perio probe is quite important to prevent pulp exposure. Okay, so what is telling us is to avoid pulp exposure, we have to measure five millimeters from the cusp tip and three millimeters from that adjacent marginal ridge to create that peripheral seal zone, okay? So if you see that picture, we will have like a tooth. So from the cusp, we’re gonna measure five millimeters from the tip, and then three millimeters for the marginal ridge of the adjacent teeth, okay?

[Jaz]
Mm-hmm.

[German]
If we are not having adjacent tooth, which can happen, we have to think about the curvature of the tooth. So obviously if we are high up, those three millimeters that you’re measuring, predicting that there is a tooth next door, it will be different because the amount of dentin will dry.

What I will have is those two millimeters of clear dentin. But we have to use the clinical judgment. Okay. We have to look at the x-rays. An older patient will have more retracted pulps, so we will be able to be a little bit more aggressive. Okay? So these are standard measures that we’re gonna, we’re gonna use, but we also have to use x-rays.

Otherwise, and that’s the important part. You’re gonna leave a lot of red, that, again, doesn’t bond properly. So the reason why bonds is because it managed to get into the affected dentin, but in the middle, you’re not gonna get such a underloading teeth will have an impact or even fail and allowed the progression of the caries again.

[Jaz]
So in order not to expose the pulp, we wanna make sure that we have no color, no pink, no red in the peripheral zone of at least two millimeters all day round. But if you’ve got a particularly deep cavity and you’re worried about pulp exposure and you get your measurements, five millimeters from the cusp tip three millimeters from the proximal marginal ridge, and it is more acceptable to leave your pink and red in that zone. Is that a fair summary?

[German]
Exactly. And then obviously, this is just something, what half is my air abrasion unit so we know to increase bond strength. It’s a great tool. Okay, so paper shows that-

[Jaz]
Well, the literature is, quite mixed, right? There’s some maybe literature that says that abrasion doesn’t increase the bond strength. Some that says it does some that says it does it. Maybe it’s because of the plaque biofilm removal effect. what’s your stance? You are more well read up on this than I am.

[German]
At the moment, most of the things that I read are going towards using air abrasion to increase the bond strength, and that’s how you achieve a 50 mega Pascals on bond strength in sound dentin. Okay, so if you repeat-

[Jaz]
I mean, I swear by, are you anal about, like some dentists is like, it has to be 27 microns on the dentin and 50 microns on when you’re doing indirect work. Like it’s not practical sometimes. So is it a sin to use 50 microns on dentin?

[German]
So that’s dentistry. And there’s so many papers and everybody tests differently and that’s the problem we’re having, we’re all testing differently. So, in terms of, for me, if it’s something outside the mouth and I’m talking to zirconia, which I barely use it, it’s not a material that it’s a common thing that I use because of the low bond strength, I will use 50 microns outside the mouth. In terms of the mouth, I’ll stick to 25.

And the reason is because it really doesn’t show any significant difference between one and the other. And what I will say, if you go quite handy, quite heavy on your hands, on a 50 microns, you’re probably gonna remove much more than what you want. And this is exactly what I was going to try to say.

Sometimes when I get to my last stage, I’ve done my measurements and I do a nice thorough air abrasion to remove that kind of red that is there. And if pops quite a big amount and I end up with a pulp exposure, it’s very likely that my bacteria was already in in the pulp. Therefore, that pulp exposure. I will take it as like it was going to be needed.

I was going to end up, or either doing pulp capping or it was going to end up doing a root canal treatment because the pulp was affected by bacteria. Bacteria was inside of the pulp. Okay. So I will go with 27 microns on that last part area gently, but enough to just like clean and see all that part of like soft decay coming out, if we can call it soft, if that makes sense that red area.

[Jaz]
Well, for those who listen to the Pulpotomy episode by Suza, they’ll be saying Pulpotomy, Pulpotomy, Pulpotomy. But, that’s a different episode. You guys should listen to that one. That was a really good one. Here’s an interesting one. Not interesting. It’s just something that’s annoyed me and I was really looking forward to this chat to speak to you about this is when I use the caries detector dye and obviously the pink and the red that’s in the middle, is it okay just to leave it? Because now that I’ve done my washing, I’ve done my air abrasion, there’s still a little bit of pink and red there, and I was thinking for the longest time, like, oh my God, how do I get rid of this stuff? Is it okay that it’s there? Please tell me you can bond to it.

[German]
Oh, of course. That’s what I said to you and if you see the articles, I’ll send you those two. Yoshiyama and Nakajima, that’s the name of them. They do the studies, bonding to caries infected and caries infected dentin using caries detector dye, and they’re getting those numbers of 25, 30.

Will it decrease? Maybe, maybe not. We don’t know. But how do we know if we are testing that or not? And it’s still getting a 25 or a 30, on anomalous 30, so we’re getting on that pink haze a good number. If by that 10, 15 that I’m getting in caries infected, basically avoiding pulp exposure, I’m winning.

I’m already winning. I’m preventing a root canal treatment. And what’s important, you now have the ability because the pulp is still alive to heal. So if there is an inflammation slightly to heal. But obviously we’re all different. We’re all different.

[Jaz]
Yeah.

[German]
Not everybody has the same immune system.

[Jaz]
Of course. So, but just to clarify, you’re not using anything to actually remove the pink or the red, once you-

[German]
No.

[Jaz]
Which is, yeah. I was just thinking about that. Was I supposed to do?

[German]
Remember what I said, the last thing I do, I test myself by another application, another drop of caries detector die, and then I rinse it and then I check if I have a proper peripheral seal zone.

[Jaz]
Okay.

[German]
Because it’s very often done that they clean, clean, clean, and on the last clean, they don’t check it, so they just go to proceed. But if you check that sometimes you might get surprised that you are actually left affected or infected caries in areas that are not affected dentin in areas that shouldn’t be.

[Jaz]
Sure. I’m using the Kuraray caries detector dye at the moment. The red one. I like it. I think next time when I finish this bottle, I’m gonna go for green because in case there is a pulp exposure in the future, I worry that if I’ve got something pinkish red and I might not notice.

[German]
Do not, when you see the pulp exposure is evident how the little bit of blood comes out. Many times I’m able to see how come the pulp horns are starting to show off. So that is actually, remember what said clinical judgment. It’s not only about my caries detector eye. It’s a few things that are coming together to find that caries removal endpoint. Okay?

[Jaz]
Mm-hmm.

[German]
So you will see that red coming out. It’s not often that I find a patient, oh, it’s hurting and I do everything, and someone just did a pulp exposure. 10 years ago, you can see the hole and it’s all dry. Okay?

[Jaz]
Mm-hmm.

[German]
So you can see the pulp horn was exposed, and that is visible and green or red. Most important thing that you have to have is the content of glycol. Okay? The glycol content is the only thing, because it’s what it helps you to penetrate. And I didn’t know exactly the brand. Basically Kuraray will have around a 90%, but there is one of the brands I can’t remember. I’ll try to send it to you. Basically the percentage is around a 45%.

Is it actually penetrating? No. So it will tell you that you probably clean, but you haven’t. So as long as you have a high percentage of glycol to allow the fuschin to penetrate properly to allow the dye to go through.

[Jaz]
Awesome. I’m a huge, Panavia fan, so when I saw that Kuraray did that caries detector dye, I was like, yeah, I trust Kuraray. So, I gave my money to them. But yeah, if you find out the name of this Mickey Mouse caries detector dye, you let me know and I’ll make sure that no one ever buys that.

[German]
I’ll find it. I think it’s half a path or something like that. I think, Ultradent is also good content of glycol is another option that you can have, and I think that one is green if you want, but I haven’t seen it.

I only have used Kuraray since I started, and one bottle of them will last me very long time. It’s a lot of caries detector dye, so.

[Jaz]
Yeah. For someone like you who’s using it very, very heavily. Yeah. I mean, it does last a long time, so, I mean, you answered all the questions, I had Germán tell us now.

Anything that you think we’ve missed that you think is important to know before someone, for the naysayers, for the haters, for those who are still not convinced that, you know what, this is just BS and I’m still gonna rely on my probe cause I’m old school or whatever. Anything you wanna say to those guys or anything you wanna say to those who want to, who are gonna now maybe try using caries detector dye and they’re interpreting the data for the first time? Anything that you think we haven’t covered yet?

[German]
Yeah. I think the most important thing is that, and I have chat this with you so many times we’ll have to do what we do know best. Okay? So introducing new things, they will have a learning curve. They take time, and the best thing that you can really do is learning and have someone that can mentor you or help you and on the process, okay?

Using caries detector dye or not, it’s a personal choice. I’m not gonna force anyone to do it. We don’t have to force people to do protocols that they don’t feel comfortable because the only thing that you’re gonna create is hate and dentistry is science not a dogma. Okay? So that’s the important thing.

Important, important, important really is to share those cases with people that are probably knowledgeable in the matter, either I know Instagram can be a hit or miss, but there are lots of great gurus. That’s how I met you. That’s how I got in contact with you. And I learned a lot of TMJ thanks to you.

So obviously we have to have a little bit of discretion on the matter, but, absolutely share those cases. Ask question, be active, you will not learn. And second thing, you will notice that when you’re using caries detector dye, you will be a little bit more aggressive than if you were not using it.

So many times what I find with the students is that because they are not cleaning it properly or they’re not removing enough, they’re really leaving some substrate that is not bonding as good as they Cool bond just because they’re scared of having a pulp exposure. And this is where sharing those cases with our people will help you and will basically make you improve in using this caries detector dye.

And there is an important article that talks about caries detector dye is too aggressive. And what they were testing actually was that they were leaving pink haze close to the DEJ, but they weren’t finding bacteria. Are we testing bacteria? No.

[Jaz]
No. Because you said it’s, it is not a plaque indicator.

[German]
Exactly. So it will become a little bit aggressive. And that’s the myth. And there is a big myth in caries detector dye being aggressive. And there is a restorative book that was used very, very frequently that was saying the caries detector dye was not good because it was too aggressive.

I was removing too much tissue. But it was because the test, once again was done based on a different data or something that we should then be testing. So it was a mistake. And that person didn’t understood what we are tested with caries detector die and they tried to find bacteria and they didn’t find it. But we are trying to achieve high bond strength by having good dentin or-

[Jaz]
To get the best substrate possible. Yeah. It reminds me, Germán of something. My mom says, and she says it in Punjabis, a Punjabi saying, but it basically translates to, ‘The truth is always bitter.’ So sometimes when you use the caries detector dye, the truth is revealed.

There’s no hiding from it. And what you see is that, oops, I have been leaving a bit of caries affected dentin in that peripheral zone where I should have been removing it all this time to get the best bond strengths at that, you know, first couple of millimeters of dentin. So, super important.

So, Germán, thanks for covering this episode. You’ve got some exciting stuff coming with the Alleman’s coming and it out the cricket ground. I’m so gutted I couldn’t come because I’m on another course. Typical, tell us about that, my friend. That’s super exciting.

[German]
So we are, 3rd and 4th of March. David Alleman, we’re gonna spend either two or three days. It depends on what’s gonna be plan is, David and Davey Alleman both come in with Sami and me helping. So we’re gonna be at Lord’s Cricket G round, London. So we’re gonna review all Biomimetic restorative dentistry and the six lesson approach.

And if we are doing the third day, it will be how to treat endodontically, how to restore endodontically treated tooth. It’s a very interesting heavy HandsOn lot of theory, which is what I find with David Alleman. If there is something that I have to really praise and really appreciate from him is that he make me read

not just have someone that comes, and this is good. You know, like, this is good. This is good. I show you my keynote about this presentation. And it is heavily, heavily based on articles that are showing different things. And all of them will have a point why this, why not this? And why do I think, and why do I have this opinion?

And I think this is one of the best things that you can have from Dr. Alleman. And from Davey cuz Sami as well is for me, one of the most amazing person, I would like you to have a conversation about whatever you want, because if you-

[Jaz]
Yeah, he’s been invited. He’s just gotta click on the link and then book in, my friend. He’s more welcome to join us to geek out on Biomimetic Dentistry. It’s a topic that I think is really exciting nowadays. It’s been around for a long time. We’ve known about it. For me, it’s a decent dentistry on steroids, right. It’s like that.

[German]
I do love Biomimetic, and I know word that, but I’m more, I like more my DC from restorative dentistry with a lot of background on Biomimetics. You know, I think it’s just I understand what you’re saying exactly is a perfect, perfect word. It’s a big intense thing. But I think what really kind of like enlightens it is the amount of literature that really provides student dentistry and for clinicians to learn.

[Jaz]
And I think what is provided based on speaking to my Biomimetic colleagues is guidelines and protocols decision making skills, based on sound literature that’s what I thought I’ve interpreted so far, basically. So, I think that’s great. I want you to tell the website and also how we can follow you on Instagram.

[German]
So my Instagram it’s a funny one, is a German T-E-K-I-L-L-A. So, it is @germantekilla. It’s nothing to do with tequila, even if people think that it is something to die. It’s just a funny thing that came from university mantequilla in Spanish means butter. So, I play with my name just like to do that when I was a university.

So, it stays. So, it’s German, T-E-K-I-L-L-A. And then we can have a look at getbondedstaybonded.co.uk and you will find all the information about that course in the UK. If you wanna level up a little bit more and have a one year program, I will recommend you to have a look to Mimétika. It’s another great program that I recommend.

Have a look to Raphael Wymann, Hugh Byrne, and Filip Keulemans , amazing clinicians, researchers that are also I’m collaborating with them and I’m gonna be in May. I’m gonna be lucky to be with, Junji Tagami. I’m gonna be lucky to be, with Ali Sadr these people teaching all of our is an amazing program, David Gerdolle which I think-

[Jaz]
Legend.

[German]
You’ve met before. Another great clinician. So if you are interested in doing something a little bit more a long year course, it’s another great option. And if you also wanna have a look, check, emulate is another restorative course based on Biomimetics and in incredible HandsOn with two amazing people like Fran and Stew, Fran Brelsford and Stewart Beggs. Incredible hands, incredible talent.

[Jaz]
And we have to shout out to, Taylor Paton again, the hybrid layer as a good resource to read up and introduction to Biomimetic Dentistry. I love what he’s done there. So there’s plenty of learning to be done there. Yeah. Thanks so much my friend, for giving your time.

[German]
Thank you. Thank you. Can’t thank you enough, honestly.

Jaz’s Outro:
Thank you, buddy. Well, there we have it guys. Thank you so much for listening and watching all the way to the end. Hope you enjoyed learning about caries detector Dye, and maybe you may start implementing this in your practice and you’ll be able to use it properly from the get-go and interpret the data so you can get the best bond strengths possible.

Now that you’ve listened all the way to the end, do answer a few questions, get that CPD that you well and truly deserve by the end of the year, all those hours will rack up. And if you want to refer to some of the notes, you can always download that as a PDF as well by scrolling on the app. And of course, if you enjoy this episode, do consider leaving a review or a rating depending on which platform you’re listen and watching on. It really helps a lot. Thank you so much and I’ll catch you in the next one.