presented by

FAIZ MOOSA T Department of Oral Medicine and Radiology Dayanada Sagar College of Dental Sciences Bangalore

 A new diagnostic modality Thermography Thermography is defined as the method of identification and analysis of skin temperature distribution of a Body surface. Thermography is based on the ability to image heat emission of the human body depends on the amount of blood flowing beneath the skin.

Historical perspective

Body temperature evaluation dates back to Greek pre-Hippocratic medicine and since then it is considered as a medical diagnostic sign.

Historical perspective

Hippocrates - Book of Prognostics The observable asymmetries in temperature distribution can aid in the diagnosis and prognosis of medical disorders

Historical perspective

1592 Galileo's Thermoscope A Semi Quantitative Air Thermometer

Historical perspective

1611 Santorio Sanctorius modified the thermoscope The Thermometer

Historical perspective

1911
Wunderlich

Fever Measurement
A Routine Clinical Diagnostic Procedure

Historical perspective

1931

Hardy
The Modern Era Of Telethermometry

Emission of the Infrared Radiation of Human Skin and its Potential Diagnostic Importance.

Liquid Crystal Thermography

It consists of flexible rubber sheets with cholesteric crystals that changes from their neutral color into different color in response to the surface temperature. The resultant color display is then photographed using Polaroid photography which gives an instant hard copy of the image. Advantages less expensive portable Disadvantages technique sensitive skin contact can alter the temperature

Infrared Telethermography
Infrared thermography is a non-contact method of temperature measurement It consists of an infrared detector amplifier- digitizer a microcomputer a video display The Infrared radiation emitted by the body is detected by the Detector and the amplifier then converts these electric signals into digital values and then feeds into a computer which reconstructs a Digitized Thermal Image Disadvantage Low resolution images

Infrared Telethermogram Sample

Left Mandibular and Maxillary regions Dental pathology Left Naso-labial fold and Frontal sinus Sinus involvement Sternocleidomastoid muscle Moderate irritation Thyroid Region Moderate Irritation

Dynamic Area Telethermometry

Dynamic area telethermometry (DAT) is advancement in infrared imaging in which quantitative assessment of temperature changes over a non-uniform temperature area is measured. It is so sensitive that it can determine neurogenic mediated thermal changes micro spatial homogeneity of skin temperature

 A Trained Telethermographer A High-quality Telethermography System consisting of

infrared camera, thermal control unit image analysis software.

An Examining Room maintaining a uniform temperature be tween 18-23 C The Humidity of the room should be controlled (30-70%) to avoid any moisture build up on the skin that can interact wi th radiant infrared energy.

Chronic Orofacial Pain Patients

In 1996, Gratt and his colleagues developed a classification system according to change in Temperature as Normal = 0.0 to +0.25C Cold = 0.26 to 0.35C

Hot when it is >0.35C

Ref:Article - Thermography in dentistry-revisited by Sudhakar S*, Bina kayshap, Sridhar reddy P

Subjects classified with Hot Thermographs had a clinical diagnosis of (1) Sympathetically maintained pain, (2) Maxillary sinusitis. Subjects classified with Cold Thermographs were found to have the clinical diagnosis of (1) Peripheral nerve-mediated pain (2) Sympathetically independent pain. Subjects classified with Normal Telethermographs included patients with the clinical diagnosis of (1) Trigeminal neuralgia (2) Psychogenic facial pain. This new system of thermal classification resulted in 92% agreement in classifying pain patients making it as an important diagnostic parameter.

TMJ Disorders
TMJ examination using thermography in Normal Persons had showed symmetrical thermal patterns with a mean T value of 0.1C According to a study T values among Active orthodontic patients +0.2C TMD patients +0.4C Patients with Asymptomatic TMJ controls +0.1C. The above findings suggest that Telethermography can distinguish between patients undergoing Active Orthodontic Treatment and patients with TMD
Ref: Studies by Beth and Gratt in 1996

Quantification of Thermal Insult to Pulp

Thermography has been used to evaluate the Thermal Insult to the Pulp while undergoing various Dental Procedures like Electro Thermal Debonding Ultra-speed Cavity Preparation Studies show that ETD method can pose serious thermal damage to the pulp and needs intermittent cooling of the teeth to prevent pulpal damage With the usage of Air-Water Coolants Ultra-speed Cavity Preparation does not cause any Thermal insult to Pulp Thus thermography can be used to evaluate and rule out the Thermal insult on the Pulp during any procedures
Ref: Studies by Cummings and his colleagues in 1999 and 1979, Carson and his colleagues

Inferior Alveolar Nerve Deficit

Studies show that patients with Inferior Alveolar Nerve Deficit when examined showed T values of +0.5C on the affected side whereas subjects with no Inferior Alveolar Nerve Deficit showed a symmetrical thermal T value of +0.1C.

Ref: Studies In 1994, Gratt and his colleagues

Pre and Post-Surgical Inflammation

Before Extraction

After Extraction

7 days after Extraction

Ref: Studies by J Christensen*, LH Matzen, M Vaeth, S Schou and A Wenzel

Additional Applications of Thermography

Quantification of the effects of Post-Surgical Inflammation. Quantification of the effects of Anti-Inflammatory Drugs Diagnosis of Inflammatory Processes within Maxilo-Facial Area Monitoring Endodontic Treatments Tissues reactions to new Dental materials In the diagnosis of Chronic and Acute Periodontitis

 Only able to directly detect surface temperatures

Quality cameras often have a high price range

Most cameras are not as accurate as Contact methods

 Thermography aids in the assessment and staging of various dysfunctions of the head and neck region, as it gives both qualitative and quantitative assessment which helps in estimation of progression of the disease and with the innovation of novel equipments, thermography in the near future will certainly emerge as A Unique Research Tool In Dentistry.

Bedford RE. Thermometry. In: The New Encyclopedia Britannica, 15th ed,Chicago. Ill. 1992; 11: 702-703 Thermography in dentistry-revisited : Sudhakar S*, Bina kayshap, Sridhar reddy P Thermology and facial telethermography: Part II. Current and future clinical applications in dentistry by BM Gratt and M Anbar Thermography- investigation method of diagnosis and treatment in temporomandibular joint territory by Daniela Gheorghi, Bogdan Gheorghi Thermography as a quantitative imaging method for assessing postoperative inflammation J Christensen*, LH Matzen, M Vaeth, S Schou and A Wenzel McBeth SB, Gratt BM. Thermographic assessment of temporomandibular disorders symptomology during orthodontic treatment Am J Orthod Dentofacial Orthop 1996 Grennan DM, Caygill L. Infra-red thermography in the assessment of sacro-iliac inflammation. Rheumatol Rehabil 1982 Hardy JD. The radiation of heat from the human body: I-IV. J Clin Invest. 1934 Gratt BM, Anbar M. Thermology and facial telethermography: Part II: Current and future clinical applications in dentistry. Dento maxillofac Radiol. 1998