How Effective are Dental Loupes and Headlamps for Dental Care?
By Carolyn Boyd, DDS, Diploma Library & Info Technology
Original article: Dental Loupes and Headlamps for Dental Care: Clinical Effectiveness, Cost- Effectiveness, and Guidelines. CADTH, October 2019
Magnification loupes have become commonly used by dental operators. Many if not all dental schools in Canada require students purchase and use them throughout their dentistry and dental hygiene programs. Asking practitioners who use loupes in their practices, they say they couldn’t imagine working without them. Intuitively, it makes sense that if you can see better then you can practice better, leading to the assumption that magnification results in better treatment outcomes. And, is this true?
Intuitively, it makes sense that if you can see better then you can practice better, leading to the assumption that magnification results in better treatment outcomes.
The Canadian Agency for Drugs and Technologies in Health (CADTH), set out to investigate that question. To find quality study designs, CADTH looked for health technology assessments first and then systematic reviews, which are the gold standard for evidence synthesis. After that in descending order of confidence follow meta-analysis, double blind randomized control trials (DBRCT), randomized control trials (RCT), non-randomized studies, economic evaluations, and evidence-based guidelines.
The CADTH Rapid Response Report was released on October 9, 2019, Dental Loupes and Headlamps for Dental Care: Clinical Effectiveness, Cost-Effectiveness, and Guidelines. The report summarizes the abstracts of the best available evidence since 2009 that address the questions of whether there are differences in clinical effectiveness when using dental loupes versus unaided vision, and when using headlamps versus operatory lights. The report is based on two systematic reviews, two randomized controlled trials, and three non-randomized research studies that specifically addressed these questions. The findings are presented in order of highest to lowest quality of evidence found.
- Both systematic reviews looked at endodontic treatment performed with magnification. The first review found no trials that met the inclusion criteria, so no conclusions could be drawn. The second review found that the use of magnifying loupes, surgical microscope or endoscope had no or minimal positive effect on treatment outcomes.
- The two randomized controlled trials found magnification tools improved scaling and root planing of teeth and removal of composite adhesive after ortho bracket debonding.
- The results of the 3 non-randomized studies were a mixed bag. One study suggested magnification improved the detection of white spot lesions in enamel, while another one concluded magnification with or without headlamps did not improve supragingival scaling treatment outcomes and added to treatment time. The last study did not assess treatment outcomes but found that loupes reduced endodontic treatment time.
- CADTH could not locate any health technology assessments, literature on cost-effectiveness, or any guidelines for the use of magnification to affect clinical effectiveness.
Just because the evidence isn’t pointing to a hard and fast answer doesn't mean that dental loupes aren’t advantageous. The onus is on individual practitioners to choose what works best for them.
This report specifically addresses the effect of magnification on clinical effectiveness, not on whether magnification improves vision of the operator. Of course magnification allows the user to see in more detail, but does it necessarily lead to measurably improved dental care either directly or indirectly?
There are other factors to consider with magnification, such as operator comfort. For example, a recent study noted improved neck angulation that suggests loupes require the operator assume a consistent posture that may lead to long-term ergonomic comfort and musculoskeletal health (1).
It takes time for new technologies to settle into widespread use and for long-term data to be available for conclusive review. Just because the evidence isn’t pointing to a hard and fast answer doesn't mean that dental loupes aren’t advantageous. The onus is on individual practitioners to choose what works best for them.
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- Wajngarten D, Garcia PPNS. Effect of magnification devices on dental students’ visual acuity. Murphy BA, ed. PLoS ONE. 2019;14(3): e0212793. doi: