2018-2019/5th Year Preventive Dentistry Lecture (24)
Dr. Nada Jafer Radhi (College of Dentistry/ University of Baghdad)
Diagnosis of dental caries
Tooth caries is chronic, progressive, and bacterial diseases. The main
characters of tooth caries are the changes in color, shape, and quality of tooth hard
tissue. The typical pathological changes have important reference value for caries
diagnosis. At present, the methods for dental caries diagnosis are mainly based on
clinical inspection and X-ray examination. However, it is difficult to identify early
caries which is in the hidden area of the tooth. Prevention is at its most effective
when detection is early within the natural history of the dental caries. The
failure to detect early caries, leaving those detectable only at the deep
enamel, or cavitated stage, has resulted in poor results and outcomes for
remineralization therapies. Therefore, the ability to monitor early lesions and
determine if they have indeed arrested or stabilized is also key to ensuring
that effective prevention can become commonplace in general dentistry.
Diagnosis is a decision process and is informed by, initially, detection
of a lesion and should be followed by an assessment of the patient’s caries
risk, which may include the number of new and past caries lesions, diet,
presence or absence of modifying factors (salivary flow, mutans streptococci
counts, oral hygiene), and qualitative aspects of the disease such as color and
anatomical location. These detection systems are therefore aimed at
augmenting the diagnostic process by facilitating either earlier detection of
the disease or enabling it to be quantified in an objective manner. The
problem of diagnosis is related to sensitivity versus specificity.
1
, Detection systems of caries
- visual and tactile examinations
- Radiographic techniques
- Electrical current measurement (electronic resistant method)
- Fiber Optic Transillumination (FOTI and DiFOTI) (Enhanced visual techniques)
- Fluorescent techniques
- Other techniques like Dyes, Ultrasound techniques, Photo-thermal Radiometry
(PTR).
Visual and tactile examinations
Visual inspection, the most widespread caries detection system, is
subjective. Assessment of features such as color and texture are qualitative in
nature. These assessments provide some information on the severity of the disease.
They are also limited in their detection threshold, and their ability to detect early,
noncavitated lesions restricted to enamel is poor. The vast majority of carious
lesions are detected by dentists using visual methods. The use of accompanying
tactile examination is not recommended because rigorous probing of lesions can
lead to cavitation and deep bacterial invasion. The use of a blunt probe, ideally a
periodontal probe, can be used to detect differences in surface roughness.
Detection of initial caries by sharp probe may lead to cavity formation which
reducing the chance of remineralization of intact surfaces. Tactile examination
using explorers allows for detection of roughness, soft floors, frank cavitation,
white spot lesion as non cavitated. Good dryness is recommended while detection
of initial lesion. Caries on proximal contact area is difficult to be examined by
inspection and probing. Dental floss can be used as a convenient method. The floss
will be torn if caries is present. Examination with floss can be misled by dental
calculus. Different types of separators can be used as orthodontic rubber rings for
several days as diagnostic aids.
2
Dr. Nada Jafer Radhi (College of Dentistry/ University of Baghdad)
Diagnosis of dental caries
Tooth caries is chronic, progressive, and bacterial diseases. The main
characters of tooth caries are the changes in color, shape, and quality of tooth hard
tissue. The typical pathological changes have important reference value for caries
diagnosis. At present, the methods for dental caries diagnosis are mainly based on
clinical inspection and X-ray examination. However, it is difficult to identify early
caries which is in the hidden area of the tooth. Prevention is at its most effective
when detection is early within the natural history of the dental caries. The
failure to detect early caries, leaving those detectable only at the deep
enamel, or cavitated stage, has resulted in poor results and outcomes for
remineralization therapies. Therefore, the ability to monitor early lesions and
determine if they have indeed arrested or stabilized is also key to ensuring
that effective prevention can become commonplace in general dentistry.
Diagnosis is a decision process and is informed by, initially, detection
of a lesion and should be followed by an assessment of the patient’s caries
risk, which may include the number of new and past caries lesions, diet,
presence or absence of modifying factors (salivary flow, mutans streptococci
counts, oral hygiene), and qualitative aspects of the disease such as color and
anatomical location. These detection systems are therefore aimed at
augmenting the diagnostic process by facilitating either earlier detection of
the disease or enabling it to be quantified in an objective manner. The
problem of diagnosis is related to sensitivity versus specificity.
1
, Detection systems of caries
- visual and tactile examinations
- Radiographic techniques
- Electrical current measurement (electronic resistant method)
- Fiber Optic Transillumination (FOTI and DiFOTI) (Enhanced visual techniques)
- Fluorescent techniques
- Other techniques like Dyes, Ultrasound techniques, Photo-thermal Radiometry
(PTR).
Visual and tactile examinations
Visual inspection, the most widespread caries detection system, is
subjective. Assessment of features such as color and texture are qualitative in
nature. These assessments provide some information on the severity of the disease.
They are also limited in their detection threshold, and their ability to detect early,
noncavitated lesions restricted to enamel is poor. The vast majority of carious
lesions are detected by dentists using visual methods. The use of accompanying
tactile examination is not recommended because rigorous probing of lesions can
lead to cavitation and deep bacterial invasion. The use of a blunt probe, ideally a
periodontal probe, can be used to detect differences in surface roughness.
Detection of initial caries by sharp probe may lead to cavity formation which
reducing the chance of remineralization of intact surfaces. Tactile examination
using explorers allows for detection of roughness, soft floors, frank cavitation,
white spot lesion as non cavitated. Good dryness is recommended while detection
of initial lesion. Caries on proximal contact area is difficult to be examined by
inspection and probing. Dental floss can be used as a convenient method. The floss
will be torn if caries is present. Examination with floss can be misled by dental
calculus. Different types of separators can be used as orthodontic rubber rings for
several days as diagnostic aids.
2
