6 Flashcards
5 ways to classify caries
by extent
by cavitation
by activity
by site
by location
2 classifications of caries by extent
D1
D3
D1 caries classification
enamel only, not breached the ADJ
(cavitated or non-cavitated)
all visibly detectable lesions
D3 caries classification
lesions extending into dentine
cavitated
shadowing
- school dental visits focus on these
treatment if cavitated caries
restoration
cavity can’t reheal itself
not-cavitated caries treatment
should be able to remineralise damage
how to detect a cavity?
use a ball ended probe or perio probe along the surface
- probe will drop in
nerve probe with a sharp probe as even a micro-cavity can be made worse
how to treat a small cavity
fissure seal over the top or thin layer of composite
appearance of active caries
soft, light brown lesion
demineralising
appearance of non-active caries
dark brown, leather like
4 site classifications of caries
smooth surface
- most worrying as should be able to clean well
occlusal
- most common, especially in young
- harder to clean pits properly
approximal
- on surface approaching
root surface
- recession and exposed dentine can get caries easier than enamel
when can remineralisation occur?
once the patient is able to cleanse tooth surface
2 classifications of caries by location
primary
- de novo/new
secondary
- adjacent to a restoration
2 types of caries scoring systems
DMFS - surfaces, each considered separately
DMFT - teeth, worst surface dictates tooth code
accuracy
measures what is claimed
- how good an operator is at measuring decay
split into sensitivity and specificity
precision
consistency of measurement
- measuring at the same level all the time
accuracy sensitivity
% of disease found correctly
e.g. only detect 1 out of 2 decayed teeth = 50%
accuracy specificity
% of healthy teeth found correctly
e.g. how many times correct if 30 healthy and 2 caries
risk of incorrectly detecting decay
want a high specificity score
4 basic requirements for clinical examination
- good light
- dry the tooth
- take your time systematically
- don’t use a sharp probe
4 ways accuracy can be improved
- ICCMS
- radiographs
- magnification
- FOTI
ICCMS
international caries care and management system
- Carefully drying for 30 seconds
- And looking at each surface carefully
caused
- increase in sensitivity
- decrease in specificity (bad as more false positive for decay)
advantage and disadvantages of taking radiographs for caries diagnosis
Advantage
- Permanent record at certain time
Disadvantages
- Ionising radiation
- Not good for all surfaces – approximal areas good, occlusal harder
Panoramic OPT – not ideal
Bitewing good take on both sides – see enamel, dentine and approximal clearly
Periapical – good
what does caries look like on radiographs?
Lesions come as darker shadows as less mineral so more X-rays get through
secondary caries can be seen as shadows around radiopaque material
advantages and disadvantages of magnification for caries diagnosis
Advantages
- Easy
- Relatively cheap
Disadvantages
- Time to adjust to them
- Field of view and depth of view gets smaller
FOTI
Fibre Optic TransIllumination
thin beam of light
advantages and disadvantages of FOTI for caries diagnosis
highly accurate
good for clinical trials
very expensive
very technique sensitive (not used in practices typically)
