6 How do we diagnose and classify it? Flashcards
How do we classify caries
By extent By cavitation By activity By site By location
How do we classify by extent
D1 - all visually detectable lesions
D3 - lesions extending into dentine
(big ranges of severities within classifications)
(Shadowing can show if it’s into the dentine)
How do we classify by cavitation?
cavitated or not cavitated
What can we use to explore whether a cavity is a cavity
a blunt rounded probe
NOT a sharp one
How do we classify by activity
active (demineralising)
inactive (remineralising)
How do we classify by site
- smooth surface (most worrying cause you should be able to clean a smooth surface well)
- occlusal
- root surface (easier to get caries in dentine if no protection of enamel)
- approximal
How do we classify by location
- primary - de novo: 1o
- secondary - adjacent to a restoration: 2o
How does the scoring system work
Surfaces: each surface is considered separately
Tooth: worst surface dictates tooth code
DMFT/dmft
How do you measure reliability of caries diagnosis
accuracy and precision
what is accuracy in diagnostics
measures what is claimed
what is precision in diagnostics
consistency of measurement
how do you measure accuracy of diagnoses
sensitivity and specificity
what is sensitivity
% of disease found correctly (how many of the carious lesions will you find correctly)
What is specificity
% of health found correctly
What are the basics of a good clinical exam
- good light
- dry the tooth
- take your time (do it systematically)
- don’t use a sharp probe
How sensitive and specific are normal exams?
Sensitive
D1 = 0.32
D3 = 0.34
specific
D1 = 0.97
D3 = 0.99
What are ways of improving accuracy of diagnosis
Cariograms
Radiographs
Magnification
Why do cariograms improve accuracy
(ICCMS)
- Iccms guide for practitioners
- much higher sensitivity but lower specificity (more false positives)
In what ways are radiographs good and bad at improving accuracy
Permanent record (advantage)
Ionising radiation (disadvantage)
Not appropriate for all surfaces (disadvantage)
- Good for aproximal areas
- Not good for occlusal caries
Types
- Bite wings are best cause you can see enamel and dentine so you’d see the legions
- Better sens at D3 and spec a little lower than normal exam
- Bitewing radiographs are good
- Periapicals are good too
Caries shows darker cause less mineralised
In what ways is magnification good and bad at improving accuracy
Advantages
- easy, cheap relatively
Disadvantage
- smaller field of view
higher sensitivity, similar specificity
what are other techniques that can improve diagnosis
FOTI (fibre optic transillumination)
Diagnodent (reflection of red light between the tooth)
Electrical techniques
All expensive and technique sensitive
If a lesion is cavitated what is the treatment
need to restore usually
if the caries is not cavitiated what is the treatment
should be able to stop decay progressing/ remineralise without restoring
