6 How do we diagnose and classify it?

Question 1

How do we classify caries

Answer 1

By extent
By cavitation
By activity
By site
By location

Question 2

How do we classify by extent

Answer 2

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)

Question 3

How do we classify by cavitation?

Answer 3

cavitated or not cavitated

Question 4

What can we use to explore whether a cavity is a cavity

Answer 4

a blunt rounded probe

NOT a sharp one

Question 5

How do we classify by activity

Answer 5

active (demineralising)

inactive (remineralising)

Question 6

How do we classify by site

Answer 6

• 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

Question 7

How do we classify by location

Answer 7

• primary - de novo: 1o

- secondary - adjacent to a restoration: 2o

Question 8

How does the scoring system work

Answer 8

Surfaces: each surface is considered separately

Tooth: worst surface dictates tooth code

DMFT/dmft

Question 9

How do you measure reliability of caries diagnosis

Answer 9

accuracy and precision

Question 10

what is accuracy in diagnostics

Answer 10

measures what is claimed

Question 11

what is precision in diagnostics

Answer 11

consistency of measurement

Question 12

how do you measure accuracy of diagnoses

Answer 12

sensitivity and specificity

Question 13

what is sensitivity

Answer 13

% of disease found correctly (how many of the carious lesions will you find correctly)

Question 14

What is specificity

Answer 14

% of health found correctly

Question 15

What are the basics of a good clinical exam

Answer 15

• good light
• dry the tooth
• take your time (do it systematically)
• don’t use a sharp probe

Question 16

How sensitive and specific are normal exams?

Answer 16

Sensitive
D1 = 0.32
D3 = 0.34

specific
D1 = 0.97
D3 = 0.99

Question 17

What are ways of improving accuracy of diagnosis

Answer 17

Cariograms

Radiographs

Magnification

Question 18

Why do cariograms improve accuracy

Answer 18

(ICCMS)

• Iccms guide for practitioners
• much higher sensitivity but lower specificity (more false positives)

Question 19

In what ways are radiographs good and bad at improving accuracy

Answer 19

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

Question 20

In what ways is magnification good and bad at improving accuracy

Answer 20

Advantages
- easy, cheap relatively

Disadvantage
- smaller field of view

higher sensitivity, similar specificity

Question 21

what are other techniques that can improve diagnosis

Answer 21

FOTI (fibre optic transillumination)

Diagnodent (reflection of red light between the tooth)

Electrical techniques

All expensive and technique sensitive

Question 22

If a lesion is cavitated what is the treatment

Answer 22

need to restore usually

Question 23

if the caries is not cavitiated what is the treatment

Answer 23

should be able to stop decay progressing/ remineralise without restoring