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Oral Micro #1 > #7 Caries Diagnosis > Flashcards

#7 Caries Diagnosis Flashcards

1
Q

Are caries dichotomous (as in black and white)?

A

No, they are a continuum from incipient to advanced.

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2
Q

What are common methods for caries diagnosis?

A
  • Explorer stick (can be damaging!)
  • Visual exam and gentle exploration with probe
  • Bitewing radiography
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3
Q

What are the best conditions for a visual exam?

A
  • clean tooth
  • dry tooth
  • good light
  • sharp probe (light touch, stroke across surface)
  • magnification?
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4
Q

What should you look for in a visual examination?

A

o frank cavitation
o decalcification (whitespot) refractive index of air >water> tooth
o opalescence (deep caries)
o discontinuities in surface

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5
Q

Is brown or black staining a reliable indicator of caries?

A

No!

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6
Q

What are some considerations when diagnosing caries?

A
  • Currently caries rates are declining. This decline is decline mostly in smooth surface lesions, so there is a predominance of fissure caries.
  • Accurate diagnosis of fissure caries is more difficult than smooth surface caries. Fissure cavitation is easily recognized, but incipient or early fissure caries are much more difficult.
  • Caries may be slowly progressing, and may be arrested, so a measurement of progression is appropriate
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7
Q

What is are treatment planning considerations for caries?

A
  • There is a spectrum of opinion on how early lesions should be managed. This ranges from:
    1) highly aggressive– “exploratory” excavation & enameloplasty, seal/restore
    to
    2) seal deep fissures and excavate & seal/restore chalky or soft enamel
    to
    3) highly conservative– seal incipient decay and intact fissures
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8
Q

Are we overtreating caries?

A

To quote some important guy, “inappropriate decisions to restore teeth are frequently made, with concomitant negative resource and patient care implications.”

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9
Q

What is the reliability of a diagnostic test?

A

reliability relates to the reproducibility of measurements

For example, a group of new dental students each take a blood pressure reading on the same patient, and due to problems with their first try, they get widely varying results. These measurements are not reliable.

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10
Q

What is the validity of a diagnostic test?

A

validity is the degree to which a measurement expresses the true value

Later when they have mastered the technique, they all take a blood pressure reading on the same large adult using a small-sized cuff. They all get the same number, but since the cuff is too small, the readings are high, and the measurement is not valid.

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11
Q

What is the gold standard for validity in caries diagnosis?

A

A histologic exam, which isn’t possible in the mouth.

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12
Q

What metrics do we use to rate the validity of a diagnostic test such as a caries exam method?

A

Sensitivity and Specificity

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13
Q

What is sensitivity?

A

The proportion of people/teeth with caries who have a positive test result. How likely we are to say disease is present when it’s there.
Perfect sensitivity= 100% (no false negatives)

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14
Q

What is specificity?

A

The proportion of healthy people who have a negative test result. How likely we are to say disease is absent when it’s not there. Perfect specificity = 100% (no false positives)

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15
Q

How is inter-observed agreement (reliability) determined?

A

by measuring how often the same answer is achieved using a kappa statistical test.

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16
Q

Look at the table of Evidence on Diagnosis of Fissure Caries.

A

Okay!

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17
Q

T or F: Small lesions on radiographs are not likely to be cavitated.

A

True! We may consider trying to reverse them by conservative methods such as fluoride treatments in conjunction with a total prevention program.

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18
Q

T or F: Studies show decrease in viable microorganisms in lesions under intact sealants, & caries progression is significant.

A

False! It is negligible. Effects result from blocking nutrients from reaching bacteria within the teeth.
This is why bacterial numbers significantly decline in incompletely excavated carious dentin after sealing.

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19
Q

Simply sealing cavitated lesions was __% successful after 9 years.

A

84%

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20
Q

Sealed conservative amalgams were __% successful after 9 years.

A

97.5%

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21
Q

Conventional amalgams were __% successful after 9 years.

A

83%

22
Q

So, hidden, sealed caries will not progress, right?

A

Right, but restorations must be mechanically supported and margins must be sealed

23
Q

What are two major (and balancing) concepts in management of small fissure lesions?

A
  1. diagnostic tests are not very sensitive (incipient lesions hard to detect)
  2. minimal treatment effective for incipient and moderate lesions (early detection may not change treatment strategy)
24
Q

What are the International Caries Detection & Assessment System scores?

A

0: Sound tooth surface.
1: First visual change in enamel.
2: Distinct visual change in enamel.
3: Microcavitation.
4: Underlying dark shadow from dentin with or without cavitation. 5: Distinct cavity with visible dentin.
6: Extensive distinct cavity with visible dentin.

25
Q

How do you detect caries in an explorer exam?

A

Probe does not stick =

No caries

26
Q

What are the sensitivity and specificity of an explorer exam?

A
  • Low sensitivity
  • High specificity

*May cause damage

27
Q

What are the sensitivity and specificity of a visual exam?

A
  • Low sensitivity
  • High specificity

*No damage


28
Q

Will a probe or visual exam detect severe caries under constricted fissure anatomy?

A

No. Caries of this kind aren’t found in nature either, epidemiological evidence for them is lacking.

29
Q

Do you need to worry about sealing in a problem when sealing pits and fissures?

A

It depends. Intact sealants block substrate & halt decay. Late detection needs to be balanced with effective therapy.

30
Q

What are some adjunctive tools in caries diagnosis?

A
  • Disclosing dyes
  • KaVo DIAGNOdent
  • Inspector Pro
  • Midwest Caries I.D.
  • Cariescreen Pro
  • DEXIS CariVu
  • Canary System
  • Microbiologic tests
31
Q

Tell me about caries detection dyes.

A
  • They are non-specific protein dyes that stain the organic matrix of less mineralized dentin.
  • You can get false positives when using them. Namely around the DEJ and circumpulpal areas.
32
Q

Tell me about KaVo DIAGNOdent.

A

• It’s a 655 nm diode laser
• It detects fluorescence from demineralized enamel.
*High sensitivity- DETECTS SMALL LESIONS!
*Low specificity

33
Q

What can the KaVo DIAGNOdent read as false positives?

A
  • (green) food
  • (green) prophy paste
  • calculus
  • composite and stained margins
  • plaque and organic plug - high natural fluorescence of tooth
  • hypocalcified enamel
34
Q

How does KaVo DIAGNOdent work?

A
  • The tip is rooted on top the tooth to “read” the fissure walls.
  • The laser penetrates 2-3 mm into tooth
  • Readings are related to
    • degree and intensity of demineralization
    • NOT depth of the lesion
35
Q

Does air abrasion improve the success rate of sealants?

A

Studies say no.

36
Q

Tell me about the Midwest Caries I.D. Detection Handpiece.

A
  • It has a Green LED light
  • and it has a Red LED light
  • and it has a Receiving fiber
  • When green light is deflected by demineralized enamel, the red light & an audible signal are activated
37
Q

Tell me about Inspektor Pro Caries Detection system.

A

It is an expensive, time-consuming research instrument that monitors caries progression

38
Q

Tell me about QLF Images.

A
  • It detects early caries through fluorescence of tooth tissue
  • Software monitors lesions over time
  • Bacterial activity is detected through red fluorescence from bacterial metabolites (e.g. porphyrins)
39
Q

What is the utility of QLF?

A

• Sensitivity high
– Finds “hidden caries”
– Reliable for determining absence of disease
• Specificity low w/ single measurement – False positives
• Tracks lesions over time to locate active caries & remineralization
• Expensive & time consuming for clinical practice
• Research tool

40
Q

Tell me about CarieScan Pro.

A
  • This technology looks for caries by comparing the greater electrical conductivity of less mineralized to the lower impedance of well calcified tissue.
  • It has lower specificity and higher sensitivity.
41
Q

What are some confounding factors for CarieScan Pro?

A
  • Young teeth are more porous
  • Enamel hydration
  • Enamel thickness
  • Area of contact
42
Q

Enlighten me about Transillumination Technology.

A
  • Visible light illumination and computer imaging
  • Research suggests more sensitive than radiography
  • No risk
43
Q

Tell me about some specific Transillumination systems.

A

Okay, no problem. There is the DEXIS CarieVu which utilizes near infra-red light. And then there is the Canary System, my personal favorite. It is a laser system, because lasers are cool, and it uses luminescence and heat (also known as Photo-Thermal Radiometry to eggheads) to create the mystical “Canary Number.” The number can range from Healthy to Advanced Decay.

44
Q

Can you tell me more about this incredibly interesting Canary System laser?

A

Of course I can! It detects up to 5mm away from the tooth surface and as close as 50 microns. In vitro studies show performance is just as good or greater than radiography for detection of proximal lesions. In fact it has better sensitivity (less false negatives) and equal specificity (the same amount of false positives) to radiography. And for one easy payment of 16k, you too can do laser/heat scans on teeth!

45
Q

What are the kinds of microbiologic tests for risk assessment?

A
  • Saliva-Check mutans
  • CariScreen susceptibility test
  • CRT (Caries Risk Test)
46
Q

Tell me about SALIVA-CHECK MUTANS Test strips.

A
  • Immunochromatography quick test contains monoclonal antibodies that selectively detect SM
  • Results in 15 min
  • Values above red line mean salivary levels of S. mutans equal to or above 500,000 cfu/ml
  • Evidence: SM tests have not been shown to be good risk predictors on an individual basis
47
Q

Tell me about the CRT® Caries Risk Test.

A
  • CRT Bacteria
    Cultivation test for
    S. mutans and lactobacilli Results in 2 days
  • CRT Buffer
    Dipstick test for salivary buffering capacity Results in 5 minutes

-Evidence limited

48
Q

Tell me about CariScreen Caries Susceptibility Test.

A
  • What it is: 1-minute chair-side bacterial test that
    measures ATP bioluminescence
  • Claim: detects levels of acid- producing, decay-causing bacteria residing in an individual’s plaque & assesses patients’ caries risk
  • Evidence: very limited,
    • Not diagnostically useful predictor of caries risk
    • Sensitivity appears low
    • Specificity appears good
49
Q

Is there an accurate microbiologic predictive caries risk assessment test available?

A

No.

50
Q

Remember what I am about to tell you …

A

New Technologies Are ADJUNCTIVE TOOLS!



Oral Micro #1 (12 decks)

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