Caries diagnosis and classification

Question 1

what are the five ways to classify caries?

Answer 1

• by extent
• by cavitation
• by activity
• by site
• by location

Question 2

how is caries classified by extent?

3

Answer 2

• D1 = all visually detectable caries
• D2 = clinically detectable caries limited to enamel
• D3 = lesions extending into dentine

D3 caries

Question 3

how is caries classified by cavitation?

2

Answer 3

• cavitated - run prove over and if caught
• non-cavitated

Question 4

how is caries classified by activity?

2

Answer 4

• active (demineralising)
• inactive (remineralising)

Question 5

how is caries classified by site?

4

Answer 5

• smooth surface
• occlusal
• root surface
• approximal

Question 6

how is caried classified by location?

2

Answer 6

• primary
• secondary - adjacent to a restoration

Question 7

what is the scoring system for caries?

2

Answer 7

• surfaces - each surface is considered separately
• tooth - worst tooth dictates the code

Question 8

how should you undergo a clinical examination of caries?

4

Answer 8

• good light
• dry the tooth
• take your time
• don’t use sharp probe - can create caries by damaging surface

Question 9

sensitivity and specificity definition in respect to diagnosing caries

Answer 9

• sensitivity: % of disease found correctly
• specificity: % of health found correctly

Question 10

what would the sensitivity and specificity be for D1 and D3 caries in normal examination?

Answer 10

• D1 sens: 0.32, spec: 0.97
• D3 sens: 0.34, spec: 0.99

Question 11

how would you improve accuracy of a caries diagnosis?

4

Answer 11

• ICCMS - international caries classification and management system
• radiographs
• magnification
• FOTI - fibre-optic transillumination

Question 12

how does ICCMS examination affect sensitivity and specificity?

Answer 12

increases sensitivity (D1: 0.32-0.65, D3: 0.34-0.80)
decreases specificity (D1: 0.97-0.85, D3: 0.99-0.80)

Question 13

what are the advantages and disadvantages of radiographs?

2(3,3)

Answer 13

advantages
* permanent record
* can see between teeth
* can see under restorations
disadvantages
* OPT not very useful
* not easy to find occlusal caries
* radiation

Question 14

how do bitewing radiographs affect sensitivity and specifity?

Answer 14

increases sensitivity (D1: 0.32-0.31, D3: 0.34-0.57)
decreases specificity (D1: 0.97-0.87, D3: 0.99-0.95)

Question 15

what are the advantages and disadvantages of magnification?

Answer 15

advantages
* easy
* more accuracy
disadvantages
* expensive
* reduces field of view

Question 16

how does magnification affect sensitivity and specificity?

Answer 16

increases sensitivity (D1: 0.32-0.42, D3: 0.34-0.37)
specificity remains the same (D1: 0.97, D3: 0.99)