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AU 15- Oral Micro > Caries Diagnosis and Management > Flashcards

Caries Diagnosis and Management Flashcards

1
Q

What are two criteria that should be met in order to have good “diagnosis and treatment planning”?

A
  1. Control the disease

2. Minimize treatment and cost

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2
Q

True or False: Caries is dichotomous.

A

True. Its two options (dichotomy), either yes or no

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3
Q

There is a continuum of caries from _______ which is hard to detect, to _______ which is clearly present.

A

incipient

advanced

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4
Q

Which method of caries detection is no longer good practice?

A

the explorer stick method

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5
Q

Why is the explorer stick method considered to be of bad practice?

A

sharp explorers can produce irreversible, traumatic defects in demineralized areas of occlusal surfaces

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6
Q

When is the explorer stick method ‘somewhat acceptable’?

A

If you already plan to restore the tooth and you’re feeling for general span

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7
Q

True or False: Black or brown staining is a reliable indicator that there is carious lesions underneath the enamel.

A

False: could just be stained

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8
Q

What are 4 (or 5) optimal conditions for visually examining and gently exploring a tooth with the probe?

A
  1. clean tooth
  2. dry tooth
  3. good light
  4. sharp probe (light touch!)
    5? Magnification
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9
Q

When observing the tooth, we look for ________, _______(whitespot), ________ (indicates deep caries), and _______ in the surface.

A

frank cavitation
decalcification
opalescence
discontinuities

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10
Q

How are whitespot lesions best detected?

A

by drying the tooth to look for a chalkiness that wasn’t previously seen. This is due to the refractive index of air being greater than water which is greater than tooth.

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11
Q

Use the probe _____ or not at all.

A

lightly!

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12
Q

What kind of radiography can be used to supplement visual tactile examination?

A

bitewing

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13
Q

Caries rates have declined for _______ lesions but increased for _______ caries.

A

smooth surface

fissure

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14
Q

What is a possible reason for the decline in overall caries rates?

A

pits and fissures are DIFFICULT to diagnose. This has become the predominant location of caries and many of them go undetected/unreported

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15
Q

Caries may be _____ progressing or may be _______. Measurement of _______ is appropriate.

A

slowly
arrested
progression

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16
Q

True or False: There is a set protocol for managing carious lesions.

A

False: there is a spectrum of opinion from highly aggressive to highly conservative

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17
Q

Someone with a “highly conservative” opinion on caries treatment would _________.

A

seal incipient decay and intact fissures

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18
Q

Someone with a “highly aggressive” opinion of caries treatment would ________.

A

excavate and enameloplasty (seal and restore)

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19
Q

True or False: It is thought that we may be overtreating.

A

True, many carious lesions can be remineralized

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20
Q

_______ relates to the reproducibility of measurements. Whereas ________ is the degree to which a measurement expresses the true value.

A

Reliability

Validity

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21
Q

If a group of dental students take a BP reading on the same person and they get a widely varying set of results. The measurements are not ________.

A

reliable

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22
Q

If a group of dental students uses a BP cuff that is too small and they all get the exact same wrong answer, the measurement is not _______.

A

valid

23
Q

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

A

sensitivity and specificity

24
Q

What is sensitivity?

A

the likelihood of saying that disease is present when it IS there (no false negatives)

25
Q

What is specificity?

A

the likelihood of saying that disease is absent when it IS absent (no false positives)
BE SPECIFIC: if it’s not there, tell me its not there!

26
Q

What are the treatment implications of sensitivity and specificity?

A

sensitivity is low = undertreating
specificity is low = overtreating
(don’t get “down” or “P.O”ed…just think! low sPecificity = Overtreat)

27
Q

Inter-observed agreement (reliability) is determined by measuring how often ______ answer is achieved by using a ______ statistical test.

A

the same
kappa

***remember that to be “reliable” it must be “reproducible”

28
Q

When using a visual examination method for caries detection, how do intra- and inter-examiner reliability numbers compare?

A

people agree with themselves ( good reliability for intra-) but they do not agree with each other (poor reliability for inter-)

29
Q

“Probing with an explorer” and “visual examination” have high ______ but low ________. What does this mean?

A

high specificity = NOT overtreating

low sensitivity = undertreating

30
Q

True or False: Evaluation of diagnostic methods for caries detection has shown that, in general, we are overtreating.

A

False: undertreating….remember it’s hard to detect fissure caries!!

31
Q

Radiographic diagnosis has high _____ and low ______.

A 
high specificity (its not there and you tell me its not)
low sensitivity (you may tell me its not there, but it is)
...its okay, radiographs are hard to read
32
Q

When evaluating radiographs for cavitation, when should teeth be restored vs when should they be remineralized?

A

Remineralize: lesions on radiograph extends into the outer half of enamel or the inner half of enamel.
Restore: lesion on radiograph extends into inner or outer half of dentin.

33
Q

True or False: Small lesions on radiographs are not likely to be cavitated.

A

True

34
Q

How can caries be “reversed?”

A

conservative methods such as fluoride treatment in conjunction with a total prevention program

35
Q

What are “perfect board lesions” and are they ethical?

A

lesions that are acceptable for filling during the national boards: radiographs can show penetration in the enamel and not yet extending into dentin. No this is not ethical. Only approximately 10% of these teeth are cavitated and should be remineralized

36
Q

True or False: Prior to sealing a tooth, you should remove any active caries.

A

False: if caries are present, the progression will be stopped by intact sealants because nutrients are blocked from reaching bacteria within the teeth

37
Q

After sealing an incompletely excavated carious lesion that extended into dentin, bacterial numbers were found to _______.

A 
significantly DECLINE
(aka: you don't have to clean it out before sealing)
38
Q

Operative intervention and restoration prior to sealing a tooth in order to avoid “hidden” caries could lead to ______.

A

substantial overtreatment and increased health care costs for patients….. submit patient to re-restoration cycle and ultimately compromise long-term tooth survival

39
Q

What are the two major concepts in management of small fissure lesions (they essentially balance each other out)?

A
  1. Diagnostic tests are not very sensitive (lesions are hard to detect)
  2. Minimal treatment is effective for incipient to moderate lesions (early detection may not change the treatment)
40
Q

What is the sensitivity and specificity of the “explorer stick” method for caries detection?

A

low sensitivity
high specificity
(doesn’t always catch the positives = undertreat)

41
Q

What is the sensitivity and specificity of “visual inspection” methods for caries detection?

A

low sensitivity
high specificity
(undertreat)

42
Q

Caries detection dyes have _____ sensitivity and ______ specificity.

A 
high sensitivity
low specificity (overtreatment due to staining of miscellaneous proteins; ex. DEJ gets stained)
43
Q

The KaVo Diagnodent Laser has high _____ and low ______.

A 
high sensitivity (detects absence of lesions well)
low specificity (false positives...over-diagnose)
44
Q

How far does the diagnodent laser penetrate?

A

2-3 mm

45
Q

The MidWest Caries I.D. Detection Handpiece (green and red lights) has ______ sensitivity and ______ specificity.

A 
high (positive when its there)
low specificity (also positive when its not there..false positives)
46
Q

The Inspektor Pro Caries Detection System monitors ______ _______.

A

Caries progression (over time)

47
Q

CarieScan PRO has high ______ but low _______.

A

sensitivity

low specificity

48
Q

What kind of technology may replace x-rays in the future due to higher sensitivity?

A

transillumination technology

49
Q

In what way is the Canary System better than radiographs?

A

[Canary=Laser system that measures luminescence and gives a number to reflect its state of mineralization and crystallization.]
Similar specificity to radiographs
BETTER SENSITIVITY

50
Q

How important is early detection?

A

Intact sealants block substrate and halt decay. If detection is late…its balanced by effective therapy (yay dentistry!)

51
Q

True or False: Microbiologic tests for risk assessment (saliva-check, CariScreen, and CRT) have been shown to accurately predict caries susceptibility.

A

False!

specificity is fine but sensitivity is low (false negatives)

52
Q

Most adjunctive tools for caries detection will give false ________except _______.

A

positives

Microbiologic tests = have low sensitivity

53
Q

In other words, normal methods for caries detection lead to ____-diagnosing; whereas, adjunctive tools lead to _____-diagnosing.

A

probing/visual- underdiagnose

adjunctive tools- overdiagnose

AU 15- Oral Micro (11 decks)

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