Caries Diagnosis and Management

Question 1

Good diagnosis and treatment planning should produce a good outcome for the patient. How so?

Answer 1

disease controlled

treatment and costs are minimized

Question 2

Caries is not ___ but a continuum from incipient (hard to detect to advance (clearly present).

Answer 2

dichotomous

Question 3

An explorer stick feels for ___ areas in enamel by breaking surface with ___. It can be done with poor light on ___, ___ tooth. It has been described as “attacking tooth with explorer.”

Answer 3

soft; probe; wet; uncleaned

Question 4

T/F. Use of sharp explorers can produce reversible trauma defects in demineralized areas in occlusal fissures.

Answer 4

False, Use of sharp explorers can produce IRREVERSIBLE trauma defects in demineralized areas in occlusal fissures.

Question 5

Damage from explorer use could prevent repair of the lesion by ___ and contribute to ___ progression.

Answer 5

remineralization; lesion

Question 6

What are the optimal visual exam and gentle exploration with probe conditions?

Answer 6

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

Question 7

What should one observe for when probing?

Answer 7

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

Question 8

Are black or brown staining reliable indicators of caries?

Answer 8

No, need chalky whiteness around stain to equal caries

Question 9

What type of radiography can supplement visual tactile exam?

Answer 9

bitewing radiography

Question 10

What type of lesions are seeing a decline in caries rates? What has this lead to?

Answer 10

smooth surface lesions

Shift to predominance of fissure caries

Question 11

Is the diagnosis of fissure caries or smooth surface caries more difficult?

Answer 11

fissure caries

Question 12

___ is easily recognized but ___ or early caries is much more difficult.

Answer 12

Cavitation; incipient

Question 13

T/F. Caries may be slowly progressing, and may be arrested. Measurement of progression is appropriate.

Answer 13

True.

Question 14

Match

1. highly conservative
2. Middle
3. Highly aggressive

A - “exploratory” excavation and enameloplasty, seal/restore
B - seal deep fissures and excavate and seal/restore chalky or soft enamel
C - seal incipient decay and intact fissures

Answer 14

1 - C
2 - B
3 - A

Question 15

___ relates to the reproducibility of measurements

Answer 15

Reliability

Question 16

If new dental students get widely varying results from taking blood pressure readings, these measurements are not ___.

Answer 16

reliable

Question 17

___ is the degree to which a measurement expresses the true value.

Answer 17

validity

Question 18

If new dental students get the same number of results from taking blood pressure readings on the same large adult using a small-size cuff, these measurements are not ___.

Answer 18

valid

Question 19

For validity in caries diagnosis, a ___ exam is the accepted reference test or “gold standard,” but it cannot be used in the mouth! What do we use in the mouth?

Answer 19

histological

????

Question 20

___ is how likely we are to say disease is present when it’s there.

Answer 20

Sensitivity

The proportion of people/teeth with caries who have a positive test result

Question 21

Sensitivity = ? What does perfect sensitivity =?

Answer 21

sensitivity = a / (a + c)

Perfect sensitivity = 100% (no false negatives)

Question 22

___ is how likely we are to say disease is absent when it’s not there.

Answer 22

Specificity

The proportion of healthy people who have a negative test result

Question 23

Specificity = ? What does perfect specificity =?

Answer 23

Specificity = d / (b + d)

Perfect specificity = 100% (no false positives)

Question 24

Inter-observed agreement (___) is determined by measuring how often the same answer is achieved using a ___ statistical test

Answer 24

reliability; kappa

Question 25

What is the diagnosis of fissure caries?

Answer 25

• diagnostic accuracy of probing and visual inspection similar
• sensitivity low
• specificity high
• reliability less than excellent
• radiography helpful

Question 26

What is the method of choice for diagnosis of fissure caries?

Answer 26

routine clinical examination, visual inspection augmented with appropriate radiographs

Question 27

Are small lesions on radiographs likely to be cavitated?

Answer 27

No

Question 28

T/F. Studies show decrease in viable microorganisms in lesions under intact sealants, and caries progression is negligible.

Answer 28

True. Effects result from blocking nutrients from reaching bacteria within the teeth

Question 29

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

Answer 29

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)