Caries Diagnosis and Management Flashcards
T/F - Caries is a dichotomous disease (yes/no)
False - it is a continuum from incipient to advanced
What is the most common method for caries diagnosis?
Explorer
What are you looking for when using an explorer to search for caries?
Feel for soft areas in enamel by breaking the surface with a probe
Can be done with poor light, on a wet, uncleaned tooth
What is a negative possibility when using an explorer to search for caries?
Use of sharp explorers can produce irreversible traumatic defects in demineralized areas in occlusal fissures
This could prevent repair of the lesion by remineralization and contribute to lesion progression
What are the optimal conditions to look for caries?
Clean tooth Dry tooth Good light Sharp probe with a light touch Magnification
What are we looking for when using a probe to search for caries?
Frank cavitation
Decalcificaiton (white spot)
Opalescence (deep caries)
Discontinuities in the surface
T/F - Black or brown staining is a reliable indicator of caries
False
How can bitewing radiographs be used to look for caries?
They can supplement visual tactile exam
Caries rates have declined over the last several years, what types of caries specifically?
Smooth surface caries - shift in prominence to fissure caries (which is more difficult to diagnose)
Why is the measurement of progression of caries necessary?
Cavitation is easily recognized, but incipient or early caries is much more difficult
Caries may be slowly progressing and may be arrested
What is the spectrum on how early lesions should be managed?
Highly aggressive –> Seal deep fissures and seal chalky or soft enamel –> Highly conservative
Highly aggressive management
“Exploratoy” excavation and enameloplasty
Seal/restore
Highly conservative management
Seal incipient decay and intact fissures
Reliability
Relates to the reproducibility of measurements
Validity
The degree to which a measurement expresses the true value
Sensitivity
How likely we are to say disease is present when it is truly there
Perfect sensitivity = no false negatives
Specificity
How likely we are to say disease is absent when it’s not there
Perfect specificity = no false positives
What are the treatment implications of low sensitivity?
Low sensitivity can lead to under treatment
What are the treatment implications of low specificity?
Low specificity can lead to over treatment
T/F - the accuracy of probing and visual inspection of caries is similar
True
What is the diagnostic accuracy of probing and visual inspection of caries?
Sensitivity low (very difficult)
Specificity high (seldom have false positives)
Reliability is less than excellent
Radiographs are helpful
What is the preferred suggested method to detect fissure caries?
Visual inspection augmented with appropriate radiographs
What types of lesions are the easiest to see via radiographs? Which are the most difficult?
Easiest = cavitated lesions Hardest = enamel lesions
Are small lesions likely to be cavitated?
No - we may want to consider trying to reverse them by conservative methods
What happens to lesions under sealants?
Studies show a decrease in viable microorganisms under intact sealants and caries progression is negligible
The effect results in blocking nutrients from reaching bacteria within the teeth
What happens if hidden caries are “sealed in”?
They can’t do anything
Exploratory operative intervention and restoration
Undertaken to avoid the risk of “hidden” caries
Could lead to substantial overtreatment
If the probe does not stick, what can we determine?
No caries
What happens if you apply too much pressure while using a probe to detect caries?
Probe can stick and cause cavitation
Caries detection dye
Non-specific protein dyes that stain organic matrix of less mineralized dentin
Can give us false positives at the DEJ and circumpulpal regions
KaVo DIAGNOdent laser
655 nm laser - penetrates 2-3 mm
Detects fluorescence form demineralized enamel
Readings are related to degree and intensity of demineralization (not depth of the lesion)
Low specificity (false positives)
High sensitivity (few false negatives)
What can the DIAGNOdent laser respond to (and can potentially give false positives)
Decalcified enamel (caries) Hypocalcified enamel High natural fluorescence of the tooth Plaque and organic plug Composite and stained margins Calculus Prophy paste (particularly green) Food (particularly greens)
How would you scan the fissure using the DIAGNOdent?
Rotate the tip around to “read” the fissure walls
INSPEKTOR PRO Caries detection system
Research instrument
Monitors caries progression
Expensive
Time-consuming
Midwest Caries ID Detection Handpiece
Has green and red LED lights with a receiving fiber
When green light is deflected by demineralized enamel, red light and audible signal is activated
QLF Utility
Tracks lesions over time to locate active caries and remineralization
Expensive and time consuming research tool
High sensitivity
Low specificity
CarieScan PRO
Less mineralized tissue contains more fluid and has greater electrical conductivity
Sensitivity is high
Transillumination technology
Visible light illumination and computer imaging
Research suggests it’s more sensitive that radiography
DEXIS CariVu
Utilizes near infra-red light
Images are captured to DEXIS system
The Canary System
Laser system that measures:
-luminescence
-heat
Creates a “Canary Number” to reflect stat of mineralization and crystalization
Detects up to 5mm from the surface and as small as 50 um
Good for proximal caries
How important is early detection of fissure caries?
If we detect it early, we can seal it
Late detection is balanced y effective therapy
What are some microbiologic tests for risk assessment?
Saliva-check mutans
CariScren susceptibility test
CRT (caries risk test)
Saliva-check mutans Test strip
Immunochromatography test that contains monoclonial antibodies that detect strep mutans
Evidence: Strep Mutans tests have not been shown to be good risk predictors on an individual basis
CRT (Caries Risk Test)
CRT bacteria: cultivated for S mutans and lactobacilli can get results in 2 days
CRT buffer: dipstick test for salivary buffering capacity can get results in 5 minutes
Evidence is limited
CariScreen Caries Susceptibility Test
1-minute chair-side bacterial test that measures ATP bioluminescence
Claims to detect levels of acid-producing bacteria residing in an individual’s plaque and assess patient’s caries risk
Evidence is very limited
Sensitivity is low
Specificity appears good
