Caries Diagnosis and Management

Question 1

T/F - Caries is a dichotomous disease (yes/no)

Answer 1

False - it is a continuum from incipient to advanced

Question 2

What is the most common method for caries diagnosis?

Answer 2

Explorer

Question 3

What are you looking for when using an explorer to search for caries?

Answer 3

Feel for soft areas in enamel by breaking the surface with a probe
Can be done with poor light, on a wet, uncleaned tooth

Question 4

What is a negative possibility when using an explorer to search for caries?

Answer 4

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

Question 5

What are the optimal conditions to look for caries?

Answer 5

Clean tooth
Dry tooth
Good light
Sharp probe with a light touch
Magnification

Question 6

What are we looking for when using a probe to search for caries?

Answer 6

Frank cavitation
Decalcificaiton (white spot)
Opalescence (deep caries)
Discontinuities in the surface

Question 7

T/F - Black or brown staining is a reliable indicator of caries

Answer 7

False

Question 8

How can bitewing radiographs be used to look for caries?

Answer 8

They can supplement visual tactile exam

Question 9

Caries rates have declined over the last several years, what types of caries specifically?

Answer 9

Smooth surface caries - shift in prominence to fissure caries (which is more difficult to diagnose)

Question 10

Why is the measurement of progression of caries necessary?

Answer 10

Cavitation is easily recognized, but incipient or early caries is much more difficult
Caries may be slowly progressing and may be arrested

Question 11

What is the spectrum on how early lesions should be managed?

Answer 11

Highly aggressive –> Seal deep fissures and seal chalky or soft enamel –> Highly conservative

Question 12

Highly aggressive management

Answer 12

“Exploratoy” excavation and enameloplasty

Seal/restore

Question 13

Highly conservative management

Answer 13

Seal incipient decay and intact fissures

Question 14

Reliability

Answer 14

Relates to the reproducibility of measurements

Question 15

Validity

Answer 15

The degree to which a measurement expresses the true value

Question 16

Sensitivity

Answer 16

How likely we are to say disease is present when it is truly there
Perfect sensitivity = no false negatives

Question 17

Specificity

Answer 17

How likely we are to say disease is absent when it’s not there
Perfect specificity = no false positives

Question 18

What are the treatment implications of low sensitivity?

Answer 18

Low sensitivity can lead to under treatment

Question 19

What are the treatment implications of low specificity?

Answer 19

Low specificity can lead to over treatment

Question 20

T/F - the accuracy of probing and visual inspection of caries is similar

Answer 20

True

Question 21

What is the diagnostic accuracy of probing and visual inspection of caries?

Answer 21

Sensitivity low (very difficult)
Specificity high (seldom have false positives)
Reliability is less than excellent
Radiographs are helpful

Question 22

What is the preferred suggested method to detect fissure caries?

Answer 22

Visual inspection augmented with appropriate radiographs

Question 23

What types of lesions are the easiest to see via radiographs? Which are the most difficult?

Answer 23

Easiest = cavitated lesions
Hardest = enamel lesions

Question 24

Are small lesions likely to be cavitated?

Answer 24

No - we may want to consider trying to reverse them by conservative methods

Question 25

What happens to lesions under sealants?

Answer 25

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

Question 26

What happens if hidden caries are "sealed in"?

Answer 26

They can't do anything

Question 27

Exploratory operative intervention and restoration

Answer 27

Undertaken to avoid the risk of "hidden" caries | Could lead to substantial overtreatment

Question 28

If the probe does not stick, what can we determine?

Answer 28

No caries

Question 29

What happens if you apply too much pressure while using a probe to detect caries?

Answer 29

Probe can stick and cause cavitation

Question 30

Caries detection dye

Answer 30

Non-specific protein dyes that stain organic matrix of less mineralized dentin Can give us false positives at the DEJ and circumpulpal regions

Question 31

KaVo DIAGNOdent laser

Answer 31

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)

Question 32

What can the DIAGNOdent laser respond to (and can potentially give false positives)

Answer 32

``` 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) ```

Question 33

How would you scan the fissure using the DIAGNOdent?

Answer 33

Rotate the tip around to "read" the fissure walls

Question 34

INSPEKTOR PRO Caries detection system

Answer 34

Research instrument Monitors caries progression Expensive Time-consuming

Question 35

Midwest Caries ID Detection Handpiece

Answer 35

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

Question 36

QLF Utility

Answer 36

Tracks lesions over time to locate active caries and remineralization Expensive and time consuming research tool High sensitivity Low specificity

Question 37

CarieScan PRO

Answer 37

Less mineralized tissue contains more fluid and has greater electrical conductivity Sensitivity is high

Question 38

Transillumination technology

Answer 38

Visible light illumination and computer imaging | Research suggests it's more sensitive that radiography

Question 39

DEXIS CariVu

Answer 39

Utilizes near infra-red light | Images are captured to DEXIS system

Question 40

The Canary System

Answer 40

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

Question 41

How important is early detection of fissure caries?

Answer 41

If we detect it early, we can seal it | Late detection is balanced y effective therapy

Question 42

What are some microbiologic tests for risk assessment?

Answer 42

Saliva-check mutans CariScren susceptibility test CRT (caries risk test)

Question 43

Saliva-check mutans Test strip

Answer 43

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

Question 44

CRT (Caries Risk Test)

Answer 44

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

Question 45

CariScreen Caries Susceptibility Test

Answer 45

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