Caries Diagnosis and Management Flashcards
How is the explorer used to diagnosis caries
use explorer to feel for soft areas in enamel by breaking surface with probe can be done with poor light on wet uncleaned tooth. describing as attacking the tooth
how does an explorer damage a tooth
using an explorer can produce irreversible traumatic defects in demineralized areas in occlusal fissures
what are the negatives of using an explorer to diagnosis caries
producing irreversible defects that can prevent repair of the lesion by remineralization and can help contribute to lesion progression
what is the optimal way to visually probe
clean dry tooth, good light, sharp probe using magnification with light strokes across surface
what do you observe for when probing for caries
frank cavitation , white spots, opalescence (deep caries), and discontinuities in surface
is black or brown staining a reliable indicator for caries?
NOO- have to see chalky whiteness around caries to diagnose it as a carious lesion
what can be used to supplement visual tactile exam for caries
radiography
caries rate are ____ and becoming a greater fraction of what kind of caries
caries rates are DEC
becoming more fissure caries
are all caries irreversible?
NO! some caries can be biologically reversed
cavitation is easily recognized but some caries can be ____
some caries can be slowly progressing or arrested
what is the aggressive caries management
exploratory, excavation and enameloplasty seal and restore
what is the moderate caries management
seal deep fissures and excavate and seal/ restore chalky or soft enamel
what is the conservative approach to caries management
seal incipient decay and intact fissures
what is reliability
reliability is the reproducibility of measurements
what is validity
validity is how accurate a measurement is, the degree of a measurement to its true value
what is the gold standard for validity in caries diagnosis but it can NOT Be used in the mouth?
a histologic exam
what is sensitivity
sensitivity is the proportion of people with a disease who have a positive test result
how likely we are to say disease is present when it actually is there
so low= lots of false negatives
what is specificity
specificity is how likely we are to say a disease is not present when in fact it is NOT present
proportion of people who have a negative test result
SO low - lots of false positives
low specificity would lead to what
overtreating
low sensitivity would lead to what
undertreating
we want what for diagnostic tests
HIGH specificity and HIGH sensitivity
how is reliability determined
by measuring how often the same answer is achieved using a app stat test
what is a good measurement for reliability?
what would be bad reliability?
good= .4-1
bad= less than .4
excellent =.75
perfect= 1
diagnosis of fissure caries has what specificity? what sensitivity? what reliability?
what helps diagnosis of fissure caries?
diagnosis of fissure caries LOW sensitivity HIGH specificity less than excellent reliability radiographs are helpful
what is the consensus for diagnosing fissure caries
visual inspection with appropriate radiographs
if you see a small lesion on a radiograph is it likely to be cavitated?
NO!
how to you treat small lesions
try to reverse them by conservative methods such as F treatment with prevention program
what do studies show about sealing in fissure caries
no evidence for dec viable bacteria, or dec in progression of lesions in fissure caries
what do sealing fissure caries do
blocks nutrients from reaching bacteria within fissure
10 year radiographs of sealed lesions showed what
no progression of carious lesions
when you incompletely excavate and then seal a carious dentin lesion what happens to bacteria?
Bacteria numbers DEC!
has simply sealing in cavitated lesions been successful for a period of years?
yes!!
exploratory operative intervention and restoration has been shown to caused what
substantial overtreatment
What is a myth not supported by science?
hidden sealed caries will progress – not true
what must restorations be to prevent caries?
restoration margins must be sealed and restoration must be mechanically supported!
what are the two concepts in management of small fissure lesions?
diagnostic tests are low sensitivity (incipient lesions hard to detect)
minimal treatment is effective for incipient and moderate lesions
explorer does not stick means what
no caries
early enamel lesion with explorer has what characteristics
low sensitivity
HIGH specificity
damage can occur
visual inspection of enamel lesion has what
LOW sensitivity
HIGH specificity
what do intact sealants do to decay
blocks substrate and halts decay
caries detection dyes
non specific protein dyes staining organic matrix of less mineralized dentin
Sense and Spec of caries dyes
Good Sensitivity
BAD specificity = a lot of false positives at DEJ and circumpulpal
KaVO DIAGNOdent laser
655 nm diode laser, detects fluorescence from demineralized enamel
Diagnodent laser spec and sense
Diagnodent has HIGH sensitivity- detects small lesions and reliably established
BUT LOW specificity - false positives
what does diagnodent measure
degree and intensity of demineralization penetrates about 2-3 mm but DOES NOT measure depth of lesion
does air abrasion improve success rates of sealants?
NO
does sealing over lesions halt decay?
YES
Midwest Caries ID detection handpiece
Green, red light, receiving fiber. When green light is deflected by demineralized enamel red light and audible signal activated
Inspektor pro caries detection system
expensive time consuming monitors caries progression uses fluorescence to detect early lesions and monitored over time by detection of bacterial activity
GLF utility:
HIGH SENSITIVITY - find hidden caries, reliable for determining absence of disease. tracks lesion over time
cariescan pro-
low specificity
high sensitivity
focus on mineralized tissue and electrical conductivity of fluid - less mineralized is more electrical flow
transillumination
more sensitive than radiograph
Canary system
luminescence and heat used to create a canary number related to state of demineralization detects up to 5 mm from tooth
compared to radiographs better sensitivity and equal specificity
Saliva Check mutans test strip
not good risk predictors on an individual basis same as CRT caries risk test
Cariscreen caries suscpetibility test
claims to detect level of acid producing bacteria in a individuals plaque
NO evidence! NOT diagnostically useful
LOW sensitivity
Good specificity
What are new caries diagnostic tools good for?
They are adjunctive tools to be used if you want but they are inaccurate and unreliable
