Caries Diagnosis and Management Flashcards

1
Q

How is the explorer used to diagnosis caries

A

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

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2
Q

how does an explorer damage a tooth

A

using an explorer can produce irreversible traumatic defects in demineralized areas in occlusal fissures

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3
Q

what are the negatives of using an explorer to diagnosis caries

A

producing irreversible defects that can prevent repair of the lesion by remineralization and can help contribute to lesion progression

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4
Q

what is the optimal way to visually probe

A

clean dry tooth, good light, sharp probe using magnification with light strokes across surface

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5
Q

what do you observe for when probing for caries

A

frank cavitation , white spots, opalescence (deep caries), and discontinuities in surface

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6
Q

is black or brown staining a reliable indicator for caries?

A

NOO- have to see chalky whiteness around caries to diagnose it as a carious lesion

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7
Q

what can be used to supplement visual tactile exam for caries

A

radiography

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8
Q

caries rate are ____ and becoming a greater fraction of what kind of caries

A

caries rates are DEC

becoming more fissure caries

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9
Q

are all caries irreversible?

A

NO! some caries can be biologically reversed

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10
Q

cavitation is easily recognized but some caries can be ____

A

some caries can be slowly progressing or arrested

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11
Q

what is the aggressive caries management

A

exploratory, excavation and enameloplasty seal and restore

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12
Q

what is the moderate caries management

A

seal deep fissures and excavate and seal/ restore chalky or soft enamel

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13
Q

what is the conservative approach to caries management

A

seal incipient decay and intact fissures

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14
Q

what is reliability

A

reliability is the reproducibility of measurements

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15
Q

what is validity

A

validity is how accurate a measurement is, the degree of a measurement to its true value

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16
Q

what is the gold standard for validity in caries diagnosis but it can NOT Be used in the mouth?

A

a histologic exam

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17
Q

what is sensitivity

A

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

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18
Q

what is specificity

A

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

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19
Q

low specificity would lead to what

A

overtreating

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20
Q

low sensitivity would lead to what

A

undertreating

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21
Q

we want what for diagnostic tests

A

HIGH specificity and HIGH sensitivity

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22
Q

how is reliability determined

A

by measuring how often the same answer is achieved using a app stat test

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23
Q

what is a good measurement for reliability?

what would be bad reliability?

A

good= .4-1
bad= less than .4
excellent =.75
perfect= 1

24
Q

diagnosis of fissure caries has what specificity? what sensitivity? what reliability?
what helps diagnosis of fissure caries?

A
diagnosis of fissure caries 
LOW sensitivity
HIGH specificity 
less than excellent reliability
radiographs are helpful
25
what is the consensus for diagnosing fissure caries
visual inspection with appropriate radiographs
26
if you see a small lesion on a radiograph is it likely to be cavitated?
NO!
27
how to you treat small lesions
try to reverse them by conservative methods such as F treatment with prevention program
28
what do studies show about sealing in fissure caries
no evidence for dec viable bacteria, or dec in progression of lesions in fissure caries
29
what do sealing fissure caries do
blocks nutrients from reaching bacteria within fissure
30
10 year radiographs of sealed lesions showed what
no progression of carious lesions
31
when you incompletely excavate and then seal a carious dentin lesion what happens to bacteria?
Bacteria numbers DEC!
32
has simply sealing in cavitated lesions been successful for a period of years?
yes!!
33
exploratory operative intervention and restoration has been shown to caused what
substantial overtreatment
34
What is a myth not supported by science?
hidden sealed caries will progress -- not true
35
what must restorations be to prevent caries?
restoration margins must be sealed and restoration must be mechanically supported!
36
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
37
explorer does not stick means what
no caries
38
early enamel lesion with explorer has what characteristics
low sensitivity HIGH specificity damage can occur
39
visual inspection of enamel lesion has what
LOW sensitivity | HIGH specificity
40
what do intact sealants do to decay
blocks substrate and halts decay
41
caries detection dyes
non specific protein dyes staining organic matrix of less mineralized dentin
42
Sense and Spec of caries dyes
Good Sensitivity | BAD specificity = a lot of false positives at DEJ and circumpulpal
43
KaVO DIAGNOdent laser
655 nm diode laser, detects fluorescence from demineralized enamel
44
Diagnodent laser spec and sense
Diagnodent has HIGH sensitivity- detects small lesions and reliably established BUT LOW specificity - false positives
45
what does diagnodent measure
degree and intensity of demineralization penetrates about 2-3 mm but DOES NOT measure depth of lesion
46
does air abrasion improve success rates of sealants?
NO
47
does sealing over lesions halt decay?
YES
48
Midwest Caries ID detection handpiece
Green, red light, receiving fiber. When green light is deflected by demineralized enamel red light and audible signal activated
49
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
50
GLF utility:
HIGH SENSITIVITY - find hidden caries, reliable for determining absence of disease. tracks lesion over time
51
cariescan pro-
low specificity high sensitivity focus on mineralized tissue and electrical conductivity of fluid - less mineralized is more electrical flow
52
transillumination
more sensitive than radiograph
53
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
54
Saliva Check mutans test strip
not good risk predictors on an individual basis same as CRT caries risk test
55
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
56
What are new caries diagnostic tools good for?
They are adjunctive tools to be used if you want but they are inaccurate and unreliable