Caries Diagnosis and Management

Question 1

How is the explorer used to diagnosis caries

Answer 1

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

Question 2

how does an explorer damage a tooth

Answer 2

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

Question 3

what are the negatives of using an explorer to diagnosis caries

Answer 3

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

Question 4

what is the optimal way to visually probe

Answer 4

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

Question 5

what do you observe for when probing for caries

Answer 5

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

Question 6

is black or brown staining a reliable indicator for caries?

Answer 6

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

Question 7

what can be used to supplement visual tactile exam for caries

Answer 7

radiography

Question 8

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

Answer 8

caries rates are DEC

becoming more fissure caries

Question 9

are all caries irreversible?

Answer 9

NO! some caries can be biologically reversed

Question 10

cavitation is easily recognized but some caries can be ____

Answer 10

some caries can be slowly progressing or arrested

Question 11

what is the aggressive caries management

Answer 11

exploratory, excavation and enameloplasty seal and restore

Question 12

what is the moderate caries management

Answer 12

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

Question 13

what is the conservative approach to caries management

Answer 13

seal incipient decay and intact fissures

Question 14

what is reliability

Answer 14

reliability is the reproducibility of measurements

Question 15

what is validity

Answer 15

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

Question 16

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

Answer 16

a histologic exam

Question 17

what is sensitivity

Answer 17

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

Question 18

what is specificity

Answer 18

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

Question 19

low specificity would lead to what

Answer 19

overtreating

Question 20

low sensitivity would lead to what

Answer 20

undertreating

Question 21

we want what for diagnostic tests

Answer 21

HIGH specificity and HIGH sensitivity

Question 22

how is reliability determined

Answer 22

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

Question 23

what is a good measurement for reliability?

what would be bad reliability?

Answer 23

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

Question 24

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

Answer 24

diagnosis of fissure caries 
LOW sensitivity
HIGH specificity 
less than excellent reliability
radiographs are helpful

Question 25

what is the consensus for diagnosing fissure caries

Answer 25

visual inspection with appropriate radiographs

Question 26

if you see a small lesion on a radiograph is it likely to be cavitated?

Answer 26

NO!

Question 27

how to you treat small lesions

Answer 27

try to reverse them by conservative methods such as F treatment with prevention program

Question 28

what do studies show about sealing in fissure caries

Answer 28

no evidence for dec viable bacteria, or dec in progression of lesions in fissure caries

Question 29

what do sealing fissure caries do

Answer 29

blocks nutrients from reaching bacteria within fissure

Question 30

10 year radiographs of sealed lesions showed what

Answer 30

no progression of carious lesions

Question 31

when you incompletely excavate and then seal a carious dentin lesion what happens to bacteria?

Answer 31

Bacteria numbers DEC!

Question 32

has simply sealing in cavitated lesions been successful for a period of years?

Answer 32

yes!!

Question 33

exploratory operative intervention and restoration has been shown to caused what

Answer 33

substantial overtreatment

Question 34

What is a myth not supported by science?

Answer 34

hidden sealed caries will progress – not true

Question 35

what must restorations be to prevent caries?

Answer 35

restoration margins must be sealed and restoration must be mechanically supported!

Question 36

what are the two concepts in management of small fissure lesions?

Answer 36

diagnostic tests are low sensitivity (incipient lesions hard to detect)
minimal treatment is effective for incipient and moderate lesions

Question 37

explorer does not stick means what

Answer 37

no caries

Question 38

early enamel lesion with explorer has what characteristics

Answer 38

low sensitivity
HIGH specificity
damage can occur

Question 39

visual inspection of enamel lesion has what

Answer 39

LOW sensitivity

HIGH specificity

Question 40

what do intact sealants do to decay

Answer 40

blocks substrate and halts decay

Question 41

caries detection dyes

Answer 41

non specific protein dyes staining organic matrix of less mineralized dentin

Question 42

Sense and Spec of caries dyes

Answer 42

Good Sensitivity

BAD specificity = a lot of false positives at DEJ and circumpulpal

Question 43

KaVO DIAGNOdent laser

Answer 43

655 nm diode laser, detects fluorescence from demineralized enamel

Question 44

Diagnodent laser spec and sense

Answer 44

Diagnodent has HIGH sensitivity- detects small lesions and reliably established
BUT LOW specificity - false positives

Question 45

what does diagnodent measure

Answer 45

degree and intensity of demineralization penetrates about 2-3 mm but DOES NOT measure depth of lesion

Question 46

does air abrasion improve success rates of sealants?

Answer 46

NO

Question 47

does sealing over lesions halt decay?

Answer 47

YES

Question 48

Midwest Caries ID detection handpiece

Answer 48

Green, red light, receiving fiber. When green light is deflected by demineralized enamel red light and audible signal activated

Question 49

Inspektor pro caries detection system

Answer 49

expensive time consuming monitors caries progression uses fluorescence to detect early lesions and monitored over time by detection of bacterial activity

Question 50

GLF utility:

Answer 50

HIGH SENSITIVITY - find hidden caries, reliable for determining absence of disease. tracks lesion over time

Question 51

cariescan pro-

Answer 51

low specificity
high sensitivity
focus on mineralized tissue and electrical conductivity of fluid - less mineralized is more electrical flow

Question 52

transillumination

Answer 52

more sensitive than radiograph

Question 53

Canary system

Answer 53

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

Question 54

Saliva Check mutans test strip

Answer 54

not good risk predictors on an individual basis same as CRT caries risk test

Question 55

Cariscreen caries suscpetibility test

Answer 55

claims to detect level of acid producing bacteria in a individuals plaque
NO evidence! NOT diagnostically useful
LOW sensitivity
Good specificity

Question 56

What are new caries diagnostic tools good for?

Answer 56

They are adjunctive tools to be used if you want but they are inaccurate and unreliable