Caries Diagnosis & Detection Flashcards
Scope of practice laid out by GDC
Carry out a clinical examination within their competence
Diagnose and treatment plan within their competence
Prescribe radiographs, take, process, and interpret various film views used in general dental practice
Plan the delivery of care for patients
Learning outcomes
Prepare students for clinical practice
Classify and describe clinical appearance of carious lesions
Understand and apply diagnostic methods of caries detection
Any diagnostic test carried out need to be..
Valid and reliable
Visual exam requirements
- requires good lightning
- dry clean tooth
- loupes if preferred
- investigation with a probe is not recommended and may cause cavitation if pressed into early lesion to see if its sticky
- wedges / separators for proximal surface
- take verbal history - sh, dh, mh + oral hygiene prior to carrying out any exam
Apart from a visual exam, how else can we diagnose / detect caries?
Radiographic exam
How is a radiographic exam carried out?
Radiographs are taken following clinical examination and need to be justified and taken in accordance with the current guidelines
Which type of radiograph is used?
What are the limitations?
Bitewings are most commonly used to help confirm the presence of caries, however their use has limitations -
- occlusal and buccal caries is difficult to detect in radiographs unless more than 2-3mm deep into dentine or 1/3 of the bucco-lingual distance
- not as good for occlusal/buccal surfaces, parallel technique (contact points)
- a certain amount of demineralisation of the tooth tissue has to have occurred for the lesion to be detected on the radiographs - this becomes increasingly important if lesions appear close to the pulp chamber
Radiographs of permanent dentition
- can clinically detect more enamel lesions than radiographically
- radiographs are more important in diagnosis of proximal carious lesions
Less frequently used caries detection aids - Transillumination
Transillumination
- assists diagnosis of approximately caries
- technique consists of shinning light through contact points
- carious lesion has low index of light transmission and appears as dark shadow
- Anterior - light reflected though teeth using dental mirror
- Posterior - stronger light needed (ie, fibrotic)
Transillumination disadvantages
Not so good for small lesions can only detect large lesions
Less frequently used caries detection aids - Detector dyes
Detector dyes
- usually 0.5% basic fushsin or 1% acid red
- claimed to aid discrimination between infected and uninflected dentine
Disadvantages of detector dyes
- unable to discriminate between infected and demineralised (but uninfected) dentine
- food debris in fissures may also be stained and may result in unnecessary removal of tooth substance
Less frequently used caries detection aid - electrical resistance
Measures the electrical resistance between the tooth surface and the tissue
Resistance values are site specific and they undergo post eruptive changes in normal teeth
Values depend on the porosity of the tooth surface and the contact medium (wet or dry) and temperature
Electrical resistance disadvantages
Calibration is difficult
The results need careful interpretation and can lead to false positive ratings
What are the treatment options when caries is diagnosed?
Indices that can aid with caries management -
ICDAS - international caries detection and assessment system
- allows clinician to clinically examine the tooth surface and appreciate the underlying damage that has been caused
Iceberg of dental caries
- diagnostic threshold determines what is recorded as disease or sound
ICDAS Code 0-6
0 - Sound tooth surface: no evidence of caries after 5 sec air drying
1 - Visual change in enamel: opacity / discolouration (white/brown) visible at entrance to pit/fissure after prolonged air drying
2 - Distinct visual change in enamel visible when wet, lesion must be visible when dry
3 - localised enamel breakdown (without clinical visual signs of dentinal involvement) seen wet and after prolonged drying
4 - Underlying dark shadow from dentine
5 - Distinct cavity with visible dentine
6 - Extensive (more than half the surface) distinct cavity with visible dentine
The iceberg of dental caries - diagnostic thresholds in clinical trials and practice
What does diagnostic threshold determine?
What is recorded as ‘diseased’ or ‘sound’
The iceberg of dental caries - diagnostic thresholds in clinical trials and practice
D1 - Clinically detectable enamel lesions with ‘intact’ surfaces
D2 - Clinically detectable ‘cavities’ in enamel
D3 - Threshold used in classical clinical trials and in survey examinations
D4 - lesions into pulp
Classifying and recognising caries by…
Classify caries according to
1. the surface affected
2. stage of the lesion
3. along the cervical margins of the tooth - root caries
4. around existing restorations - can be classified as recurrent or secondary caries
What is residual caries?
Demineralised tissue left before filling is placed
Radiation caries as a result of..
Head and neck radiotherapy
Rampant / Gross caries of the mouth
Arrested with some areas of activity
Can also classify caries according to caries activity
Concept of activity is very important as it directly affects the management of a lesion as active lesions require active management
Active carious lesions are progressive / orange / brown / soft
Arrested or inactive caries are…
Formed earlier and then stopped (arrested) / dark brown / black / hard / leathery
Due to..
- habits change
- pt stop eating / drinking sugary food
- cavity that has broken down and becomes more self cleansing
