How do we classify/diagnose caries

Question 1

what are the different classifications of caries

Answer 1

extent
cavitation
activity
site
location

Question 2

how do we classify caries by extent

Answer 2

D1
(D2)
D3

Question 3

what is D1

Answer 3

all visually detectible lesions

Question 4

what do D1 lesions extend into

Answer 4

enamel

Question 5

what is D2 lesions

Answer 5

cavitated but limited to enamel

Question 6

what is D3 lesions

Answer 6

lesions extending into dentine. once the progression hits dentine it spreads

Question 7

what is the lowest level of caries

Answer 7

demineralization

Question 8

How do we classify caries by cavitation

Answer 8

cavitated

non cavitated

Question 9

what should we never do to a cavity and why

Answer 9

probe it with a sharp probe

if there is a micro cavity probing it as such will make it worse

Question 10

what type of probe should we use when probing a caivty

Answer 10

perioprobe or round ended probe

run it against the surface – if there is a defect then the probe will run into it.

Question 11

how can we classify caries by activity

Answer 11

active

inactive

Question 12

what is the appearance of an inactive lesion

Answer 12

once caries has a brown ‘leathery’ appearance it is arrested meaning it is remineralised caries.

Question 13

When can we leave caries and not restore it

Answer 13

if the lesion is accessible and cleanable then we can arrest it

Question 14

how do we classify caries by site

Answer 14

smooth surface
occlusal
root surface
approximal

Question 15

how do we classify caries by location

Answer 15

primary

secondary

Question 16

what is a secondary caries

Answer 16

adjacent to restoration

Question 17

how can we score caries

Answer 17

surfaces - each surface is considered separately

tooth - worst surface dictates tooth code

Question 18

what is accuracy

Answer 18

measure of what is claimed

Question 19

what is precision

Answer 19

consistency of the measurement

Question 20

what is sensitivity

Answer 20

% of disease found correctly

Question 21

what is the specificity

Answer 21

% of health found correctly

Question 22

what are the clinical examination basics

Answer 22

good light
dry the tooth
take your time
don’t use a sharp probe

Question 23

what is the sensitivity and specificity for a normal examination

Answer 23

sensitivity is low but specificity is high for both D1 and D3

Question 24

how can we improve accuracy

Answer 24

ICCMS
radiographs
magnification
FOTI

Question 25

what is ICCMS

Answer 25

we dry the tooth for 30 seconds and very carefully look at each surface

Question 26

what is the ICCMS sensitivity/specificity compared to a normal examination

Answer 26

sensitivity is higher

specificity is lower

Question 27

what is the advantage of radiographs

Answer 27

permanent record

Question 28

what are the disadvantages of radiographs

Answer 28

ionizing radiation

not good on all surfaces

Question 29

why is caries darker on radiographs

Answer 29

less mineral in tooth so more X-ray beams get through

Question 30

what is the sensitivity/specificty for approximal caries in bitewing radiographs

Answer 30

sensitivity is lower for D1 but higher for D3

specificity is lower

Question 31

what are the advantages of magnification

Answer 31

easy

cheap

Question 32

what is the disadvantages of magnification

Answer 32

takes getting used to

field of view is much smaller

Question 33

what is the specificity/accuracy for magnification

Answer 33

sensitivity is higher for D1 and D3 but not significantly for D3
specificity is higher

Question 34

what is the other techniques

Answer 34

fiberoptic transillumination
diagnodent
electrical techniques

Question 35

what is fibrooptic transillumination

Answer 35

it uses the principle of illuminating teeth to detect the presence of caries. The principle behind transilluminating teeth is that demineralized areas of enamel or dentine scatter light more than sound areas