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BDS 2: Preparing for Patients > L12 Diagnosis of Dental Caries > Flashcards

L12 Diagnosis of Dental Caries Flashcards

1
Q

What is the difference between symptoms and signs?

A
  • Symptoms: manifestations of disease apparent to the patient (presenting complaint)
  • Signs: manifestations of disease detected by the clinician
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2
Q

What are the main 5 stages of caries detection?

A

1) Record patient history, PCO, risk factors
2) Extra-oral exam
3) Intra-oral exam
4) Visual-tactile examination of the teeth
5) Special investigation (e.g. radiogrpahs, sensibility testing, percussion test)

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3
Q

What risk factors for caries should be identified?

A
  • Dietary habits
  • Social and medical history
  • Plaque control
  • Saliva flow rate, buffering capacity and composition
  • Caries history
  • Restorative history
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4
Q

What symptoms may a caries patient present with?

A
  • Symptom free (not uncommon)
  • Symptoms of acute pulpitis (reversible or irreversible)
  • Tender to percussion (TTP)
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5
Q

What are the symptoms of reversible pulptitis?

A
  • Short, sharp pain
  • Stimulated by sweet, cold or hot
  • Lasts a few seconds
  • Tooth not TTP
  • Sensibility tests may have exaggerated response
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6
Q

What are the symptoms of irreversible pulptitis?

A
  • Dull, throbbing pain
  • Pain is spontaneous or exacerbated by sweet, cold or hot
  • Lasts several minutes to hours after removal of stimulus
  • Sensibility tests may have exaggerated or negative response
  • Tooth not TTP except at late stages
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7
Q

What can pain on chewing indicate other than caries?

A

Fractured restoration or cracked cusp syndrome.

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8
Q

What are the requirements for visual assessment of caries?

A
  • Clean teeth
  • Good lighting
  • Dry teeth
  • Round end probe to explore teeth but NOT to probe
  • Tooth seperators may be used in children
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9
Q

What should be performed prior to caries assessment?

A
  • Biofilm removal

- Dental prophylaxis if medical history allows, careful not to cavitate potential early lesions beneath soft deposits

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10
Q

What is FOTI?

A

Fiber-optic transillumination:

  • Light used to detect presence of crack or caries
  • Should be considered an additional supplemental technique, not commonly available in most practices
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11
Q

Why is it important to dry teeth during caries assessment?

A
  • Enamel is more porous in a carious lesion and pores will fill with water/saliva to disguise the presence of caries
  • Drying fills the pores with air which has a different refractive index to saliva in pores, therefore light is scattered and early caries lesion is detectable
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12
Q

mICDAS code 0

A
  • No or slight change in enamel after prolonged drying

- No enamel demineralisation

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13
Q

mICDAS code 1

A
  • Opacity or discolouration (white spot lesion) visible after air drying, no obvious cavitation
  • Demineralisation limited to the outer 50% of enamel
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14
Q

mICDAS code 2

A
  • White spot lesion or greyish discolouration visible without air drying, no cavitation
  • Demineralisation involving the inner 50% of enamel through to the outer third of dentine
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15
Q

mICDAS code 3

A
  • Localised enamel breakdown in opaque or discoloured enamel +/- greyish shadowing from unelrying dentine
  • Demineralisation involving the middle to inner third of dentine
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16
Q

mICDAS code 4

A
  • Gross cavitation in opaque or discoloured enamel exposing the underlying stained dentine
  • Demineralisation involving the inner third of dentine towards the pulp
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17
Q

Why are tooth separators sometimes used in paediatric dentistry?

A
  • Small elastic bands placed interproximally exerts a pressure on teeth causing slight separation
  • Allows interproximal lesion to be viewed directly
  • Requires 2 appointments, can cause discomfort
  • Less invasive than radiographs
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18
Q

What are the 2 main uses of the dental probe?

A
  • Use the side to remove biofilm

- Use the tip in gentle stroking motion at 90 degree angle to feel texture of tooth

19
Q

What should you never use a probe to do?

A
  • Never push a probe into tooth tissue

- Never probe fissures

20
Q

What does lesion activity refer to?

A

Whether a lesion is progressing or arrested/reversing.

Key to determine appropriate intervention.

21
Q

What is lesion activity indicated by?

A
  • Presence of biofilm
  • Condition of adjacent gingivae (will be red and swollen)
  • Texture, hardness and appearance
22
Q

What is the difference in texture between healthy/arrested lesions and active lesions?

A

Healthy: enamel and dentine feel smooth and glassy

Active: pitting of enamel causes rough/gritty texture, carious dentine feels like wet suede, slightly tacky and rough

23
Q

What terms describe disease activity in caries?

A
  • Active
  • Inactive/arrested
  • Rampant (can be caused by xerostomia or bottle caries in infants)
24
Q

What terms describe caries location on tooth?

A
  • Smooth surface caries
  • Interproximal caries
  • Fissure caries
  • Root caries
25
Q

What terms describe a tooth’s previous experience of caries?

A
  • Primary caries: no previous carious lesion on that site of the tooth
  • Secondary (recurrent) caries: associated with an existing restoration
  • Residual caries; retained over the pulp in a deep cavity
26
Q

Describe root caries.

A
  • Lesions on tooth roots, tend to be broad, shallow and progress more rapidly
  • Often whole exposed root surface is affected but some areas will be worse than others
  • Single lesion can contain active, chronic and arrested areas
  • More common in elderly patients
27
Q

What is the appearance of active root caries lesions?

A
  • Usually next to the gingival margin
  • Soft and dull, pale or dark
  • Covered in biofilm
28
Q

What is the appearance of inactive root caries lesions?

A
  • Usually distant from the gingival margin
  • Clean, no biofilm
  • Hard shiny appearance, pale or dark
  • Hard on stroking with probe
29
Q

What are the benefits and drawbacks of bitewing radiographs for caries diagnosis?

A
  • Shows enamel and dentine
  • Shows proximity of caries to pulp and pulp morphology
  • Allows depth of lesion to be assessed

However;

  • Difficult to diagnose early occlusal caries due to superimposition of buccal and lingual/palatal enamel- occlusal caries usually only seen once they reach dentine
  • Tend to underestimate extent of lesions
  • Overestimation may also occur due to projection errors
  • Small lesions may be completely lost by small changes in angulation of X-ray tube head
  • Cannot tell us whether a lesion is active/inactive or cavitated/non-cavitated
30
Q

When are intra-oral periapical radiographs indicated for caries diagnosis?

A
  • Used when suspected that health of pulp is compromised
  • Useful to confirm presence of carious lesions in anterior teeth and proximity to pulp- but not used in routine examination
31
Q

What is a percussion test?

A
  • Using the handle of a mirror or probe to gently tap vertically down the long axis of the tooth
  • TTP = tenderness to percussion
  • Patient feels tenderness if there is apical inflammation
32
Q

What is a tooth sleuth?

A
  • Used to detect cracked cusp

- Place rubbery plastic instrument over cusp and ask patient to bite down

33
Q

What is laser fluorescence?

A

E.g. Diagnodent

  • Laser light of specific wavelength irradiates tooth
  • In the presence of a carious lesion, the amount of fluorescence will increase
  • A photodiode at the tip of the device, measures the light feedback to give a numerical reading
  • Higher level of fluorescence = indicative of caries

Possibility of false readings due to stained fissures, tertairy dentine and plaque.

34
Q

What is an electrical caries monitor?

A

E.g. CariesScan Pro

  • Enamel has low electrical conductance
    • Increased pore volume in demineralised enamel increases electrical conductance as more saliva can fill these pores
  • High number of false positives
35
Q

What is QLF?

A

Quantitative laser fluorescence e.g. Inspektor Pro

  • Displays data on a monitor, shows shows fluorescent image of tooth
  • Uses a computer to store information including probe location and placement
  • Not to be relied on for diagnosis
36
Q

What is lower, intra-examiner or inter-examiner, reliability?

A

Inter-examiner agreement (between different clinicians) is typically lower than intra-examiner agreement.

37
Q

What are the effects of a false positive diagnosis?

A

May needlessly enter the tooth into a viscous restorative cycle.
Risk of damage to adjacent teeth.
Risk of effects on the pulp.

38
Q

What are the effects of a false negative diagnosis?

A

May cause extensive tissue breakdown and pulp involvement in patients at high risk of rapid caries progression and irregular attenders.

Lesion is likely to be detected at a later visit for slow caries progression in reliable attendees, no serious tissue destruction.

39
Q

What other conditions mimic caries?

A
  • Fluorosis
  • Idiopathic enamel opacities common on incisors
  • Molar-incisor hypomineralisation
  • Dental hypoplasia
40
Q

What are causes of tooth loss other than caries?

A
  • Attrition (tooth on tooth wear)
  • Abrasion (non-tooth on tooth wear e.g. brushing)
  • Erosion (tooth plus acidic substance)
41
Q

How is dental erosion recorded?

A

Basic Erosive Wear Examination (BEWE)
Per sextant (like BPE)
Score:
0 = no erosive tooth wear
1 = initial loss e.g. loss of brightness, opaque appearance)
2= distinct defect, hard tissue loss, less than 50% surafce area
3 = hard tissue loss in more than 50% of the surface area

42
Q

How are abrasion and attrition recorded?

A

Tooth surface loss (TSL) recorded using a tooth wear index (S&K)
Score:
0 = no loss
1 = loss of enamel surface characteristics
2 = loss of enamel exposing dentine for less than 1/3rd of surface
3 = loss of enamel exposing dentine for more than 1/3rd of surface
4 = complete enamel loss, pulp exposure or exposure of secondary dentine

Very time consuming technique.

43
Q

What system is used to record TSL in the dental hospital?

A

Modified version of Smith and Knight system.
is used.
It identifies the worst surface per tooth only.
Codes:
0 = no loss of contour
1 = minor enamel wear, no dentine exposed
2 = dentine exposed up to 1/3
3 = >1/3 dentine exposed
4 = tertiary dentine or pulp space exposed

BDS 2: Preparing for Patients (6 decks)

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