Natural History of Caries

Question 1

What is the natural history of caries?

Answer 1

the way the disease evolves and
progresses, particularly in the absence of intervention.

Question 2

Backer Dirks (1966)

Answer 2

First clinical study of clinical caries progression in recently erupted teeth.

100 Netherlands children.

Assessed all surfaces.

Question 3

Pitts’ Review (1983)

Answer 3

Reviewed all caries progression studies prior to 1983 (including Backer Dirks).

For the majority of individuals examined, the progression of approximal carious lesions is a slow progression.

Question 4

Schwartz et al (1984)

Answer 4

Generally, caries progresses through outer than inner half of enamel.

Generally, caries progress more rapidly in high- risk individuals.

Question 5

Weeheijm et al. (1992 & 1997)

Answer 5

“Fluoride Bombs”
Hidden caries: carious lesions from occlusal surface visible on a radiograph but missed on clinical examination.

Question 6

Essentialistic Caries Concept

Answer 6

Belief in the existence of a caries truth and therefore a “gold standard”.

There is no fixed caries truth.

Question 7

Caries

Answer 7

the disease resulting from an ecologic shift within a dental biofilm, caused by frequent consumption of fermentable carbohydrates, whereby an imbalance of de- and re- mineralisation leads to net tooth mineral loss

Question 8

Carious lesion

Answer 8

the detectable manifestation of the disease of caries

Question 9

Detection

Answer 9

discriminating between a tooth surface affected by a carious lesion and a tooth surface that is healthy or affected by a different condition (presence)

Question 10

Diagnosis

Answer 10

involves assessment to characterize the lesion once detected (severity/staging & activity)

Question 11

Sensitivity

Answer 11

how accurately a technique/instrument identifies the presence of disease
(% of true positives)

Question 12

Specificity

Answer 12

how accurately a technique/instrument identifies the absence of disease
(% of true negatives)

Question 13

Caries Associated with Restorations or Sealants (CARS) lesion

Answer 13

A carious lesion initiating at the margin of an existing restorative material
May be referred to in literature/other cariology systems as “recurrent” or “secondary” caries/lesions
Take care not to confuse with residual caries radiographically, or other lesion types that happen to be positioned adjacent to a restorative material

Question 14

Residual caries

Answer 14

Cariously demineralised tissue that has been left in place during a restorative procedure, generally seen radiographically beneath the restorative material

Not a separate type of carious lesion, rather a post-operatively detectable remnant of one of the previously described lesion types

Should not be confused with a subsequently developed CARS lesion.

Question 15

Rampant caries:

Answer 15

Multiple active carious lesions are present, particularly when involving surfaces not usually affected by caries.

Historically, often classified descriptively by the presumed underlying major caries-risk modifying factor e.g., “nursing bottle caries”, “radiation-induced caries”, “drug-induced caries” or “bakers’ caries”.