Unit 5 - Diagnosing Caries

Question 1

What are some general clinical features of dental caries?

Answer 1

Initial lesion is not detectable clinically or radiographically
Once sufficient decalcification occurs the enamel will appear chalky white while still feeling relatively smooth with an explorer
Enamel eventually become undermined and may fracture
With time, the surface layer of enamel will collapse (cavitation) exposing a brown zone of decomposition/demineralization dentin that is soft and tacky due to bacterial invasion
Symptoms may include slight pain stimulate by heat, cold, or sweets that disappear when the stimulus is removed
Symptoms are usually not present until the carious lesion is close to the pulp

Question 2

What are some General radiographic features of caries?

Answer 2

Radiographic appearance of caries is radiolucent; the specific shape of the lesion varies depending on the location
Caries may be clearly visible or difficult to detect depending on:
Enamel thickness
Client size/thickness
Overlying soft tissue
Degree of loss of tooth structure
Technique used (film quality)

30-50% loss of minerals is needed for caries to be apparent in radiograph
The size of the area involved varies according to degree of progression of caries and the angulation of the X-ray beam

Question 3

How are caries classified?

Answer 3

Location

Course/duration:
Incipient: beginning - not yet into the dentin
Chronic: slow onset, slow progression; typical pattern
Acute: rampant, with carious contributing factors: nursing bottle, radiation
Recurrent: adjacent to existing restorations
Arrested: not advancing - likely in enamel or cementum - open areas

Restorative parameters:
GV blacks classification according to tooth surface or location on surface
Size of lesion

Question 4

What is considered a chronic carious lesion?

Answer 4

Slow progression allowing more time for sclerotic and tertiary dentin formation
Carious dentin is often deep brown with moderate lateral spread at DEJ and little (slow rare) undermining of enamel
Pain is not common until the lesion is very close to the pulp and even at that point may be asymptomatic
More common in adults

Question 5

What classifies acute caries?

Answer 5

Rapid course; early pulpal involvement (pain varies)
Usually affects many teeth at once
Dentinal tubules open, minimal sclerosis and too rapid progression for secondary or reparative dentin formation
Most common in children and young adults
Individuals with xerostomia, combined with poor plaque control and high sucrose intake are also at risk
Rapid spread at DEJ; diffuse dentin involvement and light yellow staining of dentin

Question 6

Describe nursing bottle caries

Answer 6

A type of rampant caries affecting deciduous max anterior teeth (absence of same type of caries in lower is a distinguishing feature)
Due to prolonged nursing with liquid containing sucrose or lactose (milk, formula, juice, sweetened water)
Liquid pools around max anterior teeth when child falls asleep
Also result of sugar-coated pacifiers
Associated with habitual use past age one

Question 7

Describe recurrent caries

Answer 7

In immediate vicinity of a restoration
Often due to inadequate extension of original restoration, a leaky margin or caries left in dentin after placement of a restoration
Pattern same as in primary caries (chronic)

Question 8

Describe arrested caries

Answer 8

Carries process has stopped
Decalcified dentin is often burnished, brown and hard
Secondary and sclerotic dentin is evident microscopically
Can occur in permanent and deciduous teeth

Question 9

Describe incipient caries

Answer 9

Just in the enamel
Has not broken through the surface
Clinically you’ll see a white spot
Zone right below the surface is where the most demineralization is happening
Radiographically you’ll see it part way through the enamel though we don’t see the V and we don’t see it going into the DEJ

Question 10

Describe moderate decay

Answer 10

Clinically see some shadowing with some possible cavitation

Radiographically you will see the V shape

Question 11

Describe advanced decay

Answer 11

It’s cavitated and in the dentin
You will see shadowing
Radiographically we will see it in the dentin

Question 12

Describe severe decay

Answer 12

It’s open
It’s frank
It’s blown out!!

Question 13

What are some limitations to using radiographs to diagnose caries?

Answer 13

Angle
HA
Artifacts ability to interpret

Question 14

Describe cervical burnout

Answer 14

Density of tooth structure/location of CEJ
Appears radiolucent; anterior band near CEJ and posterior proximal wedge shape
Good to assess bone/CEJ location
Compare cervical caries and cervical burnout
Assess location of cervical bone *caries above

Question 15

Describe the difference between cervical burnout and cementum caries

Answer 15

Edges generally smoother and more distinct than on cemental caries
Outline is generally more angular, cemental caries more cup-shaped
May be more uniform in density

Question 16

Describe the Mach band effect

Answer 16

When enamel is overlapped at the interproximal area on radiographs, the change in density between overlapped surfaces results in a shadow that may be interpreted as caries

Question 17

Describe the difference between abrasion and attrition

Answer 17

Cervical abrasion due to the physical wearing of root structure shows as a decrease in density and appear radiolucent this may resemble cervical caries

With cervical abrasion, the radiolucency is usually a well defined horizontal defect, seen at the CEJ

Attrition is incisal/occlusal wear and is seen as radiolucent horizontal defects (lack mineral) on these surfaces

Question 18

What’s the difference between bruxism and bruxing?

Answer 18

Bruxing is the action

Brixism is what we are seeing

Question 19

What is attrition?

Answer 19

Natural physiological process

Wear of occlusal, incisal and interproximal tooth structures because of chronic tooth to tooth friction

Question 20

What is abrasion

Answer 20

The pathological loss of tooth structure caused by abnormal repetitive mechanical wear
Caused by abrasive agents or habits such as excessive tooth brushing (most common form), dentifrices, oral habits (tooth picks) or occupation habits (bobby pins)

Question 21

What is erosion

Answer 21

Loss of tooth structures as a result of chemical wear *acid foods and drinks
Gastric acids on teeth - from GERD, purging

Could be on lingual of max anterior teeth
Occlusal cupping from liquids pooling

Question 22

What is abfraction

Answer 22

Means to break down
The pathological loss of tooth structure at or under the CEJ caused by abnormal mechanical load
Movement from side to side grinding
Sharp wedge shaped V defect of enamel/dentin along the cervical region of the facial aspect
Perio support around the teeth is usually excellent, occlusal wear facets are present and abrasive and erosive factors are non-identifiable

Question 23

What is butricing?

Answer 23

Build up of bone along alveolar ridge due to excessive biting forces

Question 24

What are some limitations on caries risk assessment tools?

Answer 24

Caries etiology is multifactorial and current assays usually measure only a single factor in caries production
In most tests, oral microorganisms or by-products are taken from saliva samples rather than specific sites of bacterial accumulation
A high salivary count of bacteria alone, does not automatically correlate to presence of disease

Question 25

What are some preventative measures that can be taken to prevent caries?

Answer 25

Plaque biofilm control
Anticariogenic agents (fluoride, chlorohexadine, xylitol)
Pit and fissure sealants
Diet (mainly avoiding refined sugars, especially those low in nutrients *frequency and form are more important contributing factors than quantity)
Increase saliva flow or alter acidity

Question 26

How are caries diagnosed?

Answer 26

Visual - visual examination
Tactile - if you can’t see it visually
Radiographs - if you see something suspicious
Clinical - client signs & symptoms; sensitivity off and on. How long has it been? Specific tooth? More sensitive to hot/cold/sweet? Have you had any trauma to the area? Is there cementum exposure?

Take all of these things into our diagnosis corner
If someone has caries in their dentin, they will feel it though they often don’t feel it if it’s still in the enamel. All dependant on that individual.