Stepwise progression toward diagnosis & treatment planning depends on thorough assessment of the following
HIGH RISK LOW RISK Social History Socially deprived High caries in siblings Low knowledge of caries Middle class Low caries in sibling High dental aspirations Medical History Medically compromised Xerostomia Long-term cariogenic medicine No such problem Dietary habits Sugar intake: frequent Infrequent
HIGH RISK LOW RISK Use of fluoride Non-fluoridated area No fluoride supplements Fluoridated area Fluoride supplements used Plaque control Poor oral hygiene maintenance Good oral hygiene maintenance Saliva Low flow rate& buffering capacity S.mutans & lactobacillus counts Normal flow rate& buffering capacity S.mutans & lactobacillus counts
HIGH RISK LOW RISK Clinical evidence New lesions Premature extractions Anterior caries restorations Multiple/repeated restorations No fissure sealants Multi-band orthodontics No new lesions No extraction for caries Sound anterior teeth No/few restorations Fissure sealed No appliances
If there is visual enamel opacity under an ostensibly sound or stained pit or fissure, then the enamel is undermined because of dental caries and the tooth surface is classified with a non-cavitated carious lesion in dentin .
It is diagnosed whenever there is softness due to caries at a defective margin, and when the tip of a periodontal probe can enter the defect without any resistance.
A restoration with a discolored margin or a small marginal ditch (<0.5 mm or the head of the probe) is recorded as an early recurrent carious area . A larger defect should be classified as advanced recurrent carious area
Specific form of rampant caries Acute, widespread caries with early pulpal involvement of teeth that are usually immune to decay Primary dentition affected Both dentitions affected C/F: specific pattern- maxillary incisor molars Mandibular incisors not affected Rapid appearance of new lesions Mandibular incisors also affected
Tooth demineralization due to caries process causes increased porosity of tooth structure. This porosity contains fluid containing ions. This leads increased electrical conductivity, conversely, leads to decreased electrical resistance or impedance
ECM device uses a fixed-frequency (23 Hz)alternating current which measures ‘bulk resistance’ of tooth
ECM limited to occlusal sites.ECM to H/P- 97% accuracy
Cannot be used where amalgam filling is present
Materials have different responses at different frequencies. Electrical Impedance Spectroscopy (EIS) operates over different frequencies & thus determine more accurately these differences. EIS can be used on both occlusal & proximal surfaces
Buffering capacity analysis: Results 5 min Color change on each of the test pad is noted & points are assigned accordingly Green – 4 pts Blue/ Red – 1 pt Green/ blue – 3 pts Red – 0 pt Blue – 2 pts Color change pH range Red 5.0 – 5.8 Yellow 6.0 – 6.6 Green 6.8 – 7.8
Color Caries conduciveness Blue in 15 min Non- Conducive Orchid in15 min Slightly Conducive Red in 15 min Moderately Conducive Red immediately on mixing Highly Conducive Colorless in 15 min Extremely Conducive