Prepared by Dr Lea Foster
Dental Caries is a disease of the hard tissues, characterized by the
decalcification of the inorganic portions of the tooth.
Loss of the mineral content is the followed by breakdown of the organic
This destructive process results from the metabolism of carbohydrates
caries (ker´ēz), n in dentistry, the decay of a tooth.
Colloquial term is
cavity. Advanced caries.
caries, arrested, n the state existing when the progress of
the decay process has halted. It is noted by its dark
staining without any breakdown of tooth tissues.
Caries Assessment Tool (CAT), n.pr an analysis that
examines the risk factors for the development of dental
caries in infants and young children. Risk factors such as
the environment, family history, and general health can be
identified early, thereby reducing a patient's risk for
developing dental caries and other diseases of the teeth
and gingival tissues.
caries, baby bottle, n See caries, early childhood (EEC).
caries, cemental (root surface), n the decay of the
caries, gross, n a form of caries with advanced dental
decay that is easily seen clinically.
caries, healed, n See caries, arrested.
caries, incipient, n a decayed part of a tooth in which
the lesion is just coming into existence.
caries, nursing, n See caries, early childhood (EEC).
caries, pit-and-fissure, n See cavity, pit and fissure. See
also sealant, enamel.
caries, plaque-related, n the caries associated with
plaque formation. Most commonly located in the pits
and fissures of the teeth, especially the molar and
premolar teeth, and along the gingival tissue and also
the margins associated with dental restorations.
caries, proximal, n decay occurring in the mesial or, ( ), y
cementum that occurs as a result of gingival recession and
exposure of the root surface. See also caries, cervical (root
caries, cervical (root surface), n the decay that appears on
the root at the cementoenamel junction or the neck as a
result of gingival recession and exposure of the root
surface. See also caries, cemental (root surface).
caries, chronic, n a form of caries that occurs over time
and demands regular dental intervention.
caries, compound, n a type of caries that affects two or
more surfaces of a tooth.
caries, early childhood (EEC), n a form of severe dental
decay occurring in young children that is caused by long
and frequent exposure to liquids that are high in sugar,
such as milk or juice. Because this form can damage the
underlying bone structure, it may affect the development
of permanent teeth.
caries, enamel, n the decay that occurs in the enamel of a
tooth because of a fissure or the collection of bacterial
plaque. It appears first as white spots, which later darken
distal surface of a tooth.
caries, rampant, n a suddenly appearing, widespread,
rapidly progressing type of caries.
caries, recurrent, n the extension of the carious process
beyond the margin of a restoration. Also called
caries, residual, n (residual carious dentin), the decayed
material left in a prepared cavity and over which a
restoration is placed.
caries, root, n tooth decay occurring on a portion of the
root that is exposed. Root caries.
caries, senile n older term for the decay noted
particularly in the elderly when supporting tissues have
receded; occurs in cementum, usually on proximal
surfaces of the teeth.
caries, smooth surface, n the decay that occurs on the
smooth surfaces of the tooth. See also caries, proximal
Mount and Hume
1 – Pit and fissure
2 - Approximal
3 – Close to
Class I, II, III, IV,V
Class I – Originating
in occlusal or buccal
pits and fissures
Class II – Interproximal
lesions – posterior teeth
Class III –
Class IV –
lesions involving the
A Bit of EverythingA Bit of Everything
Pits and fissures
A multi factorialA multi-factorial
1. Enamel lesion- no
2. Enamel lesion –
3 Dentine lesion
Pit and Fissure
S h f ( l 3. Dentine lesion
4. Dentine lesion with
Smooth surface (early
History, Clinical Examination
and Diagnostic aidsand Diagnostic aids
Oral Hygiene habits
Level of understanding and motivation
Drug therapy impacting on saliva flow
Visual diagnostic features
Visual diagnostic features
• White ‘reverse caries’
C it t d i l i d tiCavitated – involving dentine
• Shadowing and reverse caries indicate the
extent of the lesion
Cavitated – involving pulp
Visual Diagnostic Features
White spot lesion –
Visual diagnostic features
May occur in
Occurs below the
level of the enamel
Includes Early Childhood caries
(AKA Baby bottle caries)
Visual diagnostic features
As well as
4’s and 5’s
Visual diagnostic featuresVisual diagnostic features
Affecting the margins of
May occur as a fuction of failure
of the restorative material
Or as a function of microleakage
Damage caused by the operator in the
process of treating other teeth
Damage to the approximal surface of adjacent teeth during tooth
preparation and the finishing of restorations can result in the
formation of caries
Various studies show the incidence of this type of damage being
from 50 -90% (1-3)
Scratching/pitting of the surface of sound enamel at the contactScratching/pitting of the surface of sound enamel at the contact
will remove the fluoridated surface layer and leave a rough
surface which retains plaque
Flattening of the adjacent tooth results in the creation of flat
contacts – makes it impossible to restore a natural rounded contact
area between teeth
Leads to food traps – new caries, recurrent caries in restorations &
periodontal pocket formation
How does caries feel
to the probe?
Probe may not stick –
or there may be a
Probe may or may not catch.
Surface feels sound
Pitting of the enamel surface.
Pits within the white spot lesion
Loss of overlying enamel
Dentine is soft – probe tip can penetrate
Lesions are dark and feel hard or very ‘leathery’
P b ti d t t t il if t llProbe tip does not penetrate easily if at all
Not able to reach these with a probe
Other diagnostic aids?g
Rather obvious – no mystery here
Laser induced fluorescence
Up to half way through enamel
More than halfway through enamel up to DEJ
Stage 1 Stage 1
From DEJ up to halfway through dentine
More than halfway through dentiney g
The tooth surface is illuminated by a red light
(excitation wavelength at 655 nm, modulated) that is produced by
a laser diode and transmitted by an optical fiber.
The laser induces fluorescence in mineralized tooth tissues, at a
greater intensity in carious than in sound tooth tissues
Th i d b i l fib h di d i h lThen transmitted by an optical fiber to a photodiode with a long
pass filter (wavelength >680 nm) in the detection device
Numerical value of the digital display (in units related to a
calibration standard) correlates quantitatively with the intensity of
the fluorescence detected and thus indicates the extent of caries
(colour graphics have been developed also)
Lussi et al. (5) suggested that a score of 20 indicates caries
extending into the dentin, and this reference has been used in
other studies using DIAGNOdent (6,7)
General decline in the prevalence of dental caries owing to the increased
use of fluoride in the form of fluoridated water, fluoride toothpaste, and
fluoride agents that are applied professionally or at home.
Pattern of caries has also changed: the proportion of caries found in
occlusal fissures has risen and pit and fissure caries are now perceived as
the predominant types
main reason for these changes is that fluoride inhibits enamel breakdown,
so caries reaching the dentin tend to progress beneath a clinically intact
difficulty in visually inspecting the fissures of molars - such cases of
occlusal dentinal caries, known as “hidden caries”, are commonly missed
on visual examination and carious cavities are seen only at a late stage of
Is regarded as a useful adjunct to other forms of conventional diagnosis
Reproducible and therefore excellent aid to monitor changes
Useful in the
Can help to
l l flevel of
All our diagnostic techniques
are aimed at early detectionare aimed at early detection
diagnosis is the
first step in
proper course of
then be applied
Is active caries
If so…..at what
rate is it
the risk of recurrent
with marginal gap
Prevention & remineralization
two thirds of
lesions in the inner
two thirds of dentin
about whether to place
or replace restorations
at other sites should beat other sites should be
delayed until the most
have been considered
E0 – no caries, E1- outer enamel, E2 – Inner
D1 - outer 1/3 dentine, D2 – middle 1/3
dentine, D3 – inner 1/3 dentine
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Lasers in Medical Science
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