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Detection and diagnosis of dental caries


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Here's a presentation about how we can detect and diagnose the carious lesion.

Uploaded by; Dr. Ghaith Abdulhadi Al-Otaibi
College Of Dentistry

Published in: Education
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Detection and diagnosis of dental caries

  1. 1. Detection And Diagnosis of Dental Caries Presented By: 1- Ghaith Abdulhadi 2- Mahommed Naif Supervision By: Dr. Mahammed H. Nabulsi
  2. 2. What is diagnosis? Diagnosis is an art and science that results from the synthesis of scientific knowledge, clinical experience, intuition & common sense Caries diagnosis implies deciding whether a lesion is active, progressing rapidly or slowly or whether is already arrested.
  3. 3. ASSESSMENT TOOLS Stepwise progression toward diagnosis & treatment planning depends on thorough assessment of the following Patient History  Clinical examination  Nutritional analysis  Salivary analysis  Radiographic assessment
  4. 4. 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
  5. 5. 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
  7. 7. VISUAL-TACTILE METHODS Visual methods:  Detection of white spot, discoloration / frank cavitations Magnification loupes- Head worn prism loupes (X 4.5) or surgical microscopes(X 16) may be used comfort, relatively inexpensive, available in various magnification  Use of temporary elective tooth separation
  8. 8. Tactile methods:  Explorers are widely used for the detection of carious tooth structure  Dental floss
  9. 9. Use of explorer is not advocated because;  Sharp tips physically damage small lesions with intact surfaces  Probing can cause fracture & cavitation of incipient lesion. It may spread the organism in the mouth  Mechanical binding may be due to non-carious reasons Shape of fissure Sharpness of explorer Force of application Path of explorer placement
  10. 10. Use of explorer • Explorer is useful to remove plaque and debris and check the surface characteristics of suspected carious lesions. • gentle pressure just required to blanch a fingernail without causing any pain or damage • All surfaces of a tooth are cleaned of debris and plaque, using an air syringe and examined visually.
  11. 11. SMOOTH SURFACE CARIES Non- cavitated: • No signs of cavitation after visual or tactile examination. • Location: where dental plaque accumulates (gingival margin). • Surface characteristics: Matted (not glossy) when a tooth is dried.
  12. 12. not active non-cavitated carious lesions. • Visual enamel opacity under sound marginal ridge indicate undermined enamel due to dental caries
  13. 13. Non-cavitated carious lesion ENAMEL DENTIN
  14. 14. Cavitated Lesions: • Where there is visual breakdown of a tooth surface, it is classified as cavitated carious lesion. An active cavity on a smooth surface has soft walls or floors shown below:
  15. 15. Caries in Pit or Fissure Surfaces • All discolored areas should be explored using gentle pressure. • There is no need to penetrate a suspected lesion with an explorer. • If a discolored and non-cavitated area is soft when explored, it is recorded as non-cavitated carious pit or fissure. • A cavity is detected when there is an actual hole in the tooth in which an explorer could easily enter the space. • An active cavity has soft walls or floors (detected using gentle exploring).
  16. 16. • 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.
  17. 17. Pit and Fissure Caries Non-cavitated carious lesion Enamel Enamel Dentin Enamel
  18. 18. Cavitated Carious lesion • If a discolored area is hard when gently explored then it should be marked as questionable.
  19. 19. Root Caries • Root surface caries comprises of a continuum of changes ranging from minute discolored areas to cavitation that may extend into the pulp For diagnostic purpose; they may be:  Active root surface lesion: • well-defined area showing yellowish or light brown discoloration • covered by visible plaque • presence of softening/ leathery consistency on probing with moderate pressure
  20. 20.  Inactive root surface lesion (arrested): • well-defined dark brown/ black discoloration • smooth and shiny • hard on probing with moderate pressure Active lesion Questionable
  21. 21. Arrested Caries • Arrested (remineralized) lesions can be observed clinically as intact, but discolored, usually brown or black spots. • The change in color is presumably due to trapped organic debris and metallic ions within the enamel. • These discolored, remineralized lesions are intact and are highly resistant to subsequent caries . The arrested caries need not be removed.
  22. 22. Recurrent caries • 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
  23. 23. There are two valid indicators of recurrent (secondary) caries: •softness at the margin of a filling that is detected using an explorer or •presence of a large defect (a minimum diameter of 0.4 mm) at a margin of a filling with softness in the area. Large defects are associated with a high level of colonization with cariogenic bacteria. Marginal discoloration by itself is not a valid sign for dental caries.
  24. 24. RADIOGRAPHY  Carious lesions are detectable radiographically when there has been enough demineralization to allow it to be differentiate from normal  They are valuable in detecting proximal caries which may go undetected during clinical examination.  On average they have around 50% to 70% sensitivity in detecting carious lesions.  40% demineralization is required for definitive decision on caries
  25. 25.  Radiographic examinations include; Bitewing radiographs IOPA radiographs using paralleling technique Dental panoramic tomograph  The two important decisions related to radiographic examination are (1) when to take a radiograph and (2) how to evaluate a radiograph for presence of signs of dental caries.
  26. 26. Severe occlusal lesions: Readily observed both clinically and radiographically Appear as large cavities in the crowns of the teeth However pulp exposure cannot be determined
  27. 27. PROXIMAL CARIES Density along the proximal surface is high which does not permit the detection of loss of small amounts of mineral content Incipient lesions: Commonly seen in the caries-susceptible zone Presents as a notch on the outer surface not involving more than half of enamel
  28. 28. Moderate proximal lesions: Involve more than outer half of enamel but do not extend into DEJ May have one of type of appearance: 67% - triangle with broad base towards outer surface 16% - a diffuse radiolucent image 17% - combination of both
  29. 29. Facial & Lingual Caries  They start as round lesions and enlarge to become elliptical or semilunar
  30. 30. ROOT SURFACE CARIES  Also called cemental caries with an incidence of 40%- 70% of the aged population  Buccal, lingual, proximal  Ill-defined, saucer-like radiolucency
  31. 31. DYES FOR CARIES DETECTION • They selectively complex with carious tooth structure which is later disclosed with the help of fluorescence • Aids in both quantitative & qualitative analysis of the lesion DYES FOR ENAMEL CARIES: Procion: N2 & (OH) groups irreversibly complex with caries Acts as a fixative Calcein: complexes with calcium & remains bound to the tooth Zyglo ZL-22: fluorescent tracer dye, not used in vivo Brilliant blue: 10% aqueous Brilliant Blue, not used in vivo
  32. 32. DYES FOR DENTIN CARIES:  1% acid red 52 in propylene glycol complexes specifically with denatured collagen, hence used to differentiate infected and affected dentin  Iodine penetration method (Pot iodide) for evaluating enamel permeability DISADVANTAGES • Dye staining and bacterial penetration are independent phenomena, hence no actual quantification • They also stain food debris, enamel pellicle, other organic matter • Dye aided carious removal- laborious • Stains DEJ
  33. 33. FIBEROPTIC TRANSILLUMINATION • Different index of light transmission for decayed & sound tooth. Decayed tooth structure has decreased index & appears dark • The tooth is illuminated using fiberoptics • Have a high level intra & inter-examiner variability • Digital imaging FOTI introduced, images captured by a CCD camera & fed into the computer for image analysis
  34. 34. ELECTRIC MEASUREMENTS FOR CARIES • First proposed by Magitot in 1878 • 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
  35. 35. • Two systems Vangaurd system – 25 Hz – ordinal scale of 0 –9 Caries meter L – 400 Hz – 4 colored lights green –no caries yellow – enamel caries orange – dentin caries red –pulp involvement
  36. 36. Factors affecting electrical measurements 1. Porosity 2. Surface area 3. Thickness of the tissues 4. Hydration of enamel 5. Temperature 6. Concentrations of ions in the dental tissue fluids
  37. 37. RECENT ADVANCES IN CARIES DETECTION • Optical methods used are Quantitative light- induced fluorescence- QLF™ Infrared laser fluorescence - DIAGNOdent
  38. 38. REFERENCES • 1. Pitts NB. Clinical diagnosis of dental caries: a European perspective. Journal of Dental Education 2001; 65 (10):972–8. • • 2. Pitts NB. Diagnostic tools and measurements—impact on appropriate care. Community Dentistry and Oral Epidemiology 1997; 25 (1):24–35. • 10. Pretty IA, Maupome G. A closer look at diagnosis in clinical dental practice. Part 1. Reliability, validity, specificity and sensitivity of diagnostic procedures. Journal of the Canadian Dental Association 2004; 370 (4):251–5.