This document discusses early diagnosis of dental caries. It begins by defining dental caries as a microbiological disease that results in tooth demineralization. It states that caries progresses rapidly in primary dentition, so early diagnosis and investigation are important. It then covers the etiology and risk factors of dental caries, including dental plaque, substrates, host factors, and time. Various methods for diagnosing caries are discussed, such as conventional methods using probes, radiography, tooth separation, and advanced methods like fiber optic transillumination and laser fluorescence. Classification of caries by location, rate, and severity are also summarized.

1. Early diagnosis of
dental caries
By :
Dr / Najma Mohamed Alamami
alamaminajma@yahoo.com
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2. Introduction
Dental caries is Microbiological disease of hard
structure of teeth, that results in localized
demineralization of the inorganic portion and
destruction of the organic substances of the tooth.
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3. Introduction
It is known that caries
progression in primary
dentition may be rapid,
therefore early diagnosis
and good investigations
are important.
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4. Etiology of dental caries
Dental plaque
Time
Host
factors
No caries No caries
No caries
No caries
caries
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5. The saliva, the
substrate, and the
bacteria, form a
biofilm (plaque), that
adheres to the tooth
surface, over time , the
presence of substrate
serves as a nutrient.
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6. 1) Dental plaque :
Plaque can produce aciduric bacteria that are both acid-
producing, and can survive at low salivary PH.
In the caries process, once the PH in plaque drops below a
critical level (around 5.5), the acid produced begins to
demineralize enamel, This will last for 20 minutes or longer,
depending on the availability of the substrate.
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7. 1) Dental plaque:
 Mutans Streptococci are believed to be the most important
bacteria in the initiation and progress of dental caries.
Streptococcus sobrinus may be more important in smooth
surface-decay, and are perhabs associated with rampant caries.
 following enamel cavitation , Lactobacilli become increasingly
important.
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8. 2) Substrates:
 Any carbohydrate causes the production of acid, but glucose
is more important.
 The amount of fermentable carbohydrates is relatively
unimportant, as even minute amounts of fermentable
carbohydrates will be utilized immediately.
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9. 3) Host factors: (tooth)
 Saliva plays several critical roles in the
caries process.
The flow, dilution, buffering, and
remineralization capacity of saliva are
critical factors that affect in regulate
the progression and regression of the
disease. 12
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10. 4) Time:
When the acid challenge occurs
repeatedly it may result in the
collapse of enough enamel crystals
to produce a visible cavity.
Cavitation may take from months to
years.
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11. Theories of the cause of dental
caries:
The proteolysis
theory.
The proteolytic-
chelation theory.
The acidogenic
theory.
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12. The proteolysis theory
Initial attack is enzymatic
destruction of the protein of
the enamel matrix followed by
acid dissolution of the mineral .
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13. The proteolytic _chelation
theory
oral bacteria attack organic
components of enamel, and that
the breakdown products have
chelating ability and thus dissolve
the tooth minerals.
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14. Acidogenic Theory:
This theory most acceptable.
Postulated by Miller 1989.
Proposes that acid formed from the
fermentation of carbohydrates by
bacteria leads to decalcification of
the tooth substance with a
subsequent disintegration of the
organic matrix.
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15. Clinical
Characteristics of
Caries
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16. classification of dental caries
1) According to the site
site of the attack:
1) Pit or fissure caries.
2) Smooth surface caries.
3) Cemental or root
caries.
4) Recurrent caries.
2)Classification by the rate of
of the attack:
1) Rampant or acute caries.
2) Slowly progressive or chronic
caries.
3) Arrested caries.
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17. Classification of
Caries according to the
involves site
Pits and fissure caries
Root surface caries
Recurrent caries.
Smooth surface caries
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18. 3. Classification of caries according to severity
• Moderate caries (superficial caries)
• Grater than 0.5 the thickness of
enamel , does not involve the DEJ
•Incipient caries (superficial caries)
•Less than 0.5 the thickness of enamel
Severe caries (deep caries)
Advanced caries (middle caries)
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19. Enamel caries
• cone-shaped, with the base on
the enamel surface and the
apex towards the amelodentinal
junction in smooth surface and
opposite in pit and fissure
caries .
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20. Enamel caries
• In ground sections it consists of serious of zones:
1. Translucent zone.
2. Dark zone.
3. Body of the lesion.
4. Surface zone.
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21. Dentin Caries:
 develops from enamel caries .
when the lesion reaches the ADJ lateral extension results
in the involvement dentinal tubules.
The early lesion is cone shaped with the base at the ADJ.
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22. Dentin Caries
ground section show a zoned lesion :
1. Zone of sclerosis.
2. Zone of demineralization.
3. Zone of bacterial invasion.
4. Zone of destruction.
5. Reactionary, secondary dentin.
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23. Root caries:
• cemental caries is preceded by exposure of the root to the
oral environment as a result of periodontal disease.
•Actinomysis species are
present in large number with
other organisms like S.mutans.
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24. Acute Caries
•Rapid clinical course towards the
pulp resulting in early pulpal
involvement.
•It involves young age group.
•Cavities are usually light-colored.
•Pain is a more common feature .
•Examples: Early Childhood
Caries (ECC)
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25. Rampant
Caries
.
• It is characterized by its speed of
onset and progression.
• often starting with the upper
incisors.
• Most of the teeth are involved.
• Sites which are normally at low risk
of decay may be attacked.
• Often accompanied by systemic
disorder such as saliva reduction
after radiation. 12
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26. Chronic Caries
•Progresses slowly, thus sufficient time
for sclerosis of dentin.
•Involves pulp later than acute caries.
•Brown or dark colored cavity.
•No or less pain due to sufficient time for
the pulp to protect itself by reparative
dentin.
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27. Arrested caries
Enamel
Arrest of an approximal
smooth-surface lesion prior
to cavity formation can
occur when the adjacent
tooth lost and the carious
surface becomes self-
cleansing
Dentin
The loss of unsupported
overlying enamel exposes the
carious dentin and is then
removed by attrition and
abrasion, leaving a hard
polished surface. pigmented,
brown-black in color. Its
surface is hypermineralized.
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28. Methods of caries
diagnosis
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29. Ideal caries detection method
• Should be accurate and precise.
• Should be easy to apply.
• Should be useful for all surfaces of the teeth in
addition to caries adjacent to restoration.
• Should not transfer S.mutans or other bacteria from
affected area to unaffected areas.
• Should be cost effective.
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30. 1) Conventional caries diagnostic methods
a) Use of sharp probe and mirror
known as (Americans method for
caries diagnosis)
Sharp probe may be contraindicated as
the probe may break the
demineralized enamel causing cavity.
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31. 1) Conventional caries diagnostic methods
b) Use of blunt probe and mirror
known as (European method for
caries diagnosis):
 The blunt probe is used to remove
plaque and debris.
 The probe may transfer cariogenic
bacteria from one site to another.
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32. 2) Radiographic methods
‫أكيد‬
‫مازلتوا‬
‫مذكرين‬
‫المحاضرة‬
‫ألى‬
‫فاتت‬
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33. 3) Tooth separation
placement of orthodontic
elastomeric separator between
the teeth to allow direct access
for examination and the patient
returns after 3-4 days.
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34. 4) Advanced caries diagnostic methods:
A. Fiber optic transillumination (FOTI).
B. Digital fiber optic transillumination.
C. Quantitative light fluorescence.
D. Direct digital radiography.
E. Infrared laser fluorescence (DIAGNOdent).
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35. a) Fiber optic transillumination (FOTI):
Technique:
 The technique uses a bright
fiberoptic light.
 The intact tooth absorbs very little
light allowing it free passage while
areas of caries absorb and scatter
light thus appearing dark.
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36. a) Fiber optic transillumination (FOTI):
Advantages:
1) Used with lesions which cannot be diagnosed radiographically
2) No radiation hazards.
3) Comfortable to the patient.
4) Photographs for permanent records can be obtained.
Disadvantages:
Does not detect small lesions.
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37. a) Fiber optic transillumination (FOTI)
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38. b) Digital fiber optic transillumination:
• use digital imaging fiberoptic transillumination and light
image is recorded by a Charge-Couple Device (CCD)
digital camera and are sent to the computer for analysis
this allow more accurate assessment .
• uses to identify lesions located on the interproximal
surfaces.
Advantages:
More sensitive in detecting early lesions when compared to
radiographs.
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39. Digital fiber optic
transillumination
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40. Quantitative light fluorescence:
• a small portable system was developed in which the laser source
was replaced by a regular light source and filter system.
• The images are captured using a color camera.
• Data are collected , stored, and analyzed by custom software.
• Indications : early detection of dental caries on occlusal and
smooth surfaces.
• significant limitation : is its inability to detect interproximal
lesions. 12
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41. Quantitative
light
fluorescence:
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42. ‫أكيد‬
‫مازلتوا‬
‫مذكرين‬
‫المحاضرة‬
‫ألى‬
‫فاتت‬
d) Direct digital radiography
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43. f) Infrared laser fluorescence (DIAGNOdent).
• It uses a diode laser light source
and a fiber-optic cable that
transmits the light to a hand-held
probe with a fiber-optic eye on the
tip.
• The light is absorbed and induces
infrared fluorescence by organic
and inorganic materials.
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44. f) Infrared laser fluorescence (DIAGNOdent).
• The emitted fluorescence is transmitted through ascending
fibers , processed and presented on a display window as an
integer between 0 and 99.
• Increased fluorescence reflects carious tooth substance ,
particularly for numerical values higher than about 20
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45. f) Infrared laser fluorescence (DIAGNOdent).
Advantages:
Early detection of caries.
Disadvantages:
1. The presence of restoration or fissure sealant may
affect the accuracy of the device.
2 . Secondary caries cannot be detected by diagnodent.
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46. 12
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47. Rampant
dental
caries
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48. Rampant dental caries
defined by Massler as “Suddenly
appearing , widespread, resulting in
early involvement of the pulp and
affecting those teeth usually regarded
as immune to ordinary decay”
observed in both children and adults.
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49. Clinical appearance of rampant
caries
• The initial lesion usually appears on the
labial surface of the maxillary incisors,
close to the gingival margins, as a
whitish area of decalcification after
eruption.
• These lesions soon become pigmented
to a light yellow and extend laterally to
the approximal surfaces, and downward
to the incisal edge. 12
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50. causative factors in some cases of rampant
caries
Emotional disturbance.
Salivary deficiency: ( stress, medications are decreased
salivary flow, and decrease caries resistance.
Radiation therapy: results in significantly diminished
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51. Additional factors known to influence dental
caries
• Socioeconomic status .
• Anatomic characteristics of the teeth.
• Arrangement of the teeth in the arch.
• Presence of dental appliances and restorations.
• Hereditary factors.
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52. Early childhood caries,
severe early childhood
caries, nursing caries,
Baby bottle tooth decay
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53. Introduction
• . Caries in primary dentition follows a certain
pattern where :
• the second primary molar is more prone to caries than the
first molar.
• the lower molars are affected by caries more than the upper
molars .
• This pattern of caries may change in some conditions as in
rampant caries and nursing caries.
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54. Early Childhood Caries (ECC)
Definition:
It is diagnosed when there is
one or more decayed (non
cavitated or cavitated lesions),
missing (due to caries) or filled
tooth surface in any primary
tooth in a child 71 months of
age or younger.
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55. Early Childhood Caries (ECC)
• The term severe ECC (S-ECC) refers to :
• Any sign of smooth surface caries in children younger than
3 years.
• •One or more cavitated, missing (due to caries) or filled
smooth surface in primary maxillary anterior teeth in
children 3-5 years.
• DMF score > or = 4 at age 3.
• DMF score > or = 5 at age 4.
• DMF score > or = 6 at age 5
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56. cause of ECC :
Excessive frequent bottle feeding, and/or prolonged bottle or
breast feeding or a pacifier that has been dipped in honey is often
associated with early childhood caries.
 ECC is usually the result of inappropriate feeding pattern: the
child has been put in the bed with a nursing bottle holding
milk, or a sugar-containing beverage. The child falls asleep, and
the liquid becomes pooled around the teeth .
 Note : ( the lower anterior teeth are usually unaffected because tend to be
protected by the tongue).
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57. Prevention of acute caries
(rampant caries or nursing caries)
• prevented by pre and post natal counseling with the
parents to proper feeding habits and proper oral
hygiene measures.
• Controlling and improving maternal oral hygiene can
be helpful in reducing the severity of bacterial
transmission from mother to child during the window
of infectivity
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58. Recommendations for preventing
nursing caries
• Regular feeding schedule should be encouraged.
• Infant should be held while nursing.
• If infant fell asleep, stop feeding, burp and place in bed.
• Avoid nocturnal feeding after the primary tooth begins to
erupt.
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59. Recommendations for
preventing nursing
caries
• when first tooth erupts using a moist cloth or gauze wrapped
around fingers to rub teeth and gingiva.
• Discontinue nursing at 12-15 months (use a cup)
• If night feeding is necessary only water in the bottle.
• The first dental visit between 6 and 12 months of age
• Tooth brushing can start at the age of 18 months.
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60. Control of
Dental Caries
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61. • Pediatric dentists who
see patients on a referral
basis may hear a parent
remark “My child has
so many cavities that
my dentist doesn’t
know where to start”.
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62. Note :
• The successful management of active dental caries
depends on :
1. the parent’s, and/or patient’s interest in maintaining the
patient’s teeth .
2. their cooperation in a customized and specific caries
control program.
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63. Control or Management of dental
caries
1. Control of active carious lesions.
2. Reduction in the intake of fermentable carbohydrates.
3. Reduction of dental plaque and microorganisms with
good oral hygiene procedures.
4. Use of fluorides and topical antimicrobial agents.
5. Restorative dentistry in the control program.
6. Pit and fissure sealants.
7. Reassessment and regular professional supervision.
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64. 1-Control of active carious lesions.
The removal of the superficial caries and the filling of the
cavity GIC or ZOE (IRM) will at least temporarily arrest
the caries process and prevent its rapid progression to the
dental pulp, this is can be done in one( under G A ) or two
(out patient setting ) appointments.
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65. 2- reduction of the intake of fermentable
carbohydrates
 dental caries activity could be increased by the consumption of
sugar if the sugar were in a form easily retained on the tooth
surface.
 The more frequently this form of sugar was consumed
between meals , the greater was the tendency for an increase in
dental caries.
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66. 2- reduction of the intake of fermentable
carbohydrates
 Sweetened liquids provided to young children in nursing
bottles can have numerous cariogenic potential.
 sweetened drinks so popular with older children and
adolescents is another form of snacking that can promote and
accelerate caries progression.
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67. 3-Reduction of dental plaque good oral
hygiene procedures
 supervised tooth brushing with instruction produces
significantly lower plaque scores even in preschool children.
 Dental flossing results in 50% reduction of proximal caries in
primary teeth.
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68. 4- Use of fluorides and topical antimicrobial
agents.
The ingestion of fluoride results in its incorporation into the
dentin and enamel of unerupted teeth; this makes the teeth
more resistance to acid attack . (fluorohydroxyappatite)
 fluoride is secreted into saliva enhances the remineralization
of the underlying enamel.
Fluoride in saliva is also incorporated into the enamel of the
newly erupted teeth thereby enhancing the enamel
calcification.
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69. Fluoridation
 Topical fluoride
• (( professional application at dental office as gels,
foams, and varnishes ))
• ((at home as dentifrices , mouth rinses, gels , Xylitol
chewing gum and other fluoride preparations )).
fluoridation of water supply (( is the most effective
method of reducing the dental caries problem in the
general population)).
School water fluoridation . 12
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70. 12
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71. Fluoride-containing dentifrices ( stannous
fluoride combined with calcium
pyrophosphate ).
not more than pea sized amount of
fluoridated toothpaste should be used when
brushing the teeth of infants and very young
children.
Caution should be exercised for children
under 4 years of age who may not have full
control over their swallowing reflexes.
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72. 5- Restorative dentistry in the control program. ???
cavities can be treated with restorations.
 Advanced cases will need full coronal coverage ( strip
crowns for the anterior teeth and SSC for the posterior
teeth.
 Pulpotomy or pulpectomy are indicated in cases of
extensive caries with pulp involvement.
 if tooth extraction is indicated a prosthetic appliance
should be provided for space maintenance.
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73. 6- pit and fissure sealants.
it is advised to seal the newly erupted
permanent molars
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74. 7) Reassessment and regular
professional supervision:
• This will be carried out every
three months to evaluate the
effectiveness of the control
program.
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75. 12
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76. Managemen
t of dental
caries
How ?????
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