The document discusses the objectives and methods of caries diagnosis and prevention. It aims to identify lesions requiring treatment, persons at high risk, and assess factors like patient history, clinical examination, investigations. Prevention methods include plaque control, fluoride use, diet modification, pit and fissure sealants, and caries control restorations to limit bacterial growth and remineralize early lesions.

2. Objectives of caries diagnosis
To identify
 lesions that require restorative treatment,
 lesions that require non restorative treatment,
 persons who are at high risk for developing
carious lesions.

3. Assessment tools
Stepwise progression towards diagnosis and treatment
planning depends on thorough asssessment of the
following
 Patient history
 Clinical examination
 Nutritional analysis.
 Salivary analysis
 Radiographic assessment

4. History
Factors to be considered are
 age
 fluoride exposure
 medications .
 dietary habits
 general health
 past caries experience.

5. Examination
1.Visual examination
o Inspection
o Transillumination, magnification.
 Visual evidence of caries includes white spot ,cavitation,
or discoloration.

6. Non cavitated enamel
caries (white spot)

9. Fiberoptic transillumination

10. 2.Tactile examination ;
 Tactile evidence of caries includes roughness and softness
of the tooth surface , using explorers (or dental floss)
 Injudicious use of sharp dental explorers on
noncavitated,subsurface lesions could cause a cavitation
3.Dyes
o Selectively complex with carious tooth structure which is
later disclosed with the help of fluorescence.

12. Investigations
o Radiological diagnosis is valuable in the
identification of interproximal caries and recurrent
caries.
o Bitewing radiographs are the view of choice for
diagnosis of occlusal and proximal caries in posterior
teeth.

13. Radiography versus histology

14. Radiographs have limitations in diagnosing caries
1. cannot detect occlusal carious lesions that are
confined to enamel
2. Radiography taken on one occasion is unable to
distinguish an actively progressing from a passive
lesion,.
3. Occlusal caries has to be quite advanced in dentin
before enamel radiolucency and cavitation are seen on
the radiograph.
4. False-positive radiological diagnoses of caries occur
with cervical “burnout”

15. Investigations
Additional investigations may include
 Dietary analysis
 Salivary analysis
bacterial count
flow rate
buffering capacity

16. Caries diagnosis for pits and
fissures
 Discoloration of pits and grooves, limited to the depth
of the fissure or pit, is almost a universal finding in
normal healthy teeth of adults
 Additional criteria include
(1) opacity surrounding the pit or fissure, indicating
undermining or demineralization of the enamel;
(2) softened enamel that may be flaked away by the
explorer.

19. Caries diagnosis for pits and
fissures
Mechanical binding of an explorer in the pits or
fissures may be due to noncarious causes, such as
o the shape of the fissure,
o sharpness of the explorer, or
o force of application.

20. Caries diagnosis for pits and
fissures
 Porous enamel (resulting from demineralization)
appears chalky, or opaque, when dried with
compressed air.
 The diagnosis is confirmed when the affected area is
rehydrated (wetted) and the chalky area partially or
totally disappears.

21. Caries diagnosis for smooth
surfaces
 Proximal smooth surfaces are not readily assessed
visually or tactilely
 Bitewing radiographs are used.
 Lesions on buccal and ligual surfaces are almost always
seen in individuals with high caries activity.

22. Caries diagnosis for smooth surfaces
 Incipient lesions have intact surfaces .
CARE SHOULD BE TAKEN TO
AVOID DAMAGING THE
SURACE WITH AN EXPLORER
TIP

24. Caries diagnosis for root surfaces
 Active, progressing root caries shows little
discoloration and is primarily detected by the presence
of softness and cavitation
 Root caries is usually shallow initially, spreads laterally,
 light brown to yellow (although white at first),and
without patient symptoms.
Early diagnosis is
essential.

27. Advanced methods for early detection of
caries
 Laser fluoresence

28. Advanced methods for detection of caries
 Electric caries monitor

29. Advanced methods for detection of caries
 Fiberoptic transillumination

31.  The primary goal of a caries prevention should
be to reduce the numbers of cariogenic bacteria.
 Preventive treatment methods are designed to limit
tooth demineralization caused by cariogenic bacteria

32. Risk factors

General health of the patient

Fluoride exposure history

Frequent sugar containing diet

Poor oral hygiene

Low salivary flow

Deep pits and fissures


33. Modifying the carious process

Can be influenced by factors such as oral hygiene ,diet
, fluoride and salivary flow .

In addition a number of other variables are important
such as social class, income, education, knowledge
,attitudes and behavior .

34. Prevention and control

The primary goal of caries prevention should be to
reduce the numbers of cariogenic bacteria

Caries control methods are operative procedures used
both to stop the advance of individual lesions and to
prevent the spread of pathogenic bacteria.

35. Important factord in caries
prevention are :

Plaque control

Use of fluoride

Salivary stimulation or replacement

Dietary modification

Pit and fissure sealants

Caries control restorations

36. Plaque control

Brushing , flossing

Brushing and flossing And rinsing after every meal is
indicated for high risk patients .

Antimicrobial agents e.g chlorhexidine

Chlorhexidine varnish enhance remineralization and
decreases MS presence

Immunization


37. Fluoride use
Fluoride in trace amounts increases the resistance of tooth
structure to demineralization
Forms of administration :
1- fluoridated community water systems (1ppm)
2- tooth paste
3- mouth rinses
4- professional topical application
Acidulated phosphate fluoride , sodium fluoride, stannous
fluoride .
•
Indication for fluoridated mouth rinses are high risk
patients e.g pt with orthodontic appliances , dry mouth .

38. Levels of caries prevention
 There are various levels for prevention of dental
caries .
1. Primary prevention(maintaining a disease free
state)
2. Secondary prevention (reverse, arrest incipient
caries)

39. Methods of Caries prevention
1. Increasing the resistance of tooth structure to
demineralization
2. Modification of diet
3. Plaque control
Limiting pathogen growth

40. 1. Increasing resistance of tooth structure
to caries
a. fluoride exposure.
b. use of pit and fissure sealants

41. Forms of fluoride administration
• Fluoridated community water systems
• Salt and milk fluoridation
• Fluoride tablets and drops.
systemic
• Toothpastes
• Mouth rinses
• Professional topical application
topical

42. Protective role of fluoride
Fluoride exerts its anticaries effect by three different
mechanisms.
 The presence of fluoride ion greatly enhances the
precipitation into tooth structure of fluorapatite .
This insoluble precipitate replaces the soluble salts
containing manganese and carbonate that were lost
because of bacteria-mediated demineralization
 Incipient, noncavitated , carious lesions are
remineralized by the same process.
 Fluoride has antimicrobial activity

43. Pit and fissure sealants

44. Indications for Use of Sealants
Do Not Seal
Seal
Criteria
Teeth that have remained
caries-free for ≥4 yr;
Recently erupted teeth
Tooth age
Wide, easily cleaned grooves
Deep, retentive, narrow pits
and fissures
Occlusal morphology
Teeth that have remained
caries-free for ≥4 yr;
Teeth showing signs of
softening or opacity in pit or
fissure
Recent caries activity
.
Proximal cavitated lesion on
tooth to be sealed, cavitation of
occlusal (tooth will require
restoration)
Occlusal or smooth surface
lesions on other teeth; no
proximal cavitated lesions on
tooth to be sealed
General caries activity

45. 2.Modification of diet
 Limitation of sucrose to meal times
 Replacement of sucrose by other sweeteners(xylitol,
sorbitol)
 Addition of caries inhibiting agents(ca, p, f)

46. Modification of diet
The goals of dietary counseling should be
 to identify the sources of sucrose in the diet and
reduce the frequency of sucrose ingestion.
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47. Saliva stimulation or replacement

Saliva may be stimulated by chewing gum (xylitol)

Xylitol is a natural sugar it keeps the sucrose molecule
from binding with MS .

MS can not ferment (metabolize ) xylitol

In case of Sjogren’s syndrome or postdadiotherapy to
head and neck , a saliva substitute may be required.


48. 3. Plaque control
 Mechanical method (brushing , flossing)
 Chemical methods (chlorhexidine)

49. Plaque control: mechanical method

50. Flossing

51. Plaque control: chemical method
 Antimicrobial agents e.g.chlorhexidine, xylitol
 Chlorhexidine( varnish , rinse) enhances
remineralization and decreases MS presence.

52. Xylitol
 Xylitol is a natural sugar .
 It seems to have several mechanisms of action to
reduce caries incidence.
 It keeps the sucrose
molecule from binding with MS. MS cannot ferment
(metabolize) xylitol, so no acid is produced.
Xylitol reduces MS by altering the metabolic pathways.
xylitol chewing gum is effective in reducing caries

53. Recent prevention methods
Amorphous calcium – phosphates(ACP) compounds:
 Have the potential to remineralize tooth structure.
Probiotics :
 The fundamental concept is to inoculate the oral cavity
with bacteria that will compete with cariogenic
bacteria and eventually replace them

54. Caries control restorations

Caries control is an intermediate step in restorative
treatment .

Temporary restorative materials (intermediate restorative
Material (IRM) are usually the treatment materials of
choice .

Indications :

Teeth with questionable pulpal prognosis

When a tooth is unexpectedly found to have extensive
caries

The goal of treatment is to remove the nidus of caries
infection in the patient’s mouth .