Preventive Dentistry

Caries Diagnosis

Lec.21 Dr.Jihan Abdulhussein

Saliva It is about detection of sign and symptoms of caries. The caries diagnostic criteria
used and the means and methods employed have changed overtime. Clinical caries
diagnosis completely depend on visual –tactile examination using a probe to search for
caries lesions.
Assessment Tools
1. Patient history
2. Clinical examination
3. Nutritional analysis
4. Salivary analysis
5. Radiographic assessment
Method of Caries Detection
Clinically for treatment purpose , Invivo method
For research purpose, In vitro method
Invivo Method
1. Visual- Tactile examination
2. Radiographic examination
3. Fiber optic transillumination
4. Fluorescence
5. Electronic resistance method
6. Caries detection dyes
Visual-Tactile Examination
• Discoloration of teeth
• White spot on teeth (active non-cavitated)
• Lesion clinically visible (frank cavitation)
• Rough surface
Visual examination of caries use criteria such as
• Mouth mirror
• Temporary elective tooth separation
- Used in both deciduous & permanent dentition
The emphasis is on a visual examination, rather than a visual–tactile examination,
because the sharp probes which were traditionally used to aid diagnoses are
contraindicated for a number of reasons.
1-The probe does not improve diagnosis—all a ‘sticky’ fissure means is that the probe
fits the fissure.
2-Probing a demineralized lesion will break the enamel matrix, making remineralization
impossible and thus creating a cavity.
3-The probe may transfer cariogenic bacteria from one site to another free sites with
cariogenic bacteria.
4-A ball-ended or blunt probe can be used gently to confirm the presence of cavitation,
sealants, and restorations.
The first visible sign of caries is the white spot lesion, which at first can only be seen
when the surface is dried .
This is because when demineralized enamel becomes porous, the pores contain water; if
dried, the water in the pores is replaced with air and the lesion becomes more obvious.
This appearance is enhanced if the lesion is dried; the water is removed from the porous
lesion. Water has a similar refractive index (RI) to enamel, but when it is removed and
replaced by air, which has a much lower RI than enamel, the lesion is shown more
clearly. This demonstrates the importance of ensuring the clinical caries examinations are
undertaken on clean, dry teeth detection of caries on all surfaces and is particularly useful
at proximal lesions.
Unfortunately, active carious lesions are not the only causes of white areas on teeth.
Hypoplasia, fluorosis, and arrested hypermineralized carious lesions, can all mimic a
white spot carious lesion.
The decision as to the etiology depends on factors such as site and surface
characteristics. Caries tends to occur at predilection sites; therefore a white area at the
gingival margin is much more likely to be caries than one of similar appearance at the
incisal edge.
Active carious lesions are matt white with a rough surface, while arrested lesions tend to
be glossy with a smooth surface. A similar process is conducted for brown spot lesions.
Tactile Examination
Instrument
1. Mouth mirror
2. Explorer
3. Sharp /blunt probe
4. Floss
Criteria of Tactile Examination
* Roughness & softness
* Catch if present (Penetration & resistance to removal of the probe)
* Soft floor of cavitation is detected with probe
Disadvantage of Use of Explorer
* Physical damage to small lesion with intact surface
* Probing may lead to fracture & cavitation in incipient lesion
* Mechanical binding of explorer in deep pit & fissure leading to feeling of catch
Radiographic Examination
Digital radiographs
Digital radiography has offered the potential to increase the diagnostic yield of dental
radiographs, and this has manifested itself in subtraction radiography
Subtraction radiology
using digital radiographs offers a number of opportunities for image enhancement,
processing, and manipulation. One of the most promising technologies in this regard is
that of radiographic subtraction, which has been extensively evaluated for both the
detection of caries and also the assessment of bone loss in periodontal studies
* Dental radiograph provide useful information in diagnosing carious lesion .
* Radiograph may show lesion that is not visible clinically
* Radiography is a non- invasive method
* Radiograph can be filed and re-examined for comparison
Disadvantages of Radiography
1. Technical difficulty
* Exposure
* Angulation
* Tooth position
* Interpretation bias
2. Demineralization in enamel that is visible radiographically may not be indicative of
active caries
3. Conventional radiograph are 2 – D image
Fiber Optic Transillumination (FOTI and DiFOTI)
The basis of visual inspection of caries is based upon the phenomenon of light scattering.
Sound enamel is comprised of modified hydroxyapatite crystals that are densely packed,
producing an almost transparent structure. The color of teeth, for example, is strongly
influenced by the underlying dentin shade. When enamel is disrupted, for example in the
presence of demineralization, the penetrating photons of light are scattered (that is, they
change direction, although do not lose energy), which results in an optical disruption. In
normal, visible light, this appears as a ‘whiter’ area—the so-called white spot.
Different index light transmission for decayed &sound teeth. Decayed tooth has a lower
index for light transmission than the sound tooth
1. Area of decayed show a darken shadow
2. Specially effective in anterior region
3. Adjuvant to visual radiographic examination
4. FOTI does not detect small lesion (this is limit of its use)

Fluorescence
Visible emission spectra differ for decayed & non decayed region of tooth. Largest
difference between carious and non carious lesion found at 600 nm.
DiagnoDent by Ka Vo, 1999.
New Method of caries detection, Based on principle of fluorescence
This system has a range of (0 to 99),0 indicate tooth is sound
This method detect
1. Early stage of pathological changes.
2. Initial lesion
3. Demineralization changes
4. Precavitation stage of caries
5. Determining the caries involvement in different area of same tooth.

Detection systems based on electrical current measurement

A number of physical factors also will affect ECM results. These include such things as
the temperature of the tooth, the thickness of the tissue, the hydration of the material (that
is, one shouldn’t dry the teeth prior to use), and the surface area ,ECM is capable of
longitudinal monitoring and that clinicians may be able to employ the device to monitor
attempts at remineralizing, and thus potentially arresting, incipient lesion and root caries
lesions .