Caries Detection and Diagnosis

Diagnosis of Caries

• Diagnosis involves identifying disease through signs and symptoms, primarily informed by lesion detection and patient caries risk evaluation.
• Clinicians make the final diagnosis decision based on initial findings and further assessments.

Methods of Caries Detection

• Visual and Tactile Examinations

  • Visual inspection is the most common but subjective; relies on color and texture.
  • Limited detection ability for early, noncavitated lesions in enamel.
  • Tactile examination uses explorers but rigorous probing can lead to further cavitation and bacterial invasion.
  • Dental floss is effective for detecting caries, but can be misled by dental calculus.
  • Methods are quick, easy, and don’t require expensive tools.

• Radiographic Techniques

  • Utilizes traditional and digital x-rays to locate caries, including proximal and secondary caries.
  • Non-invasive method essential for assessing caries proximity to the pulp chamber.
  • Common radiographs include periapical and bite-wing; identifies radiolucency indicating demineralization.
  • Digital radiography enhances diagnostic yield and reduces radiation exposure; facilitates easy archiving and replication.
  • Misdiagnosis can arise from superimposition, cone angulation, and film positioning issues.

• Electrical Current Measurement

  • Increased porosity in carious tissue results in higher fluid content, detectable by electrical resistance changes.
  • The Electronic Caries Monitor (ECM) measures the "bulk resistance" of tooth tissue using fixed-frequency alternating current.
  • Factors affecting ECM readings include tooth temperature, tissue thickness, hydration, and surface area.
  • Provides objective data for monitoring lesion progression, arrest, or remineralization.

• Visible Light Techniques

  • Techniques include Fiber Optic Transillumination (FOTI), Digital image Fiber Optic Transillumination (DiFOTI), and Quantitative Light-induced Fluorescence (QLF).
  • FOTI and DiFOTI exploit light scattering in sound versus carious enamel for detection.

• Other Techniques

  • Additional methods include the use of dyes, ultrasound techniques, and photo-thermal radiometry to detect caries.

Importance of Accurate Detection

• Early detection is crucial for effective treatment and prevention of caries progression.
• Different techniques provide a multi-faceted approach to diagnosing caries, enhancing overall dental care outcomes.