Dental Caries Detection Techniques

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Questions and Answers

What is the sensitivity percentage of radiographic examination for proximal surfaces?

90.5%

75%

59% (correct)

95%

What phenomenon can create a false positive response resembling cervical caries?

Cervical burnout (correct)

Overexposure to radiation

Tooth decay

Periapical lesions

Which software reportedly improves the sensitivity of caries detection in radiographic examinations?

Digital Radiography System

Advanced Imaging Software

Caries Detector Pro

Logicon Caries Detector (correct)

In which scenario does cervical burnout disappear in radiographic imaging?

In a periapical radiograph of the same tooth Signup and view all the answers

What percentage reflects the specificity of radiographic examination for proximal surfaces?

95% Signup and view all the answers

What is the significance of brown spots on intact enamel in older patients?

They are a result of extrinsic staining from previous caries episodes. Signup and view all the answers

What is indicated if dental floss tears during a tactile examination on proximal surfaces?

There may be a cavity with sharp edges present. Signup and view all the answers

Which technique is NOT reliable for detecting early-stage lesions?

Digital radiographic imaging Signup and view all the answers

What is a common misconception regarding brown spots on older patients' teeth?

They represent current decay requiring treatment. Signup and view all the answers

What does extensive cavitation result in concerning the marginal ridge?

Undermining of the marginal ridge resulting in dark shadows. Signup and view all the answers

Which statement is true regarding the resistance to caries of discolored areas?

They are more resistant due to fluorohydroxyapatite formation. Signup and view all the answers

What does fiber optic transillumination primarily assess?

Cavitation presence and depth. Signup and view all the answers

How can overlapping images in digital radiography affect diagnosis?

They may lead to false positive results. Signup and view all the answers

What is the primary purpose of resin infiltration in treating enamel caries lesions?

To penetrate the lesion and prevent its progression Signup and view all the answers

What is the role of Icon-Etch in the resin infiltration technique?

To erode the surface layer of the lesion Signup and view all the answers

Which of the following steps follows after etching with Icon-Etch in the resin infiltration procedure?

Application of an ethanol desiccant Signup and view all the answers

How long is the low viscosity resin infiltrant applied during the infiltration step?

5 minutes Signup and view all the answers

What visual change can be expected in lesions after successful resin infiltration?

They resemble the appearance of sound enamel Signup and view all the answers

Which component of the resin infiltration technique is used to create capillary force for resin penetration?

Low viscosity resin Signup and view all the answers

When considering alternative treatments for white spot lesions, resin infiltration may serve as an alternative to which of the following?

Microabrasion and restorative treatments Signup and view all the answers

What is the effect of desiccation in the resin infiltration process?

It enhances the bonding of resins to enamel Signup and view all the answers

What is the initial site of plaque accumulation that leads to early proximal lesions on posterior teeth?

Below the contact area Signup and view all the answers

What characterizes the preparation design for a box shape cavity in a dental restoration?

Extends buccally and lingually to include proximal caries Signup and view all the answers

What should be avoided in tunnel preparation for carious lesions?

Heavy occlusion on the marginal ridge Signup and view all the answers

Which of the following statements regarding caries in relation to the marginal ridge is true?

A strong marginal ridge can remain intact if the lesion is below 2.5 mm from the crest Signup and view all the answers

What is the recommended approach when a large carious lesion is diagnosed?

Seek alternative methods due to difficult access Signup and view all the answers

What is the primary advantage of tunnel preparations?

The preservation of intact and strong marginal ridges Signup and view all the answers

During lesion development in enamel, what is a characteristic change that occurs?

Confined breakdown of enamel, limited to below the contact area Signup and view all the answers

What happens to the zone of demineralized enamel as proximal lesions develop?

It generally surrounds the area of cavitation Signup and view all the answers

What is the recommended clearance for amalgam when freeing the contact area?

0.5mm Signup and view all the answers

Which of the following statements about composite materials is true?

B and L margins must remain intact and smooth. Signup and view all the answers

What is indicated for caries that have not advanced beyond the outer third of the dentine?

Resin infiltrate Signup and view all the answers

What does a lesion that has progressed beyond the outer third of the dentine require?

Traditional invasive therapy Signup and view all the answers

Which margin of a restoration must be checked to ensure smoothness in composite procedures?

Gingival margin Signup and view all the answers

What is the requirement if initial lesions are detected on a neighboring tooth during invasive treatment?

Application of Icon Signup and view all the answers

What area does the gingival margin typically extend to in healthy gums?

To the crest of the healthy gum margin Signup and view all the answers

Why is it necessary to remove excess material in amalgam restoration?

To prevent complications in contact area Signup and view all the answers

What is the most suitable position for entry when accessing a lesion on the tooth?

On the fossa next to the medial marginal ridge Signup and view all the answers

Which type of cavity preparation is characterized by leaving the demineralized approximal enamel intact?

Closed 'tunnel' preparation Signup and view all the answers

Which material is best suited for small cavities due to its ability to flow and remineralize enamel margins?

Glass ionomer Signup and view all the answers

What is a significant disadvantage of the closed 'tunnel' preparation technique?

It may damage the pulp due to close angles Signup and view all the answers

What is a crucial consideration when preparing a closed 'tunnel' preparation?

Adjusting for the angulation of access Signup and view all the answers

Under what condition is the approach of an intact occlusal surface indicated?

With gingival recession or wide embrasure Signup and view all the answers

What potential issue arises from reduced visibility during a closed 'tunnel' preparation?

Higher risk of incomplete caries removal Signup and view all the answers

What is a primary characteristic of a fragile marginal ridge during cavity preparation?

It must be more than 2.5 mm apical to the crest Signup and view all the answers

Study Notes

Proximal Caries Detection

Anterior teeth are more visible and accessible for examination than posterior teeth.
Visual examination starts as a white spot on the proximal surface, and proximo-facial and lingual line angles.
Visual detection can occur as a color change in the marginal ridge, after the lesion has developed considerably.
When caries invades the proximal enamel surface, demineralizing dentin causes a white chalky shadow under the marginal ridge.

Tooth Separation

Careful visual and tactile examination is done after temporary tooth separation (1-2 days) with orthodontic rubber rings (0.2-1mm spacing).
Injection of silicon impression material verifies cavitation after separation.

Extensive Cavitation

Extensive cavitation results in undermining of the marginal ridge, appearing as a dark shadow beneath the marginal ridge (MR).

Brown Spots on Intact Enamel

Brown spots on intact, hard proximal enamel, adjacent to the contact area, are common in older patients with low caries activity.
These discolored areas result from extrinsic stains during early caries and subsequent remineralization episodes.
The areas are less carious and resist caries due to fluorohydroxyapatite formation; therefore, treatment isn't necessary.

Tactile Examination

Tactile examination of proximal surfaces with dental floss can detect cavities with sharp edges.
If the floss tears, there is likely a cavity present.

Fiber Optic Transillumination (FOT/DIFOTI)

FOT/DIFOTI doesn't detect early lesions or distinguish between cavitation and its absence.
Overlapping images can give false positive results.

Radiography

Radiographs show lesions that have progressed histologically.
Radiographic examination of the proximal surfaces exhibits high specificity (95%) but moderate sensitivity (59%). Digital software is used for greater sensitivity (90.5%).

Overlapped Teeth and Burnout

Cervical burnout appears as a radiolucent band around tooth necks, more pronounced at proximal edges.
X-ray photons overpenetrate or "burn out" the thinner tooth edge.

Radiographic Scoring Systems

Scoring systems (ICDAS/ICCMS™) classify radiographic caries into stages like incipient, moderate, advanced, and severe based on radiolucency extent within enamel and dentin.

Conservative Management of Cavitated Lesions

Simple class II, conventional, box-only (occlusal slot), tunnel, and buccal/lingual slot designs are used for proximal cavity preparations.

Simple Class II Design

Missing adjacent teeth, senile caries with gingival recession, widely embrasured rotated teeth, and access through adjacent cavities are situations requiring this design.

Proximal Box-Only (Occlusal Slot)

This design involves access from the occlusal surface preparing a box-shaped cavity extending buccally/lingually and including proximal caries.

Tunnel Preparation

The early proximal lesion on a posterior tooth begins below the contact area, where plaque accumulates.
Demineralization and cavitation may occur but remain confined until well-advanced.
A zone of demineralized enamel surrounds the cavitation.

Indications and Contraindications for Tunnel Preparation

Suitable for small proximal carious lesions preserving the marginal ridge.
Avoid for large carious lesions, difficult access, and heavy occlusions or crack in the tooth.
Entry point may be from fossa immediately next to medial marginal ridge.
Glass ionomer is ideal for small cavities, remineralizing enamel and dentin axial walls.

Disadvantages of Tunnel Preparation

Highly technique-sensitive and requires precise operator control to maintain marginal ridge, potentially close to pulp.
Reduced visibility and uncertainty of caries removal, needing specialized caries detecting solutions.
Fragile marginal ridge requires care (at least 2.5mm apical to crest).

Facial or Lingual Slot

This design is indicated when the occlusal surface is intact and has wide embrasures or gingival recession.
These slots provide excellent resistance and retention.

Resistance and Retention Form

Retentive grooves are placed in facial/lingual slot designs, which are positioned occlusally and cervically.

Resin Infiltration Technique

Used for early caries lesions not penetrating beyond the outer third of the dentin.
Low-viscosity light-curing resins (infiltrants) are applied to eroded/desiccated surface layers.
Resin penetrates into microporosities using capillary force and light curing to harden and stop progression.

Resin Infiltration Technique - Steps

Etch (15% hydrochloric acid gel) for 2 minutes, rinse.
Dry (Ethanol) for 30 seconds.
Apply infiltrant (low viscosity resin) for 5 minutes.
Use proximal tips and wedges during application.

Management Based on Lesion Activity and Risk Level

Management options (Non-Operative care [NOC], Tooth-Preserving Operative care [TPOC], and Plaque Stagnation Area [PSA]) are detailed.
Based on caries activity, risk-based prevention (NOC) or more involved TPOC treatments are implemented.

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Description

This quiz explores the techniques used in detecting proximal caries and understanding various characteristics of dental decay. It covers visual examination methods, signs of caries in different tooth areas, and the implications of extensive cavitation on dental health. Test your knowledge on the nuances of caries detection and its significance in dental treatments.