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?

<p>In a periapical radiograph of the same tooth (C)</p> Signup and view all the answers

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

<p>95% (A)</p> Signup and view all the answers

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

<p>They are a result of extrinsic staining from previous caries episodes. (B)</p> Signup and view all the answers

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

<p>There may be a cavity with sharp edges present. (A)</p> Signup and view all the answers

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

<p>Digital radiographic imaging (A)</p> Signup and view all the answers

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

<p>They represent current decay requiring treatment. (C)</p> Signup and view all the answers

What does extensive cavitation result in concerning the marginal ridge?

<p>Undermining of the marginal ridge resulting in dark shadows. (A)</p> Signup and view all the answers

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

<p>They are more resistant due to fluorohydroxyapatite formation. (D)</p> Signup and view all the answers

What does fiber optic transillumination primarily assess?

<p>Cavitation presence and depth. (A)</p> Signup and view all the answers

How can overlapping images in digital radiography affect diagnosis?

<p>They may lead to false positive results. (B)</p> Signup and view all the answers

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

<p>To penetrate the lesion and prevent its progression (D)</p> Signup and view all the answers

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

<p>To erode the surface layer of the lesion (C)</p> Signup and view all the answers

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

<p>Application of an ethanol desiccant (A)</p> Signup and view all the answers

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

<p>5 minutes (A)</p> Signup and view all the answers

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

<p>They resemble the appearance of sound enamel (D)</p> Signup and view all the answers

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

<p>Low viscosity resin (A)</p> 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?

<p>Microabrasion and restorative treatments (C)</p> Signup and view all the answers

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

<p>It enhances the bonding of resins to enamel (D)</p> Signup and view all the answers

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

<p>Below the contact area (A)</p> Signup and view all the answers

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

<p>Extends buccally and lingually to include proximal caries (A)</p> Signup and view all the answers

What should be avoided in tunnel preparation for carious lesions?

<p>Heavy occlusion on the marginal ridge (B)</p> Signup and view all the answers

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

<p>A strong marginal ridge can remain intact if the lesion is below 2.5 mm from the crest (C)</p> Signup and view all the answers

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

<p>Seek alternative methods due to difficult access (A)</p> Signup and view all the answers

What is the primary advantage of tunnel preparations?

<p>The preservation of intact and strong marginal ridges (D)</p> Signup and view all the answers

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

<p>Confined breakdown of enamel, limited to below the contact area (B)</p> Signup and view all the answers

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

<p>It generally surrounds the area of cavitation (C)</p> Signup and view all the answers

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

<p>0.5mm (A)</p> Signup and view all the answers

Which of the following statements about composite materials is true?

<p>B and L margins must remain intact and smooth. (D)</p> Signup and view all the answers

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

<p>Resin infiltrate (C)</p> Signup and view all the answers

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

<p>Traditional invasive therapy (A)</p> Signup and view all the answers

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

<p>Gingival margin (D)</p> Signup and view all the answers

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

<p>Application of Icon (B)</p> Signup and view all the answers

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

<p>To the crest of the healthy gum margin (C)</p> Signup and view all the answers

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

<p>To prevent complications in contact area (C)</p> Signup and view all the answers

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

<p>On the fossa next to the medial marginal ridge (B)</p> Signup and view all the answers

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

<p>Closed 'tunnel' preparation (A)</p> Signup and view all the answers

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

<p>Glass ionomer (B)</p> Signup and view all the answers

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

<p>It may damage the pulp due to close angles (B)</p> Signup and view all the answers

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

<p>Adjusting for the angulation of access (D)</p> Signup and view all the answers

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

<p>With gingival recession or wide embrasure (D)</p> Signup and view all the answers

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

<p>Higher risk of incomplete caries removal (D)</p> Signup and view all the answers

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

<p>It must be more than 2.5 mm apical to the crest (B)</p> Signup and view all the answers

Flashcards

Radiographic Lesions

Lesions visible on a radiograph indicate deeper progression in the tooth structure compared to what might be seen clinically.

Radiograph Specificity for Proximal Surfaces

Radiographs are very good at identifying proximal caries (95% specificity), but less accurate at detecting them early (59% sensitivity).

Digital Software for Caries Detection

Digital software can significantly improve the sensitivity of detecting proximal caries, reaching 90.5% in some cases.

Cervical Burnout

A radiolucent band around the neck of a tooth that is more pronounced at the proximal edges due to X-ray photons overpenetrating thinner areas.

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Cervical Burnout and False Positive

Cervical burnout can mimic cervical caries, giving a false positive. This can be distinguished by taking a periapical radiograph of the same tooth.

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Tooth separation for view

Having enough space between teeth to see a cavity directly without needing an impression.

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Extensive cavitation

A large cavity causing a weakening of the tooth's edge, visible as a dark shadow underneath.

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Brown spots on enamel

Discolored areas on intact enamel near the gum line, often seen in older patients with low caries activity. These spots are a result of past demineralization and remineralization episodes.

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Tactile examination

Using touch to check for cavities, often with dental floss.

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Tearing floss

Dental floss tearing during examination suggests a sharp-edged cavity.

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Fiber optic transillumination

Using light to see through tooth enamel for caries.

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Radiograph limitations

X-rays can't detect early cavities or distinguish between a cavity and a non-cavity.

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Overlapping images

In x-rays, overlapping can create false positive results.

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Contact clearance for amalgam

The space between the restoration and the tooth surface beyond the contact area, typically 0.5mm for amalgam. This clearance allows for proper condensation forces to extrude excess material without causing distortion.

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Composite Margin Requirements

Unlike amalgam, composites do not require contact clearance. However, the buccal and lingual margins must be smooth and intact, ensuring a perfect fit with the tooth.

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Gingival Margin Placement

The gingival margin of the restoration should extend slightly below the crest of the healthy gum margin and encompass any defects.

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Resin Infiltrate Indications

Resin infiltrate (like Icon) is used to effectively stop caries progression in teeth where X-rays show the lesion hasn't reached beyond the outer third of the dentin (E1-D1).

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When is Resin Infiltrate NOT indicated?

If X-rays show the caries lesion has extended past the outer third of the dentin, resin infiltrate is not appropriate. Traditional invasive therapy is then required.

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Resin Infiltrate for Neighboring Teeth

During invasive treatment for a cavity, if initial lesions are found on adjacent teeth, resin infiltrate can be used to prevent further decay in those teeth.

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Proximal Sealants after Tooth Separation

After teeth are separated for treatment, proximal sealants can be applied to prevent decay in those areas.

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Lesion Infiltration for Initial Non-Cavitated Lesions

Resin infiltrate can be used for initial non-cavitated lesions to strengthen the tooth structure and prevent further decay.

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Occlusal Pit and Fissure Preparation

A type of preparation used when the pits and fissures of a tooth are caries-free. It involves preparing the tooth from the occlusal surface to include proximal caries within a box-shaped cavity.

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Proximal Caries

A type of decay that starts on the tooth's side, often near the contact area with the adjacent tooth.

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Early Proximal Lesion

A small area of tooth decay that begins on the side of a tooth beneath the contact area, where plaque accumulates.

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Contact Area

The point where two adjacent teeth touch.

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Marginal Ridge

The raised edge of a tooth, located on the side of the tooth, just above the contact area.

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Tunnel Preparation

A preparation technique used for small, proximal carious lesions where the marginal ridge remains intact. It involves removing decay through a tunnel-like access.

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Contraindication for Tunnel Preparation

Situations where tunnel preparation should be avoided, such as large carious lesions with difficult access or a weakened marginal ridge.

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Heavy Occlusion

When a tooth experiences excessive biting force, potentially making it difficult to use tunnel preparation.

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Resin infiltration technique

A minimally invasive treatment that involves filling initial enamel caries lesions with low-viscosity resin infiltrants.

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Infiltrants

Low-viscosity light-curing resins that are used to penetrate and fill microporosities in enamel caries lesions.

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How does resin infiltration work?

  1. The surface layer of the lesion is eroded and dried (desiccated). 2. The resin infiltrant is applied, penetrating the lesion's microporosities driven by capillary force. 3. The resin is hardened by light curing.
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What does resin infiltration treat?

Resin infiltration is used to treat initial enamel caries lesions, also known as white spot lesions.

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Icon-Etch

A 15% hydrochloric acid gel used in resin infiltration to erode the surface layer of the enamel lesion.

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Icon-Dry

Ethanol used in resin infiltration to dry the lesion after etching.

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Icon-Infiltrant

The low-viscosity resin used in resin infiltration to penetrate and fill the microporosities of the enamel lesion.

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What are the benefits of resin infiltration?

Resin infiltration can prevent lesion progression, improve the appearance of white spot lesions, and can be an alternative to microabrasion or restorative treatment.

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Closed Tunnel

A tunnel preparation that leaves the demineralized approximal enamel intact.

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Open Tunnel

A tunnel preparation that is accessed from the occlusal surface and exits through the approximal surface.

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Ideal Tunnel Entry Position

The ideal entry point for a tunnel preparation is in the fossa immediately adjacent to the medial marginal ridge.

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Tunnel Preparation Advantages (1)

Tunnel preparation preserves the occlusal surface and marginal ridge, minimizing damage to the tooth.

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Tunnel Preparation Advantages (2)

Glass ionomer is ideal for tunnel preparations, as it flows easily into small cavities and helps remineralize enamel and dentin.

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Tunnel Preparation Challenges (1)

Tunnel preparation requires meticulous technique and careful preparation control by the dentist.

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Tunnel Preparation Challenges (2)

Tunnel preparation can be challenging due to limited visibility and the risk of damaging the pulp.

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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.

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