Dental Diagnosis and Caries Assessment

Hard Tissue Diseases and Abnormalities

• Diagnosis of hard tissue diseases and abnormalities depends on prevalence, clinical signs and symptoms, and follow-up imaging techniques.
• Learners should be able to detect and diagnose carious lesions (dental decay) and their sequelae (complications).
• Other imaging techniques are essential for comprehensive detection and diagnosis of various hard tissue abnormalities.
• A key aspect of diagnosis includes differentiating dental caries (cavities) from other dental abnormalities such as dental fluorosis, erosion, attrition, fracture, abfraction, cracked tooth syndrome and others.
• Linking caries or other hard tissue abnormalities to systemic health conditions and/or their treatment is critical. Management demands early detection of carious lesions to identify patients requiring intensive preventative intervention.

Objectives

• Detect and diagnose hard tissue diseases or abnormalities.
• Clinically detect and diagnose carious lesions and sequelae.
• Radiographically detect and diagnose carious lesions and sequelae.
• Use other imaging methods for caries detection.
• Differentiate dental caries from other dental abnormalities (fluorosis, erosion, attrition, fracture, abfraction, cracked tooth syndrome).
• Link hard tissue abnormalities to systemic health conditions and treatment.

Oral Diagnostic Process

• A thorough oral diagnostic process is necessary for accurate diagnosis.
• Initial history or health history, general health history, medication history, personal history, social history, emotional history, behavioral history, and oral health history are key aspects of the initial assessment.
• Medical or dental consultations should be considered
• Ninety percent of diagnoses can be established accurately with a thorough history and physical exam.
• Specialized examinations and supplementary exams (radiology, labs, biopsies) are important if the above is inconclusive. About 10% of diagnoses require more specialized investigation

Caries Diagnosis

• Early detection of carious lesions is crucial for effective management
• A critical component is linking a patient’s systemic health to dental caries
• Assessing the clinical presentation of caries is imperative such as the characteristics (pit and fissure lesions versus smooth surface lesions)
• Determining contributing factors is necessary
• Patient's complete diagnosis should be comprehensive.

Diagnostic Tools & Methods

• Traditional caries diagnosis is often subjective, with low sensitivity and high specificity.
• Visual examination (inspection), tactile sensation using an explorer and radiographic examination are traditional methods.
• Other methods may include quantitative laser (or light fluorescence), electrical conductance measurements, infrared (IR) laser fluorescence, digital imaging using fiber-optic transillumination, two-dimensional radiographic imaging, optical coherence tomography and CBCT.

Symptoms & Signs of Dental Caries

• Symptoms include current complaints (CC) and history of complaints (HPI)
• Signs can be clinical-visual, tactile, or based on thermal or other diagnostic tests in addition to radiography
• The detection of characteristics (smooth surface vs pit and fissure lesions) is critical for appropriate diagnostic classification
• Complete diagnosis requires the identification of contributing factors and a comprehensive diagnostic list for the patient's dental caries.

Criteria for Diagnosis

• Clinical and radiographic findings are essential.
• Correlate history, symptoms, clinical findings, radiographic findings, and patient's systemic health status.
• Complete diagnosis should include details for a decayed tooth and a comprehensive diagnosis for the entire patient.

ICD-10 CM Diagnostic Terms

• Use ICD-10-CM disease names and codes for consistent and accurate record-keeping.
• Specific criteria and symptoms are associated with each dental disease coded.
• The ADA provides official and definitive resources for dental terminology (CDT).

Caries Sequelae

• Different stages of dental caries can lead to various sequelae, including pulpitis, pulpal necrosis, apical periodontitis, acute apical abscess, chronic apical abscess and osteomyelitis of the jaw.

Types of Caries

• Enamel: characterized by a change in color or texture
• Dentin: sensitive to sweets and temperatures (potentially spontaneous pain)
• Pulp: spontaneous pain, which can progress to more serious inflammation if care is not initiated

Diagnostic Process

Visual assessment

• Use appropriate lighting (inspecting clean, dry tooth surfaces)
• Tactile sensation is necessary using exploration tools and instruments.
• Radiographic findings are an essential component of establishing a comprehensive diagnosis.

Diseases of the Pulp and Periapical Tissues

• This section details the ICD-10-CM codes for various pulp and periapical diseases.

Disease Process and Sequelae of Dental Decay

General overview of the disease process.

• Dental decay and sequelae are presented
• The process of decay progressing into the tooth
• Symptoms and signs associated with dental issues

Deep Neck Infections

Classifications of deep neck infections

• The most prevalent causes are frequently odontogenic
• DM (Diabetes Mellitus) is the most common systemic condition
• The risk factors associated with deep neck infections can be linked to glycemic control and presence of diabetes

Acute Apical Periodontitis (AAP)

• AAP is a manifestation of acute inflammation of periapical tissue
• It is a consequence of pulpitis and/or pulpal necrosis.

Acute Apical Abscess (AAA)

• Usually a consequence of AAP.
• Severe pain with pressure or percussion.
• No thermal response (when pulp necrotic)
• Often results from pus formation.

Chronic Apical Periodontitis (CAP)

• Chronic apical periodontitis (CAP) involves chronic inflammation of the periapical tissue.
• CAP originates from pulpal necrosis or other causes.
• Radiographic findings often help establish a diagnosis

Chronic Apical Abscess (CAA)

• This is an abscess with a sinus tract, often from chronic apical periodontitis
• Pus discharge through gingiva
• Poorly defined radiolucency near the root apex

Condensing Osteitis

• A radiographic term for a type of chronic periodontitis.

Osteomyelitis of the Jaw

• Bone inflammation.
• Common consequence of odontogenic infections, often associated with dental decay.
• Affected areas may not be limited to the root apex

Differential Diagnosis

Methods to differentiate between various conditions.

Dental Decay in Patients with Diabetes

• The outcome of dental decay and sequelae may be worse in patients with uncontrolled diabetes mellitus.

Supporting Evidence for Differential Diagnoses

• Supporting data from research studies is presented.

Examples

• Case studies, or examples of how the above concepts manifest clinically are included in the presentation.

Diagnostic Terminology and Codes

• ICD-10-CM, SNODENT codes are relevant for classifying and diagnosing these conditions. CDT is also presented as a source of information.