Dental Caries Review and Diagnosis - PDF

DENTAL CARIES REVIEW Dental Caries Disease VS Dental Caries Lesion  DENTAL CARIES DISEASE Dental caries is a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease resulting in net mineral loss of d...

DENTAL CARIES REVIEW Dental Caries Disease VS Dental Caries Lesion  DENTAL CARIES DISEASE Dental caries is a biofilm-mediated, diet modulated, multifactorial, non-communicable, dynamic disease resulting in net mineral loss of dental hard tissues. It is determined by biological, behavioral, psychosocial, and environmental factors. As a consequence of this process, a caries lesion develops. Fejerskov 1997, Pitts et al., 2017, Machiulskiene V. et al. 2020 TERMINOLOGY Caries Lesion “The results of a localized chemical dissolution of the tooth surface caused by metabolic events taking place in the biofilm (dental plaque) covering the affected area. The destruction can affect enamel, dentin and cementum.”  UNERUPTED ENAMEL SURFACE Very outermost enamel-porous Perikymata Pits of Tomes’ processes Intercrystalline space  DEMINERALIZATION AND REMINERALIZATION OF DENTAL HARD TISSUE Under physiological condition (pH 7.4) saliva and the oral fluids are supersaturated with respect to hydroxyapatite and fluorapatite. If oral fluids were unsaturated with respect to apatite the dental hard tissues would dissolve.  SOLUBILITY OF HYDROXYAPATITE Salivary concentrations of Calcium and phosphate- horizontal line. Caries develops in pH 4.0- 5.5 Erosion in pH 2.5-4.0 CARIES DEMINERALIZATION  Subsurface hydroxyapatite is dissolved, while fluorhydroxyapatite is formed at surface layers of ename The more undersaturated the plaque fluid with respect to hydroxyapatite, the greater the tendency fo dissolution of enamel apatite Moth-eaten surface appearance if pH in plaque fluid decreased for a long period of time. MICROSCOPICAL & CLINICAL CHANGES IN ENAMEL COVERED BY PLAQUE 1 week Wider intercrystaline space Loss of mineral to depth 20-100 µ 2 weeks Increase porosity Subsurface lesion Visible whitish when air-drying After 3 and 4 weeks Increase porosity More extensive loss of mineral beneath the outer surface Visible whitish without air-drying WHITE SPOT LESION  ENAMEL LESION (POLARIZED LIGHT MICROSCOPE) Quinoline 1. Surface zone 2. Body of lesion 3. Dark zone 4. Translucent zone  SURFACE ZONE (1) Dynamic equilibrium of enamel surface and oral fluid Protective role of salivary proline-rich proteins and other salivary inhibitors; Prevent spontaneous and selective precipitation of calcium phosphate directly onto enamel surface Inhibit demineralization Specific inherent properties; ultrastructural and chemical composition.  Body of the lesion (2) Most pronounced of the loss of minerals Dark zone (3) Located between translucent zone and body of the lesion Pore volume 2-4% Precipitation of minerals in the demineralized translucent zone. Result in smaller pore; quinoline can’t penetrate into the small pore Translucent zone (4) 5-100 µm in width Pore volume >1% RI of Quinoline = RI of Enamel = 1.62, translucent RI of Water = 1.33, RI of air = 1  PULPO-DENTINAL RESPONSE TO CARIES LESIONS Slowly progressing lesion Rapidly progressing lesion Bacteria invade into dentinal Tubular sclerosis tubule Reparative dentin Destruction of odontoblastic process; “Dead tract” Inflammation in pulp No tubular sclerosis Pulp response; forms tertiary dentin from secondary odontoblast Inflammation in pulp leading to reversible or irreversible pulpitis  DENTIN REACTION TO CARIES PROGRESSION Tubular sclerosis (Translucent dentin); “Deposition of mineral at peritubular dentin within dentinal tubules + calcification of Odontoblastic process” Defence reaction of pulpo-dentinal organ Three stimuli that accelerate tubular sclerosis Age Attrition Caries PULPO-DENTINAL REACTION BEFORE BACTERIAL INVASION INTO DENTIN Initial tubular sclerosis is seen before the advancing front of enamel lesion reaches DEJ PULPO-DENTINAL REACTION BEFORE BACTERIAL INVASION INTO DENTIN When caries lesion reaches DEJ, the first sign of dentin demineralization can be seen along the junction in term of brownish discoloration. CARIES DETECTION AND DIAGNOSIS Dr. Supattriya Chutinan  LEARNING OBJECTIVES Students will learn how to perform caries diagnosis process Students will be able to detect caries on occlusal, smooth surface, and proximal surface Students understand the process of visual-tactile caries diagnosis criteria Students will be able to interpret proximal caries on radiographic images Students will be able to select the appropriate caries examination on each location Students will be able to differentiate the change on tooth structure due to caries and other causes DENTAL CARIES LESION CARIES LESION IS THE CLINICAL SIGN OF CARIES. CARIES LESIONS CAN BE CATEGORIZED ACCORDING TO THEIR ANATOMICAL LOCATION ON THE TOOTH (CORONAL OR ROOT/CEMENTUM SURFACE), THEIR SEVERITY (E.G., NON- CAVITATED, CAVITATED), DEPTH OF PENETRATION INTO THE TISSUE (E.G., ENAMEL, DENTIN, PULP), AND THEIR ACTIVITY STATUS (ACTIVE, INACTIVE).  REVIEW CARIES LESION IN DENTINE Innes et. Al., 2016  CARIES PROCESS REVIEW DENTINE CARIES Active caries in dentin is soft and yellowish-brown color. Soft and wet= Heavily infected Soft and dry= Significantly less infected Hard=Minimally infected Stain did not correlate to infection  CARIES DIAGNOSIS The clinical judgement integrating available information, including the detection and assessment of caries signs (lesions), to determine presence of the disease. The main purpose of clinical caries diagnosis is: 1. To achieve the best health outcome for the patient by selecting the best management option for each lesion type 2. To inform the patient 3. To monitor the clinical course of the disease Nyvad et al., 2015. Caries Research, 2020  CARIES DIAGNOSTIC CONCEPTS Essentialistic caries concept Nominalistic caries concept  ESSENTIALISTIC CARIES CONCEPT Signs Caries Causes and Process Symptom Current concept of caries diagnosis  NOMINALISTIC CARIES CONCEPT Signs and Causes Caries Symptoms Considerable concept of caries diagnosis  WHY DO WE DO CARIES DIAGNOSIS? Achieve the best To do restoration? health outcome for the patient by selecting the best management option for each lesion type Inform patient Monitor the clinical course of the disease  ACHIEVE THE BEST HEALTH OUTCOME FOR THE PATIENT BY SELECTING THE BEST MANAGEMENT OPTION FOR EACH LESION TYPE Not require Professional Nonoperative Operative any management means intervention professional intervention Wait Reassessment OHI Sealant Nutrition counseling Fluoride varnish Drill and Fill Behavior management See  FACTORS THAT INFLUENCE TO SELECT THE BEST MANAGEMENT OPTION FOR EACH LESION TYPE Cavitated caries lesions VS Noncavitated and microcavitated caries lesions Active caries lesions VS Inactive caries lesions  CAVITATED CARIOUS LESION Difficult to control biofilm by oral hygiene process Treatment of choice ; Operative Intervention Restoration makes it easier to perform proper oral hygiene but doesn’t manage the cause of caries If cavitated carious lesion is inactive and hard, restoration is required only due to need for function and cosmetic reason  NONCAVITATED AND MICROCAVITATED CARIOUS LESION Can be managed by nonoperative means such as tooth brushing with fluoride toothpaste or professional fluoride application depends on the activity state of lesion and risk factors.  ACTIVE VS INACTIVE CARIOUS LESION Active noncavitated carious lesion – Likely to progress Daily removal of biofilm ACTIVE CAVITATED CARIOUS LESION  INACTIVE CARIOUS LESION Not require any professional intervention  INFORMING THE PATIENT Patients’ role – Control the process Dentists’ role – Inform the patient of diagnosis and treatment options, and whether any action is required.  LONGITUDINAL ASSESSMENT OF CARIES PROCESS Active-Inactive / Inactive-Inactive ; Positive outcome Active-Active / Inactive-Active ; Lack of compliance, consider whether the chosen intervention is suitable CARIES DETECTION & DIAGNOSIS Caries detection + Caries risk assessment Caries diagnosis CARIES DETECTION  CARIES DETECTION The identification of the signs of dental caries. Caries lesions can be detected clinically at various detection thresholds and stages, e.g., non-cavitated, micro- cavitated, and cavitated. Caries lesions can also be detected by supplementary detection tools, such as radiography and optical and electrical methods. In vitro caries lesion detection includes histology, transmission and scanning electron microscopy, as well as confocal laser scanning microscopy Caries Research 2020 IMPORTANCE OF CARIES DETECTION “The more accurate and early the detection can be, the better the diagnosis will be, and the more effective the preventive approach will be.” Featherstone, Early Detection of Dental Caries, 1996  CARIES DETECTION INDICES Provide a Carious lesions The location, quantitative method may be classified development, and for measuring, by progression of lesions scoring, and differs depending on analyzing dental location conditions in individuals and Location Smooth surface groups Etiology Pit and fissure Rate of progression Affected hard tissues  CARIES DETECTION INDICES Provide a Carious lesions The location, quantitative method may be classified development, and for measuring, by progression of lesions scoring, and differs depending on analyzing dental location conditions in individuals and Location Smooth surface groups Etiology Pit and fissure Rate of progression Affected hard tissues  CARIES DETECTION INDICES Provide a Carious lesions The location, quantitative method may be classified development, and for measuring, by progression of lesions scoring, and differs depending on analyzing dental location conditions in individuals and Location Smooth surface groups Etiology Pit and fissure Rate of progression Affected hard tissues TECHNIQUE  TECHNIQUE Traditional diagnostic techniques Visual Visual and Tactile Detection based on site, severity and activity Detection Technology Radiographic, Laser Fluorescence, LED, QLF, FOTI, and Spectra  DETECTION METHODS BY SITE Occlusal Visual or Visual and tactile Hardest to detect Approximal Use bitewing radiographs Easiest to remineralize Facial/Lingual Use direct visual and tactile Most difficult to restore because they are usually on root surface  VALIDATION METHOD Receiver Sensitivity and operating specificity characteristic curves (ROC) TRADITIONAL DIAGNOSTIC TECHNIQUES  VISUAL EXAMINATION Cleaned, dry, good lighting Surface texture Change in color (white or brown spot) Dark shadow Cavitation Temporary tooth separation technique (2-3 days)  VISUAL-TACTILE Clean, dry, good lighting Dull explorer / Sharp eye Softness or binding of explorer or probe tip  MECHANICAL BINDING OF EXPLORER MAY BE DUE TO Shape of fissure Sharpness of explorer Force of application Probing accelerated the rate of subsequent caries progression “Lesions were converted into cavities upon probing with the size of the defect related to the pressure force“ van Dorp et al, 1988 , Yassin, 1995 EXPLORERS 17-40% correct May damage intact surface May transfer bacteria to other sites False positive or False negative D'Hondt et al., 1982  Visual inspection plus probing may lead to a number of teeth with undetected dentin caries DO NOT POKE LESIONS! Use of an explorer does not improve validity of the diagnosis of fissure caries when compared to visual inspection alone Verndonschot et al., 1992 Lussi, 1991  INFECTED VS. AFFECTED DENTIN Infected Dentin Soft and wet Many bacteria Tan in color Affected Dentin Remineralized already (Schlerotic Dentin) Hard and dry Few bacteria Deminineralization (Demineralized dentin) under bacterial layer Slightly softer, dryer Few bacteria Dark or black in color Stain Not an indicator of bacteria but may help with activity status Kidd et al., 1993 OCCLUSAL LESIONS Difficult to detect depth Difficult to quantify radiographically Difficult to clean Difficult to monitor remineralization Require aggressive prevention Rock & Kidd, 1988 DETECTION OF LESIONS ON FACIAL/LINGUAL SURFACES (USE DIRECT VISUAL AND TACTILE EXAM) Roots hardest to restore (consider glass ionomer cement) The lesion will be either: White-spot Brown-spot Cavitated or not Active or arrested REMINERALIZATION IS AN OPTION Demin Remin Dull + Rough Smooth + = active decay Shiny = inactive G.V. BLACK CARIES CLASSIFICATION CLASS I CARIES-EARLY CLASS I CARIES-LATE CLASS II CARIES- EARLY CLASS II CARIES-LATE CLASS III CARIES- MODERATE CLASS III CARIES-LATE CLASS V CARIES - EARLY CLASS V CARIES-LATE  ICDAS CARIES CLASSIFICATION SYSTEM ICDAS II: A NEW APPROACH International Caries Detection and Assessment System II A visual classification system that correlates with known histology Introduced in 2004 Coding consists of 2-digits First digit refers to presence of sealants or restorations Second digit refers to the carious lesion classification EADPH logo ICDAS II: A NEW APPROACH For use on coronal and root surfaces, as well as caries adjacent to restorations and sealants. These unifying, predominantly clinical, criteria code a range of the characteristics of clean, dry teeth in a consistent way that promotes the valid comparison of results between studies, settings, and locations. ICDAS criterion record both enamel and dentin caries and explore the measurement of caries activity in all of the domains.  1 0 2 6 3 4 5 ADA Caries Classification HSDM CARIES CLASSIFICATION (PROPOSED) HSDM Caries Classification Sound Initial Moderate Advanced Secondary Caries Proposal Clinical presentation No clinically Earliest clinically Visible signs of enamel Enamel is fully cavitated 1. Carious defects of < detectable lesion. detectable lesion breakdown or signs of the and dentin is exposed. 0.5 mm with the Dental hard tissue compatible with mild dentin is moderately Dentin lesion is signs of distinct visual appears normal in demineralization. Lesion demineralized deeply/severely change in color, translucency, is limited to enamel or to demineralized. enamel/dentin and gloss. shallow demineralization adjacent to a of cementum/dentin. restoration/sealant Mildest form detectable margin only after drying. When 2. Marginal caries in established and active, enamel/dentin/cem lesion may be white or entum adjacent to brown and enamel lost restoration/sealant its normal gloss. with underlying dark shadow from dentin 3. Distinct cavity adjacent to restoration/sealant 4. Extensive distinct cavity with visible dentin Other label No surface change or Visually noncavitated Established early cavitated, Spread/disseminated, late adequately restored shallow cavitation, cavitated, deep cavitation microcavitation Appeareance of occlusal surfaces (Pit and fissure) Accessible smooth surfaces including cervical and roots Radiographic presentation of the approximal surface  HARD TISSUE CHARTING TRADITIONAL CARIES CLASSIFICATION Primary carious lesion Incipient carious lesion Secondary carious lesion  DEFINITION Primary carious lesion “The original carious lesion of the tooth. Carious lesions originating in enamel pits and fissures, enamel smooth surface, and root surface.” It can be referred to white or brown color with evidence of cavitation and/or dark shadow. Softness or binding of explorer or probe tip. There is an evidence of carious lesions in DEJ and Dentine.  DEFINITION Incipient carious lesion “A caries lesion without evidence of cavitation using clinical tools such as light, good eyesight, radiographs (interproximal lesions in enamel). This lesion is still potentially reversible by biochemical means.”  DEFINITION Secondary carious lesion “The caries that occurs at the junction of a restoration and the tooth and may progress under the restoration. It is often termed recurrent caries.” HSDM CARIES CLASSIFICATION (OCCLUSAL CARIES) HSDM Caries Classification Sound Initial Moderate Advanced Secondary Caries Proposal Clinical presentation No clinically Earliest clinically Visible signs of enamel Enamel is fully cavitated 1. Carious defects of detectable lesion. detectable lesion breakdown or signs of the and dentin is exposed. < 0.5 mm with the Dental hard tissue compatible with mild dentin is moderately Dentin lesion is signs of distinct appears normal in demineralization. Lesion is demineralized deeply/severely visual change in color, translucency, limited to enamel or to demineralized. enamel/dentin and gloss. shallow demineralization adjacent to a of cementum/dentin. restoration/sealant Mildest form detectable margin only after drying. When 2. Marginal caries in established and active, enamel/dentin/ce lesion may be white or mentum adjacent brown and enamel lost its to normal gloss. restoration/sealant with underlying dark shadow from dentin 3. Distinct cavity adjacent to restoration/sealant 4. Extensive distinct cavity with visible dentin Other label No surface change or Visually noncavitated Established early cavitated, Spread/disseminated, late adequately restored shallow cavitation, cavitated, deep cavitation microcavitation Appeareance of occlusal surfaces (Pit and fissure) Accessible smooth surfaces including cervical and roots Radiographic presentation of the approximal surface  Sound Initial Moderate Advanced Sound tooth First visual Distinct Localized Underlying Distinct Extensive surface; no change in visual enamel dark shadow cavity with distinct caries enamel; change in breakdown from dentin, visible cavity with change seen only enamel; with no with or dentin; frank dentin; after air after air seen when visible dentin without cavitation cavity is drying (5 drying, or wet, white or or underlying localized involving less deep and sec); or colored colored, shadow; enamel than half of wide hypoplasia, change “wider” than discontinuity breakdown a tooth involving wear, “thin” limited the of surface surface more than erosion, and to the fissure/fossa enamel, half of the other confines of widening of tooth noncaries the pit and fissure phenomena fissure area  Sound Initial Moderate Advanced Sound tooth First visual Distinct Localized Underlying Distinct Extensive surface; no change in visual enamel dark shadow cavity with distinct caries enamel; change in breakdown from dentin, visible cavity with change seen only enamel; with no with or dentin; frank dentin; after air after air seen when visible dentin without cavitation cavity is drying (5 drying, or wet, white or or underlying localized involving less deep and sec); or colored colored, shadow; enamel than half of wide hypoplasia, change “wider” than discontinuity breakdown a tooth involving wear, “thin” limited the of surface surface more than erosion, and to the fissure/fossa enamel, half of the other confines of widening of tooth noncaries the pit and fissure phenomena fissure area  Sound Initial Moderate Advanced Sound tooth First visual Distinct Localized Underlying Distinct Extensive surface; no change in visual enamel dark shadow cavity with distinct caries enamel; change in breakdown from dentin, visible cavity with change seen only enamel; with no with or dentin; frank dentin; after air after air seen when visible dentin without cavitation cavity is drying (5 drying, or wet, white or or underlying localized involving less deep and sec); or colored colored, shadow; enamel than half of wide hypoplasia, change “wider” than discontinuity breakdown a tooth involving wear, “thin” limited the of surface surface more than erosion, and to the fissure/fossa enamel, half of the other confines of widening of tooth noncaries the pit and fissure phenomena fissure area  Sound Initial Moderate Advanced Sound tooth First visual Distinct Localized Underlying Distinct Extensive surface; no change in visual enamel dark shadow cavity with distinct caries enamel; change in breakdown from dentin, visible cavity with change seen only enamel; with no with or dentin; frank dentin; after air after air seen when visible dentin without cavitation cavity is drying (5 drying, or wet, white or or underlying localized involving less deep and sec); or colored colored, shadow; enamel than half of wide hypoplasia, change “wider” than discontinuity breakdown a tooth involving wear, “thin” limited the of surface surface more than erosion, and to the fissure/fossa enamel, half of the other confines of widening of tooth noncaries the pit and fissure phenomena fissure area HSDM CARIES CLASSIFICATION (SMOOTH SURFACE CARIES) HSDM Caries Classification Sound Initial Moderate Advanced Secondary Caries Proposal Clinical presentation No clinically Earliest clinically Visible signs of enamel Enamel is fully cavitated 1. Carious defects of detectable lesion. detectable lesion breakdown or signs of the and dentin is exposed. < 0.5 mm with the Dental hard tissue compatible with mild dentin is moderately Dentin lesion is signs of distinct appears normal in demineralization. Lesion is demineralized deeply/severely visual change in color, translucency, limited to enamel or to demineralized. enamel/dentin and gloss. shallow demineralization adjacent to a of cementum/dentin. restoration/sealant Mildest form detectable margin only after drying. When 2. Marginal caries in established and active, enamel/dentin/ce lesion may be white or mentum adjacent brown and enamel lost its to normal gloss. restoration/sealant with underlying dark shadow from dentin 3. Distinct cavity adjacent to restoration/sealant 4. Extensive distinct cavity with visible dentin Other label No surface change or Visually noncavitated Established early cavitated, Spread/disseminated, late adequately restored shallow cavitation, cavitated, deep cavitation microcavitation Appeareance of occlusal surfaces (Pit and fissure) Accessible smooth surfaces including cervical and roots Radiographic presentation of the approximal surface  INITIAL Carious opacity or brown carious discoloration with no sign of cavitation of the enamel surface. There is a clearly demarcated area on the root surface or at the cement-enamel junction (CEJ) that is discolored (light/dark brown, black) but there is no cavitation present (loss of anatomical contour < 0.5 mm).  Moderate Visible sign of enamel breakdown or signs of dentine is moderately demineralized There is a clearly demarcated area on the root surface or at the CEJ that is discolored (light/dark brown, black) and there is cavitation (loss of anatomical contour ≥ 0.5 mm ≤ 2 mm (Moderate) ICCMS) Advanced Cavitation due to caries exposing the dentin beneath. There is a clearly demarcated area on the root surface or at the CEJ that is discolored (light/dark brown, black) and there is cavitation (loss of anatomical contour > 2mm (Extensive)) pre LET’S PRACTICE  Surface texture Change Cavitation in color Dark Shadow  Surface texture Change Cavitation in color Dark Shadow  Surface texture Change Cavitation in color Dark Shadow  Surface texture Change Cavitation in color Dark Shadow  Surface texture Change Cavitation in color Dark Shadow RADIOLOGRAPHIC  DIGITAL RADIOGRAPH 1989 Film is replaced by sensitive Charge Coupled Device (CCD) Image fiber-optic Computer Lower dose of radiation Provide instantaneous images Accuracy was comparable to conventional technique (Haak et al, 2001) HSDM CARIES CLASSIFICATION (PROXIMAL CARIES) HSDM Caries Classification Sound Initial Moderate Advanced Secondary Caries Proposal Clinical presentation No clinically Earliest clinically Visible signs of enamel Enamel is fully cavitated 1. Carious defects of detectable lesion. detectable lesion breakdown or signs of the and dentin is exposed. < 0.5 mm with the Dental hard tissue compatible with mild dentin is moderately Dentin lesion is signs of distinct appears normal in demineralization. Lesion is demineralized deeply/severely visual change in color, translucency, limited to enamel or to demineralized. enamel/dentin and gloss. shallow demineralization adjacent to a of cementum/dentin. restoration/sealant Mildest form detectable margin only after drying. When 2. Marginal caries in established and active, enamel/dentin/ce lesion may be white or mentum adjacent brown and enamel lost its to normal gloss. restoration/sealant with underlying dark shadow from dentin 3. Distinct cavity adjacent to restoration/sealant 4. Extensive distinct cavity with visible dentin Other label No surface change or Visually noncavitated Established early cavitated, Spread/disseminated, late adequately restored shallow cavitation, cavitated, deep cavitation microcavitation Appeareance of occlusal surfaces (Pit and fissure) Accessible smooth surfaces including cervical and roots Radiographic presentation of the approximal surface  INITIAL Radiolucency in the outer half of enamel (E1) Radiolucency in the inner half of enamel up to DEJ (E2)  Moderate Radiolucency at DEJ (Late E2) Radiolucency limited to outer 1/3 of dentin (D1) Advanced Radiolucency reaching the middle third of dentin (D2) Radiolucency reaching the inner third of dentin (D3) Radiolucency reaching the pulp (D3)  BITEWING RADIOGRAPH #13 M (initial), D (advanced) #3 M(advanced), D(initial) #14 M(advanced), D(advanced) #4 M D (advanced) #19M(initial), D(initial) #5 D(advanced) #20 M(initial), D(moderate) #30 M D(moderate) #21 D(moderate)  BITEWING RADIOGRAPH Advantages Most effective method for evaluation approximal caries Small approximal carious lesions at an early, potentially reversible stage. Provide permanent record Noninvasive  BITEWING RADIOGRAPH Disadvantages Use of ionizing radiation Inability to obtain direct confirmation of whether the approximal surfaces are cavitated. (not all proximal radiolucencies are associated with cavitation) Underestimate / overestimate Subjective interpretation RADIOGRAPHIC DETECTION AND INTERPRETATION RADIOGRAPHIC DETECTION AND INTERPRETATION THE IMPORTANCE OF CAVITATION OCCLUSAL VS APPROXIMAL LESIONS THE APPROXIMAL LESION LESION SEVERITY CLASSIFICATION E0= No Lesion E1= Lesion in the outer half of enamel E2=Lesion in the inner half of enamel D1=Lesion in the outer third of dentin D2=Lesion in the middle third of dentin D3=Lesion in the inner third of dentin Kidd, 2005  AN IN VIVO COMPARISON OF RADIOGRAPHIC AND DIRECTLY ASSESSED CLINICAL CARIES STATUS OF POSTERIOR APPROXIMAL SURFACES IN PRIMARY AND PERMANENT TEETH N. B. PITTS AND P. A. RIMMER CARIES RESEARCH, 1992  SECONDARY DENTITION 0% 10.8% 40.9% 100% % Cavitation Pitts N.B., Rimmer M.A. Caries Res 1992;26:146-152.  PRIMARY DENTITION 0% 2.9% 28.4% 48% % Cavitation Pitts N.B., Rimmer M.A. Caries Res 1992;26:146-152. RADIOGRAPHIC DETECTION AND INTERPRETATION LET’S PRACTICE DETECTION TECHNOLOGY  PRINCIPLE OF FLUORESCENT IRIDESCENCE Tooth surface fluoresces when irradiated by blue-violet light wavelength The fluorescence changes in response to the optical characteristics of tooth tissue, associated with bacteria The value of this change may indicate the extent of the disease process LASER FLUORESCENCE Targets bacterial porphyrins Increased effectiveness when fissures are clean  DIAGNODENT THERAPY DISPLAY VALUE 0 – 14 No special measures. 15 – 20 Usual prophylactic measures. 21 – 30 More intensive prophylaxis or restoration: Indication is dependent on caries activity, caries risk, recall interval, etc. 30+ Restoration and more intensive prophylaxis. LIGHT EMITTING DIODE (LED) LED light is absorbed into healthy tooth= Green light LED light is reflected or scattered in demineralized tooth=Red Light Helpful with occlusal or approximal lesion detection  QUANTITATIVE LIGHT-INDUCED FLUORESCENCE® (QLF) Identifies pre-invasive caries via scattering properties of visible light http://www.inspektordentalcare.com/nl/media/img/IPSide.JPG Active early lesions are porous and less transparent than sound enamel and dentin, resulting in a lower fluorescence. System allows for tracking of progression or regression of dental caries System provides visual feedback of depth of lesions QUANTITATIVE LIGHT-INDUCED FLUORESCENCE® (QLF) White Light QLF FIBER-OPTIC TRANS-ILLUMINATION Helpful in diagnosing smooth surface and approximal caries on unrestored teeth Peers, 1993  DEXIS CARIVU Patented transillumination technology by using near infrared light Make enamel appear transparent while porous lesion trap or absorb the light SPECTRA CARIES DETECTION AID Spectra identifies cariogenic bacteria based on the fluorescence principle. LED's project high-energy blue light onto the tooth surface. Light of this wavelength stimulates bacteria to fluoresce red, while healthy enamel fluoresces green. AUTO FLUORESCENCE  PRINCIPLES OF ELECTRICAL IMPEDANCE Impedance is an electrical parameter that is directly influenced by the physical properties of the material being investigated Use of multiple electrical frequencies using a method is known as the AC Impedance Spectroscopy Technique (ACIST) THE CARIESCAN PRO The product platform is based on the application of a technique called ac impedance spectroscopy (ACIST) A small electrical current is passed through the patient’s tooth & response is measured Comparison of the response with the applied signal leads to the impedance measurement  THE CANARY SYSTEM PTR-LUM technology to detect early caries and monitor remineralization therapy Laser light is shone onto the tooth, the system measures the level of glow (luminescence or LUM) and heat (Photo-Thermal Radiometry or PTR) released from the tooth.  PARAMETERS CONCERNING CARIES ACTIVITY (DIAGNOSIS) Immediate past caries experience Development of new lesions within a certain period of time Progression of the lesions Progression or arrest of previously registered lesions Structure: shiny, matte, smooth, cavitated Appearance of the lesions/cavities Consistency: hard, soft Moistness: wet, dry Color: white, yellow, brown, black Lesions only on sites of predilection or on Location of the lesions/cavities sites not normally affected by caries Lesions covered or not covered by plaque; Presence of plaque/gingivitis gingival inflammation near lesion or not