Diagnosis of Dental Caries BDT3 PDF

# Diagnosis of caries:BDT3 The first page of the presentation features a cartoon image of a dentist checking a tooth with a mirror while holding a dental tool. The title of the page is "Diagnosis of caries:BDT3". ## Definition * Dental caries is an irreversible microbial disease of the calcified...

# Diagnosis of caries:BDT3 The first page of the presentation features a cartoon image of a dentist checking a tooth with a mirror while holding a dental tool. The title of the page is "Diagnosis of caries:BDT3". ## Definition * Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by demineralization of the tooth surface, which often leads to cavitation. * An image of a set of teeth numbered 1 to 6 shows varying degrees of tooth decay. ## The Caries Process * For caries to develop, three factors must occur at the same time: * A susceptible tooth * Diet rich in fermentable carbohydrates * Specific bacteria (regardless of other factors, caries cannot occur without bacteria) ## Cont'd The next page shows a diagram of four overlapping circles representing different factors contributing to dental caries and how they all converge in the center of the graphic to form the caries: * **Individual Factors:** Host and Saliva * **Microorganisms** * **Substrate for microorganisms** * **Duration and frequency of exposure** ## Caries Classification ### Based on tissue involvement * The following bullets describe different stages of caries according to tissue involvement: * **Initial caries:** Demineralization without structural defect * **Incipient (superficial caries):** Enamel caries, but has not yet penetrated the dentin. * **Moderate:** Dentin caries. Extensive structural defect. Caries has penetrated up to the dentin * **Deep caries (Advanced):** Deep structural defect. Caries has penetrated up to the dentin layers of the tooth close to the pulp. * **Deep complicated caries (severe):** Caries has led to the opening of the pulp cavity (open pulp). ### Based on anatomical site * **Occulsal** * **Smooth surface caries** * **Linear enamel caries** * **Root caries** ## Smooth Surface Caries * Includes Class V buccal, lingual surfaces of anterior and posterior teeth, and Class II interproximal surfaces of all teeth below the interproximal contact points. ## Pit and Fissure Caries * Includes Class I occlusal surfaces of posterior teeth, lingual pits of maxillary incisors. * **Signs** * Softening at the base of pit and fissure * Opacity surrounding the pit or fissure, indicating demineralization of enamel * Brown-gray discoloration radiating peripherally from the pit or fissure * Softened enamel that may be flaked away by explorer. ## Root Surface Caries * Root surface caries occurs where there is a recession of the gingival margin. Caries originating on the root is alarming because * It has a comparatively rapid progression * It is often asymptomatic * It is closer to the pulp * It is more difficult to restore ## Linear Enamel Caries * Linear enamel caries (odontoclasia) is seen to occur in the region of the neonatal line of the maxillary anterior teeth. The line, which represent a metabolic defect such as hypocalcemia or trauma of birth, may predispose to caries, leading to gross destruction of the labial surface of the teeth (labial surfaces incisor teeth). * An image shows an example of linear enamel caries. ## Secondary or Recurrent Caries * Includes caries seen adjacent to or beneath an existing restoration. * An image shows an example of secondary or recurrent caries. An image follows showing a diagram of a tooth with labels showing "smooth surface cavity", "pit and fissure cavity", and "root cavity". Two more images follow showing different examples of tooth decay. ## Diagnosis of Caries * Diagnosis is the process of identifying disease by its signs, symptoms, and results of various diagnostic procedures. * Caries diagnosis implies deciding whether a lesion is active (progressing) or whether it is already arrested. ## Types of dx * **PROVISIONAL DIAGNOSIS:** It is also called tentative diagnosis or working diagnosis. It is formed after evaluating the case history & performing the physical examination. * **DIFFERENTIAL DIAGNOSIS:** The process of listing out of 2 or more diseases having similar signs and symptoms of which only one could be attributed to the patient's suffering * A final diagnosis is only possible after carrying out further investigations. ## Assessment tools for proper diagnosis A diagram shows the following in order: * **Patient history** * **Clinical Examination** * **Nutrition analysis** * **Salivary analysis** * **Radiograph assessment** ## Signs & Symptoms * **Cavity symptoms include:** * Toothache * Sensitivity to sweet, hot or cold foods or drinks * Pain when chewing ## Conventional methods of caries detection * **Visual Detection (light and minor Most commonly applied method)** * **Tactile sensation with explorers** * **Radiographs** ## Visual-tactile methods * The traditional method of detecting caries signs is by visual inspection of dental surfaces, with the aid of a bright light and dental mirror * Detection of white spot, discoloration * Frank cavitations Explorers are widely used for the detection of carious tooth structure * Dental floss ## Cont'd * **Explorer is useful to remove plaque and debris and check the surface characteristics of suspected carious lesions.** * All surfaces of a tooth are cleaned of debris and plaque, using an air syringe and examined visually. Suspicious areas are explored to check for the surface texture ## Benefits and limitations of Visual Diagnosis * Visual diagnosis is quick and easy to perform, does not require expensive equipment, and can be completed without unnecessary radiation. * Currently, activity assessment according to the criteria suggested by the ICCMS™™ is considered the best choice for performing a caries diagnosis. * Visual-tactile diagnosis requires subjective evaluations to be made by the practitioner. Lesions can go undetected because teeth are typically examined by the naked eye, and there is need for supplemental analysis ## Radiographic diagnosis * Radiographic examination is useful to confirm the extent of caries, to detect lesions where visual examination of the tooth surface is hampered, and to serve as an aid in making appropriate clinical decisions. * Proper diagnosis of caries is made through a combination of the clinical examination and radiographs. * E.g of interproximal caries in the posterior region usually requires radiographs to make a diagnosis. * **Radiographs types:** * **Bitewing** * **periapical radiograph** * **occlusal radiographs** An image follows showing different types of radiographs used for the diagnosis of dental caries. Another image shows various examples of radiographs with red arrows pointing to areas of radiolucencies indicating caries. ## Radiographic view A table shows the stages of caries, an illustration, and the corresponding radiographic images for each stage: | Stages | Illustration | Radiographs | |---|---|---| | Incipient | [Illustration of incipient caries] | [Radiographs showing incipient caries] | | Moderate | [Illustration of moderate caries] | [Radiographs showing moderate caries]| | Advanced | [Illustration of advanced caries] | [Radiographs showing advanced caries]| | Severe | [Illustration of severe caries] | [Radiographs showing severe caries] | ## ICCMS RADIOGRAPHICAL SCORING SYSTEM A table shows a rating system for assessing different stages of dental caries according to the amount of radiolucency observed in a radiographic image. | STAGE | SCORE | CRITERIA | |---|---|---| | Initial stage | 1 | Radiolucency in the outer ½ of the enamel | | | 2| | | | 3| | | Moderate stage | 4 | Radiolucency reaching the middle 1/3 of dentin | | Extensive stage | 5 | Reaching the inner 1/3 of the dentin | | | 6 | Radiolucency into the pulp, clinically cavitated | ## Risks of radiographic diagnosis * Possible health risks of exposure to **low-dose** radiation in children, who appear to be more at risk than adults, include parotid, bone marrow, and thyroid cancer. * Unnecessary radiation to the patient should be avoided, and care used to reduce radiation exposure if radiography is necessary * Use of protective shield to reduce radiation exposure ## Newer Methods of Caries Detection and Assessment * In addition to the use of radiographic evaluation, the ICCMS recognizes the potential benefits that can be gained by the use of additional, supplemental detection aids as a means of enhancing caries detection. * They can be divided into methods that are based on: * **X-ray** * **Methods based on light emission** * **Methods based on electrical current** ## Methods Based on X-Ray * **Digital radiography** – which is increasingly replacing bitewing radiography and that is as accurate as film for the detection of caries lesions. * **Digital image enhancement** – which studies show can provide superior results to radiographs when enhanced correctly but takes a significant amount of technical skills and expensive equipments * **Digital subtraction radiography** * **Tuned aperture computed tomography** ## Digital radiograph * **Digital radiography is a type of X-ray imaging that uses digital X-ray sensors to replace traditional photographic X-ray film, producing enhanced computer images of teeth, gums, and other oral structures and conditions.** * It uses an electronic sensor placed in the mouth to record images ## Methods Based on Light * **Quantitative laser- light induced fluorescence,** which can quantitatively detect the difference in fluorescence between sound tissue and that of a caries lesion. * **Fiber-optic transillumination** which is qualitative diagnostic methods by which teeth are transilluminated to detect shadows, which has been associated with the presence of carious lesions. * To address the need to decrease patients' exposure to ionizing radiation, clinicians can safely evaluate difficult-to-access proximal surfaces using FOTI to supplement the clinical examination. ## Fiber-optic transillumination * **FOTI is a no-risk, minimally invasive, pain-free procedure that can be used repeatedly during routine dental examinations.** * Using a narrow beam of bright white light directed across the facial and interproximal surfaces, the dry tooth can be visualized for changes in color, texture, tooth surface appearance, and the presence or absence of shadows within the tooth. An image follows showing a dental tool being used to transilluminate teeth. ## Methods Based on Electrical Current * These include electrical conductance and electrical impedance, such as the **CarieScan PRO** system. With the understanding that dentin is more conductive than enamel, and that porous (lesioned) enamel is more conductive than sound enamel, measuring the electrical conductance of the tooth can detect demineralized sites in enamel, sites that have become porous (indicating a lesion), and cavities. ## Special tests * **PULP vitality testing:** Pulp testing may be indicated for selected teeth prior to restorative or orthodontic interventions. * **Electric Pulp Testing:** This involves sending an electric current through the patients tissues to assess the pulp vitality. * **Cold pulp test:** No sensation indicates a non-vital tooth). * **Heat test** * **Percussion:Tenderness** * **Test Cavity:** Cut a cavity, without LA ## Remember that: * Proper diagnosis play a critical role in making a proper treatment. And this is formulated from assessment done on: * **Patient History** * **Clinical examination** * **Nutritional analysis** * **Salivary analysis** * **Radiographic assessment** * Data obtained from PH, CE,NA,SA, and RA are combined by the dentist to identify deviations from the normal tooth. ## References * Philip D.Marsh, Michael V Martin, *Plaque mediated Diseases, DentalCaries and Periodontal diseases in oral Microbiology* * Pickards Manual of Operative Dentistry 6th edition. E.A.M. Kidd and B.G.N. * Robinson HB. *The nature of the diagnostic process*. Dent Clin North Am 1963; 1: 3–8. 2 * Ehrmann EH. *Pulp testers and pulp testing with particular reference to the use of dry ice*. Aust Dent Smith Oxford Medical Publications * Ismail al. *clinical diagnosis of precavitated carious lesions.community oral epidemiol 1997* * Pitts NB,ZeroDT,marsh PD,et al. *Dental caries*. Not.Rev.Dis.primers 2017 may 25 ## End * **Any questions?** * **Assignment**