caries diagnosis and treatment planning Flashcards
what is dental caries?
> Disease of mineralized dental tissues caused by action of microorganisms on fermentable carbohydrates
> In its early stages the disease can be arrested -remineralization is possible above critical pH of 5.5
what does the clinical caries diagnosis process involve?
- Caries detection (non-cavitated or cavitated)
- Diagnosing if lesion: arrested/ active/ progressing rapidly
- Recording findings
what does early caries diagnosis allow us to do?
> successful prevent caries and manage the patient
what is the WHO classification of caries? (iceberg dental caries)
> sub-clinical initial lesions in a dynamic state of progression regression = no active care advised
> lesions detectable with only traditional diagnostic aids = preventative care advised
> D1 - clinically detectable enamel lesions with intact surfaces = preventative care advised
> D2 - clinically detectable cavities limited to the enamel = preventative care advised
> D3 - clinically detectable lesions in dentine = preventative and operative care advised
> D4 - lesions in pulp = preventative and operative care advised
what are all classifications of caries?
CLASSIFICATION BASIS
> Anatomical site = Occlusal/ smooth surface (proximal/buccal)/root
> Activity = active/ arrested
> Virginity = primary/ resurrent
> Extent = incipient/ compound/ cavitation
> Tissue = initial/superficial/moderate/deep/deep complicated OR enamel/dentine/pulp
> No. of surfaces = simple/ compound/ complex
> Chronology = early child hood/ adolescent/ adult
> Tooth surface affected = mesial/ distal/ occlusal/ buccal
> Blacks Classification = class 1,11,111, IV, V, VI
> WHO classification = D1 D2 D3 D4
> ICDAS = code 1-6
what are the conventional technique in diagnosing caries?
> simple visual = dry tooth, separator
> tactile = probe
> radiographs = digital image enhancement, digital subtraction radiography
what are novel techniques used to diagnose caries?
> electrical correct = electrical conduction measurement, electrical impedance
> fluorescence = visual (QLF), laser (diagnodent)
> enhanced visual techniques = FOTI, DiFOTI
what is required for visual diagnosis of caries?
> Dry tooth – compressed air
> Clean teeth – brush, prophy
> Good light
> Dental mirror
> Sharp eyes
> Blunt or ball ended probe (NOT sharp probe)
what does a white spot lesion indicate on a dry tooth?
> the caries penetrated 1/2 through the enamel
what does a WSL and BSL indicate on a wet tooth?
> the caries is through enamel and may be into the dentine
how do you carry out a temporary tooth separation and what is it used for?
> Elastomeric separator inserted for 30 mins-1 week
> Direct exam or indirectly via impression
> Diagnosis of interproximal lesions
> May avoid need for radiograph/ supplement radiograph
> Multiple visits
how do you carry out a tactile diagnosis of caries?
> Visual is aided by ball ended explorer NOT sharp probe
> Remove any remaining plaque and debris and to check for surface contour, minor cavitation or sealants.
> Sharp probe – not increased accuracy and may damage intact enamel over a carious lesion (Lussi 93)
> Stickness with probe may reflect morphology of fissure (Kidd et al 1993)
what are the % caries detection rates per examination? (lussi 1993)
> Visual inspection of cavitated occlusal lesion
= 62% caries detection
> Bitewings only
= 79% caries detected
> Visual inspection + BW’s
= 90% caries detection
why can clinical diagnosis of caries be difficult?
> Can be difficult e.g. with dentine caries there may be no break in the surface
> Adjunctive diagnostic aids are therefore often required
> Radiographs are the most commonly used.
what are the radiograph options for diagnosing caries in paediatric patients?
> bitewings
> lateral oblique jaw views (extra oral view for uncooperative children)
> OPT
what is first choice for caries diagnosis in children in the deciduous or mixed dentition?
> intra oral radiography (bitewings)
