Caries Diagnosis

Caries balance:
Caries Diagnosis:
Caries diagnosis & ttt has traditionally been limited to the detection &
restoration of cavitated lesions (Drill & Fill), it's a symptomatic ttt only
without dealing with the real cause.
he unaffected teeth are superior to restored teeth, so early detection of caries
(insipient caries) before cavitation is very important.
!efore cavitation, there is serious of deminerali"ation.
Variety of diagnostic methods are available to detect
caries activity at early stage
#. $dentification of subsurface deminerali"ation (inspection, %adiograph& due
upta&e method).
'. !acterial testing.
(. )ssessment of environmental condition such as *+ , salivary flow because there
is no single test has been developed that is #,,-
*redict of later development of cavitated lesions a concept of caries risk has
been promoted.
$f failure to detect caries in early stage, cavitation will occur and diagnosis will
be visually, by tactile sensation & radiographs.
.o single test for caries is diagnostic #,,-
herefore , multiple criteria must be used & the diagnostic criteria
should be ad/usted according to the patient overall ris&s(age, gender, general
health , 0etc.)
Visual evidence1 cavitation 2surface roughness 2 opacification 2
discoloration.
Tactile evidence1 roughness 2 softness of the tooth surface.
Old ways for diagnosing caries:
1. Dental explorer mirror
!. x"ray
#. Transullmination
$. %nwaxed floss
1. Dental explorer mirror:

$t's done usually by sharp e3plorer, when catch occur , so there is caries. 4sually
used for diagnosis of caries in pits & fissure.
*its & fissure are incomplete union of different lobes
' lobes fissure
( lobespit
&'y do catc' (mec'anical )inding* occur:
a. he shape of the fissure
b. 5harpness of e3plorer
c. Forces of application
hus e3plorer tip binding is not by itself sufficient indication to ma&e caries
diagnosis
Disadvantages of t'is way:
a. 5ome lesions are without cavitation but only needs reminerali"ation ,its
enamel is wea& & with pressure by the e3plorer it changes from
deminerali"ed to cavitated (irreversible destruction), the probe may
catch due to friction with ' parallel walls.
b. $n a short fissure, & when we open it no caries is found( false
diagnosis), so the e3plorer is used to remove debris from fissure & loo&
carefully.
c. he fissure may be too tight , so the e3plorer doesn't catch u thin& it's
simple occlusal caries, but when opening it appear to be deep class $$ or
67D
d. he fissure may be curved & not straight so the e3plorer will not catch
& the caries won't be diagnosed
e. !acteria may be transferred from a carious lesion to an intact tooth so the
bacteria find a habitat & do action
+.,: so from now:
i. Don't use forceful probing
ii. Don't depend on stic&iness of the probe
iii. 4se a blunted probe (perio probe)(force e8ual that bleach the nail of the
finger) & your sharp eyes
iv. )lways remember that's a criminal to do a cavity in a teeth that doesn't
need it at all..
!. -"ray:
$t's usually used to detect caries in the pro3imal surfaces & the bitwing is the
most one used.
he 39ray significantly underestimates the e3tent of the occlusal dentin lesion
& misses many of them.
) number of studied has demonstrated a poor correlation between
radiographic, clinical & histological finding. )lso insipient caries in the
pro3imal surfaces that appear as a radiolucences
:e should give them time and observe cause arrested lesions are routinely
found in the pro3imal surfaces & are visible clinically as slight discolored,
hard spot in older persons after e3traction of an ad/acent tooth has occur.
.o study said that the newer high speed films demonstrated '- reduction on
the ability to detect caries.
,itwing radiograp' only estimate ;,- to <=- & com)ination of different
radiograp' doesn't seems to improve the overall sensitivity while panoramic
radiograp' estimate only #>- to ;#-
5o radiograph can't be used solely for complete caries diagnosis without
additional clinical e3amination & history
#. Transllumination :
Direct lightening on the tooth , the decayed part appears dar&end & not decayed
parts (sound tooth) appear light.
$. %nwaxed floss:
o detect pro3imal caries, the floss is frayed
)ll these are traditional ways in diagnosis & can't detect early
deminerali"ation
5o how can we diagnose early caries?????
+ew ways for diagnosing caries
1. .aser(O! laser*
!. .aser fluorescence system
#. /uantitative"lig't fluorescence
$. 0lectronic detection
1. Computeri2ed radiograp'y
3. Cariogram
1. .aser (O! laser*:
$t causes photo vapori"ation of saliva inside deminerali"ed microscope leaving
blac& carboni"ed residue.
!. .aser fluorescence system:
$t's based on the fact that caries induced changes in teeth lead to increase
fluorescence at specific e3citation wavelength (Diagno Dent)
#. /uantitive 4lig't fluorescence:
Clinical system constitutes a sensor that collect light induce fluorescence image of
any accessible area of the tooth.
$. 0lectronic detection:
@lectronic detection of occlusal lesions relies upon decreases electrical resistance
within a specific carious fissure location compound to anther fissure or location..
he normal healthy tooth doesn't transmit electricity (high electrical
resistance)
he carious teeth transmit co" of saliva is a good connector.
1. Computeri2ed radiograp'y:
%adiology compound with digital receptor & image analysis, radiovisography
(%AB)) is an effective diagnosis aid for detection of insipient caries.
3. Cariogram
!ut we don't have all these new e8uipments, so what $ have to do??
Daily used simple tec'ni5ue for diagnosis of caries
#. ,y )lunt pro)e s'arp eye:
!y proper light, dry area & magnification
Dry the area well to notice any chal& white opicification or loss of lusters
5oftness in the base of the fissue
@namel of the fissure is brittle & easy flac& down
he normal tooth is glossy even with staining.
!. Caries detecting die:
$t's ared die used with cotton pellet & after the patient rinse hisCher mouth , the
stained parts are infected dentin , this is due to destruction of organic (collagen)
by bacteria.
#. 6issurotomy (fissure )iopsy*

$t's done by fissurotomy bur or can be done with smallest round bur.
!y this fissure ma&e an e3plortation biopsy go into the fissure & ma&e a small
hole.
$f
Caries found cavity preparation & restoration
$f no caries close by glass ionomer or composite
increase 5taining increase reminerali"ation
Fluroappetite will not collapse & could mas& caries under it.
)lways DDoo& hin& D Design
5ummari"ed by Scorpion dentist from )rt & science te3t boo& 4sing Dr.
+ani 5lides ... @dited & 6odified by Dr.Strawberry