DIAGNOSIS OF DENTALCARIES

DEFINITION OF
DENTAL CARIES
dental caries is an irrerversible microbial
disease of teeth that result in localized
dissolution & destruction of calcified tissue
TYPES OF CARIES
1. pit & fissure caries
2. smooth surface caries
3. Root caries
 PRIMARY OBJECTIVE OF
CARIES DIAGNOSIS

1. Identifying those lesion that require surgical

(restorative)treatment
2. lesion that require non surgical treatment
3. Those person who are at high risk for
developing caries
4. Early detection of incipient caries
5. limitation of caries objectivity before.
Significant tooth destruction.
 ASSESSMENT TOOLS

1. Patient history
2. Clinical examination
3. Nutritional analysis
4. Salivary analysis
5. Radiographic assessment
DIAGNOSTIC TEST MUST BE
• ACCURATE
• SENSITIVE
• SPECIFIC
• REPRODUCIBLE
• RELIABLE
• NOT TRANSFER THE NFECTION ONE
PATIENT TO ANOTHER PATIENT
• COST EFFECTIVE
 METHOD OF CARIES DETECTION
Traditionally caries has been
Diagnosed by the mean of visual
Examination & tactile sensation the
use of radiographs
Method of caries detection can be used
Clinically for treatment purpose.
INVIVO METHOD
For research purpose
IN VITRO METHOD
 INVIVO METHOD
 Visual examination
Tactile examination
Radiographic examination
Fiber optic transillumination
 Fluorescence
Electronic resistance method
Ultrasonic method
Caries detector dyes
 IN VITRO METHOD
 Chemical analysis
 Cross sectional micro hardness testing
Polarized light microscopy
Traditional transverse microradiography
 Microprobe analysis
 Iodine absorbitometry
 Surface micro hardness testing
 VISUAL EXAMINATION
(EUROPEAN METHOD)
Visual examination of caries use
criteria such as

* Discoloration of teeth
* White spot on teeth
* Lesion clinically visible(frank cavitation)
* Surface roughness
AIDS IN VISUAL EXAMINATION
* Temporary elective tooth separation
- Used in both deciduous & permanent dentition
* Mouth mirror
* Slide have been used
* Magnification loupe
 TACTILE EXAMINATION
(AMERICAN METHOD)
INSTRUMENT
* Mouth mirror
* Explorer
* Sharp /blunt probe
* Floss
CRITERIA OF TACTILE EXAMINATION
 * Roughness & softness of two surface
 ∗ Catch is present
 ∗ Soft floor of cavitation is palpable with probe
CATCH MEANS
* Penetration & resistance to removal
* Catch indicate the demineralization & weakening of tooth surface
DISADVANTAGE OF USE OF EXPLORER

 ∗ Physical demage to small lesion with intact surface

 ∗ Probing may lead to fracture & cavitation in incipient lesion
 ∗ Mechanical binding of explorer in deep pit & fissure leading
to feeling of catch
MECHANICAL BINDING OF EXPLORER DEPEND
ON
 ∗ Shape of fissure
 ∗ Sharpness of explorer
 ∗ Force of application
 ∗ Path of explorer placement
 RADIOGRAPHIC EXAMINATION
* Dental radiograph provide useful information in diagnosing carious
lesion
* Radiograph may show lesion that is not visible clinically
∗ Minimum depth of detectable lesion on radiograph is about 500 um
∗ Mineral loss must exeed at least 20 to 30% for radiographically
 visible

RADIOGRAPH FOR DENTAL CARIES

CONVENITIONAL ADVANCE
IOPA DIGITAL RADIOGRAPHYCALLY
BITE WING * XERO RADIOGRAPHY
 DRAW BACK OF RADIOGRAPHY

1. Technical difficulty
* Exposure
* Angulation
* Tooth position
* Interpretation bias
2. Demineralization in enamel that is visible
radiographically may not be indicative of active
caries
3. Conventional radiograph are 2 – D image

IOPA & BITEWING are mostly use for detection

of dental caries

FIBER OPTIC TRANSILLUMINATION (FOTI)
PRINCIPLE
Different index light transmission for decayed & sound
teeth Decayed tooth has a lower index for light
transmission then the sound tooth
1. Area of decayed show a darken shadow

 2. Specially effective in anterior region

3. Adjuvant to visual radiographic examination
 4. FOTI does not detect small lesion
– (this is limit of its use)

 ELECTRIC CONDUCTANCE
MEASUREMENT
* Given by magitat in 1947
* Principle
• Sound enamel have limited or no conductivity where crious or
• deminealized enamel have measurable conductivity
* Conductivity deminalization
TYPE OF INSTRUMENT
* VECD –vanguard electronic caries dectetor
 * CARIES METER -L
CARIES DETECTOR DYES
Various dyes have been used for detection of
caries.
For Enamel caries
CALCEIN
ZYGLO
ZL-22
 For Dentin caries
FUSCHIN
ACID RED SYSTEM
AMINO ACRIDINE
 ULTRASONIC
Ultrasonic is the use of sound wave for
detection of caries as a diagnostic
instrument.
 This method apply to easily accessible
area not to proximal surface
 FLUORESCENCE
Inthis Monochromatic light is used at 350,
410,530, & 600 nm.
Principle
Visible emission spectra differ for decayed
& non decayed region of tooth.
Largest difference b/w carious and non
carious lesion found at 600 nm.
 DIAGNODENT
 Patented by Ka Vo, 1999.
 New Method of caries detection
 Based on principle of fluorescence
 This system has a range of (-9 to 99)
- 9 indicate tooth is healthiest
 This method detect
1. Early stage of pathological changes.
2. Initial lesion
3. Demineralization changes
4. Precavitation stage of caries
 Determining the caries involvement in different area of
same tooth.
 CARIES ACTIVITY TEST
 Measure of speed of progression of a
carious lesion.
 To Identify some parameters related to triad
of challenges, defense & repair that will
indicate existent caries activity.

OBJECTIVES:
• To determine the need & extent of personalized
preventive measure
• To identifying high risk group & individuals
 CARIES ACTIVITY TEST
 Should be
- Reproducible
- Valid
- Simple & In expensive
- Non Invasive
- Easy to evaluate
- Applicable to any clinical condition
- Less chances of false result


 VARIOUS CARIES ACTIVITY TEST
 Lacto Bacillus colony count test.
 Calorimetric Snyder test.
 Swab Test ( use for young patient. )
 Albans test (Modified Snyder test.
 Enamel Solubility test ( Susceptibility test)
 Salivary buffering capacity test.
 Salivary reductase test
 Strepto coccus mutans in saliva.
 Strepto coccus mutans screening test.
 REFERENCES

1. McDonald RE, Avery DR, Dean JA.

Dentistry for the child and adolescent,
8th edn. Mosby, 2004 :117-28

2. Tandon S. Textbook of pedodontics,

1st edn. Paras Publishing, 2001 :196-
200