Here's a presentation about how we can detect and diagnose the carious lesion. Uploaded by; Dr. Ghaith Abdulhadi Al-Otaibi College Of Dentistry

1. Detection And
Diagnosis of Dental
Caries
Presented By:
1- Ghaith Abdulhadi
2- Mahommed Naif
Supervision By:
Dr. Mahammed H. Nabulsi

2. What is diagnosis?
Diagnosis is an art and science that results from the
synthesis of scientific knowledge, clinical experience,
intuition & common sense
Caries diagnosis implies deciding whether a lesion is active,
progressing rapidly or slowly or whether is already arrested.

3. ASSESSMENT TOOLS
Stepwise progression toward diagnosis &
treatment planning depends on thorough
assessment of the following
Patient History
 Clinical examination
 Nutritional analysis
 Salivary analysis
 Radiographic assessment

4. HIGH RISK LOW RISK
Social History
Socially deprived
High caries in siblings
Low knowledge of caries
Middle class
Low caries in sibling
High dental aspirations
Medical History
Medically compromised
Xerostomia
Long-term cariogenic
medicine
No such problem
Dietary habits
Sugar intake: frequent Infrequent

5. HIGH RISK LOW RISK
Use of fluoride
Non-fluoridated area
No fluoride supplements
Fluoridated area
Fluoride supplements used
Plaque control
Poor oral hygiene
maintenance
Good oral hygiene
maintenance
Saliva
Low flow rate& buffering
capacity
 S.mutans & lactobacillus
counts
Normal flow rate& buffering
capacity
 S.mutans & lactobacillus
counts

6. CONVENTIONAL METHODS OF CARIES
DETECTION
• VISUAL-TACTILE METHOD
• RADIOGRAPHY
• CARIES DETECTING DYES
• FIBEROPTIC TRANSILLUMINATION
• ELECTRONIC CARIES MONITOR

7. VISUAL-TACTILE METHODS
Visual methods:
 Detection of white spot, discoloration / frank cavitations
Magnification loupes- Head worn prism loupes (X 4.5) or
surgical microscopes(X 16) may be used
comfort, relatively inexpensive, available in various
magnification
 Use of temporary elective tooth separation

8. Tactile methods:
 Explorers are widely used for the detection of carious tooth
structure
 Dental floss

9. Use of explorer is not advocated because;
 Sharp tips physically damage small lesions
with intact surfaces
 Probing can cause fracture & cavitation of
incipient lesion. It may spread the organism
in the mouth
 Mechanical binding may be due to non-carious
reasons
Shape of fissure
Sharpness of explorer
Force of application
Path of explorer placement

10. Use of explorer
• Explorer is useful to remove plaque and
debris and check the surface
characteristics of suspected carious
lesions.
• gentle pressure just required to blanch
a fingernail without causing any pain or
damage
• All surfaces of a tooth are cleaned of
debris and plaque, using an air syringe
and examined visually.

11. SMOOTH SURFACE CARIES
Non- cavitated:
• No signs of cavitation after visual or tactile
examination.
• Location: where dental plaque accumulates
(gingival margin).
• Surface characteristics: Matted (not glossy)
when a tooth is dried.

12. not active non-cavitated carious lesions.
• Visual enamel opacity under sound marginal ridge
indicate undermined enamel due to dental caries

13. Non-cavitated carious lesion
ENAMEL DENTIN

14. Cavitated Lesions:
• Where there is visual breakdown of a tooth
surface, it is classified as cavitated carious lesion.
An active cavity on a smooth surface has soft walls
or floors shown below:

15. Caries in Pit or Fissure Surfaces
• All discolored areas should be explored using gentle
pressure.
• There is no need to penetrate a suspected lesion with an
explorer.
• If a discolored and non-cavitated area is soft when
explored, it is recorded as non-cavitated carious pit or
fissure.
• A cavity is detected when there is an actual hole in the
tooth in which an explorer could easily enter the space.
• An active cavity has soft walls or floors (detected using
gentle exploring).

16. • If there is visual enamel opacity under an ostensibly
sound or stained pit or fissure, then the enamel is
undermined because of dental caries and the tooth
surface is classified with a non-cavitated carious
lesion in dentin.

17. Pit and Fissure Caries
Non-cavitated carious lesion
Enamel
Enamel
Dentin
Enamel

18. Cavitated Carious lesion
• If a discolored area is hard when gently explored then it should
be marked as questionable.

19. Root Caries
• Root surface caries comprises of a continuum of
changes ranging from minute discolored areas to
cavitation that may extend into the pulp
For diagnostic purpose; they may be:
 Active root surface lesion:
• well-defined area showing yellowish or light brown
discoloration
• covered by visible plaque
• presence of softening/ leathery consistency on probing
with moderate pressure

20.  Inactive root surface lesion (arrested):
• well-defined dark brown/ black discoloration
• smooth and shiny
• hard on probing with moderate pressure
Active lesion
Questionable

21. Arrested Caries
• Arrested (remineralized) lesions can
be observed clinically as intact, but
discolored, usually brown or black
spots.
• The change in color is presumably
due to trapped organic debris and
metallic ions within the enamel.
• These discolored, remineralized
lesions are intact and are highly
resistant to subsequent caries . The
arrested caries need not be removed.

22. Recurrent caries
• It is diagnosed whenever there is softness due to
caries at a defective margin, and when the tip of a
periodontal probe can enter the defect without
any resistance.
• A restoration with a discolored margin or a small
marginal ditch (<0.5 mm or the head of the probe)
is recorded as an early recurrent carious area. A
larger defect should be classified as advanced
recurrent carious area

23. There are two valid indicators of recurrent
(secondary) caries:
•softness at the margin of a filling that is detected using
an explorer or
•presence of a large defect (a minimum diameter of 0.4
mm) at a margin of a filling with softness in the area.
Large defects are associated with a high level of
colonization with cariogenic bacteria. Marginal
discoloration by itself is not a valid sign for dental
caries.

24. RADIOGRAPHY
 Carious lesions are detectable radiographically when
there has been enough demineralization to allow it
to be differentiate from normal
 They are valuable in detecting proximal caries which
may go undetected during clinical examination.
 On average they have around 50% to 70% sensitivity
in detecting carious lesions.
 40% demineralization is required for definitive
decision on caries

25.  Radiographic examinations include;
Bitewing radiographs
IOPA radiographs using paralleling technique
Dental panoramic tomograph
 The two important decisions related to radiographic
examination are (1) when to take a radiograph and
(2) how to evaluate a radiograph for presence of
signs of dental caries.

26. Severe occlusal lesions:
Readily observed both
clinically and
radiographically
Appear as large cavities in
the crowns of the teeth
However pulp exposure
cannot be determined

27. PROXIMAL CARIES
Density along the proximal surface is high
which does not permit the detection of loss of
small amounts of mineral content
Incipient lesions:
Commonly seen in the caries-susceptible
zone
Presents as a notch on the outer
surface not involving more than
half of enamel

28. Moderate proximal lesions:
Involve more than outer half
of enamel but do not extend
into DEJ
May have one of type of
appearance:
67% - triangle with broad base
towards outer
surface
16% - a diffuse radiolucent
image
17% - combination of both

29. Facial & Lingual Caries
 They start as round lesions
and enlarge to become
elliptical or semilunar

30. ROOT SURFACE CARIES
 Also called cemental caries
with an incidence of 40%- 70%
of the aged population
 Buccal, lingual, proximal
 Ill-defined, saucer-like
radiolucency

31. DYES FOR CARIES DETECTION
• They selectively complex with carious tooth structure which
is later disclosed with the help of fluorescence
• Aids in both quantitative & qualitative analysis of the lesion
DYES FOR ENAMEL CARIES:
Procion: N2 & (OH) groups irreversibly complex
with caries
Acts as a fixative
Calcein: complexes with calcium & remains bound
to the tooth
Zyglo ZL-22: fluorescent tracer dye, not used in vivo
Brilliant blue: 10% aqueous Brilliant Blue, not used in vivo

32. DYES FOR DENTIN CARIES:
 1% acid red 52 in propylene glycol complexes specifically with
denatured collagen, hence used to differentiate infected and
affected dentin
 Iodine penetration method (Pot iodide) for evaluating
enamel permeability
DISADVANTAGES
• Dye staining and bacterial penetration are independent
phenomena, hence no actual quantification
• They also stain food debris, enamel pellicle, other organic
matter
• Dye aided carious removal- laborious
• Stains DEJ

33. FIBEROPTIC TRANSILLUMINATION
• Different index of light transmission for
decayed & sound tooth. Decayed tooth
structure has decreased index & appears
dark
• The tooth is illuminated using fiberoptics
• Have a high level intra & inter-examiner
variability
• Digital imaging FOTI introduced, images
captured by a CCD camera & fed into the
computer for image analysis

34. ELECTRIC MEASUREMENTS FOR CARIES
• First proposed by Magitot in 1878
• Tooth demineralization due to caries
process causes increased porosity of
tooth structure. This porosity contains
fluid containing ions. This leads
increased electrical conductivity,
conversely, leads to decreased electrical
resistance or impedance
• ECM device uses a fixed-frequency (23
Hz)alternating current which measures
‘bulk resistance’ of tooth

35. • Two systems
Vangaurd system – 25 Hz – ordinal scale of 0 –9
Caries meter L – 400 Hz – 4 colored lights
green –no caries yellow – enamel caries
orange – dentin caries red –pulp involvement

36. Factors affecting electrical measurements
1. Porosity
2. Surface area
3. Thickness of the tissues
4. Hydration of enamel
5. Temperature
6. Concentrations of ions in the dental tissue fluids

37. RECENT ADVANCES IN CARIES DETECTION
• Optical methods used are
Quantitative light- induced fluorescence- QLF™
Infrared laser fluorescence - DIAGNOdent

38. REFERENCES
• 1. Pitts NB. Clinical diagnosis of dental caries: a European perspective.
Journal of Dental Education 2001; 65 (10):972–8.
•
• 2. Pitts NB. Diagnostic tools and measurements—impact on appropriate
care. Community Dentistry and Oral Epidemiology 1997; 25 (1):24–35.
• 10. Pretty IA, Maupome G. A closer look at diagnosis in clinical dental
practice. Part 1. Reliability, validity, specificity and sensitivity of
diagnostic procedures. Journal of the Canadian Dental Association
2004; 370 (4):251–5.