Caries Diagnosis Caries balance: Caries Diagnosis

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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.

  • The unaffected teeth are superior to restored teeth, so early detection of caries (insipient caries) before cavitation is very important.

  • Before cavitation, there is serious of demineralization.

  • Variety of diagnostic methods are available to detect caries activity at early stage

    1. Identification of subsurface demineralization (inspection, Radiograph& due uptake method).

    2. Bacterial testing.

    3. Assessment of environmental condition such as PH , salivary flow because there is no single test has been developed that is 100%

  • Predict of later development of cavitated lesions a concept of caries risk has been promoted.

  • If failure to detect caries in early stage, cavitation will occur and diagnosis will be visually, by tactile sensation & radiographs.

  • No single test for caries is diagnostic 100%

  • Therefore , multiple criteria must be used & the diagnostic criteria should be adjusted according to the patient overall risks(age, gender, general health , …etc.)

  • Visual evidence: cavitation _surface roughness _ opacification _ discoloration.

  • Tactile evidence: roughness _ softness of the tooth surface.

Old ways for diagnosing caries:

    1. Dental explorer & mirror

    2. x-ray

    3. Transullmination

    4. Un-waxed floss

  1. Dental explorer & mirror:

It's done usually by sharp explorer, when catch occur , so there is caries. Usually used for diagnosis of caries in pits & fissure.

Pits & fissure are incomplete union of different lobes

2 lobes fissure

3 lobespit

Why do catch (mechanical binding) occur:

  1. The shape of the fissure

  2. Sharpness of explorer

  3. Forces of application

Thus explorer tip binding is not by itself sufficient indication to make caries diagnosis
Disadvantages of this way:

  1. Some lesions are without cavitations but only needs remineralization ,its enamel is weak & with pressure by the explorer it changes from demineralized to cavitated (irreversible destruction), the probe may catch due to friction with 2 parallel walls.

  2. In a short fissure, & when we open it  no caries is found( false diagnosis), so the explorer is used to remove debris from fissure & look carefully.

  3. The fissure may be too tight , so the explorer doesn't catch u think it's simple occlusal caries, but when opening it appear to be deep class II or MOD

  4. The fissure may be curved & not straight  so the explorer will not catch & the caries won't be diagnosed

  5. Bacteria may be transferred from a carious lesion to an intact tooth so the bacteria find a habitat & do action

N.B: so from now:

    1. Don't use forceful probing

    2. Don't depend on stickiness of the probe

    3. Use a blunted probe (perio probe)(force equal that bleach the nail of the finger) & your sharp eyes

    4. Always remember that's a criminal to do a cavity in a teeth that doesn't need it at all..

2. X-ray:

      • It's usually used to detect caries in the proximal surfaces & the bitwing is the most one used.

      • The x-ray significantly underestimates the extent of the occlusal dentin lesion & misses many of them.

      • A number of studied has demonstrated a poor correlation between radiographic, clinical & histological finding. Also insipient caries in the proximal surfaces that appear as a radiolucences

      • We should give them time and observe cause arrested lesions are routinely found in the proximal surfaces & are visible clinically as slight discolored, hard spot in older persons after extraction of an adjacent tooth has occur.

      • No study said that the newer high-speed films demonstrated 2% reduction on the ability to detect caries.

      • Bitwing radiograph only estimate 40% to 65% & combination of different radiograph doesn't seems to improve the overall sensitivity while panoramic radiograph estimate only 18% to 41%

      • So radiograph can't be used solely for complete caries diagnosis without additional clinical examination & history

3. Transllumination:

Direct lightening on the tooth , the decayed part appears darkened & not decayed parts (sound tooth) appear light.

    1. Un-waxed floss:

To detect proximal caries, the floss is frayed
All these are traditional ways in diagnosis & can't detect early demineralization
So how can we diagnose early caries?????

New ways for diagnosing caries

  1. Laser(O2 laser)

  2. Laser fluorescence system

  3. Quantitative-light fluorescence

  4. Electronic detection

  5. Computerized radiography

  6. Cariogram

  1. Laser (O2 laser):

It causes photo vaporization of saliva inside demineralized microscope leaving black carbonized residue.

  1. Laser fluorescence system:

It's based on the fact that caries induced changes in teeth lead to increase fluorescence at specific excitation wavelength (Diagno Dent)

  1. Quantitive –light fluorescence:

Clinical system constitutes a sensor that collect light induce fluorescence image of any accessible area of the tooth.

  1. Electronic detection:

Electronic detection of occlusal lesions relies upon decreases electrical resistance within a specific carious fissure location compound to anther fissure or location..

    • The normal healthy tooth doesn't transmit electricity (high electrical resistance)

    • The carious teeth transmit coz of saliva is a good connector.

  1. Computerized radiography:

Radiology compound with digital receptor & image analysis, radiovisography (RVG)) is an effective diagnosis aid for detection of insipient caries.

  1. Cariogram

But we don't have all these new equipments, so what I have to do??
Daily used simple technique for diagnosis of caries

  1. By blunt probe & sharp eye:

By proper light, dry area & magnification

    • Dry the area well to notice any chalk white opicification or loss of luster

    • Softness in the base of the fissure

    • Enamel of the fissure is brittle & easy flack down

The normal tooth is glossy even with staining.

  1. Caries detecting die:

It's a red die used with cotton pellet & after the patient rinse his/her mouth , the stained parts are infected dentin , this is due to destruction of organic (collagen) by bacteria.

  1. Fissurotomy (fissure biopsy)

It's done by fissurotomy bur or can be done with smallest round bur.

By this fissure make an exploration biopsy go into the fissure & make a small hole.


  • Caries found cavity preparation & restoration

  • If no caries close by glass ionomer or composite

  • Increase Staining  increase remineralization

  • Fluro-appetite will not collapse & could mask caries under it.

Always LLook TThink D Design

Scorpion dentist & Dr.Strawberry

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