2.Diagnosis of Dental Caries

7/30/2019 2.Diagnosis of Dental Caries

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Diagnosis of dental caries


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It is important to realize that all lesions,irrespective of their stage of progression, are

arrestable if the biofilm that drives theirprogress can be removed. Thus two importantquestions for the practitioner to answer are:

1) is the lesion active or arrested?

2) if it is active, is a restoration needed so that thepatient can clean effectively?

It is also important to recognize active cariouslesions as soon as possible so that preventive

treatment has a chance to arrest lesionprogression. The methods for caries diagnosisare:


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good lighting

clean teeth a three-in-one syringe so that teeth can

be viewed both wet and dry

sharp eyes with vision aided bymagnification. This is particularly

necessary for older dentists who are

unlikely to be able to see as well as they

did in their youth

bitewing radiographs.


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The white spot lesion, although caused by

plaque, is also obscured by it. A logical way to

proceed is for the dentist to examine the teethboth before and after removal of plaque.

A white spot lesion that is visible only once the

enamel has been thoroughly dried haspenetrated about halfway through the enamel.

A white or brown spot lesion that is visible on a

wet tooth surface has penetrated all the way

through the enamel and the demineralizationmay be in the dentine.


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Before brushing and drying after brushing and drying


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On no account should

a white spot lesion be

jabbed with a sharpprobe to see if the

probe sticks in the

tissue. The probe is

likely to break therelatively intact

surface zone of the

enamel lesion and

cause a cavity.


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good bitewing

radiographs are

essential for the

diagnosis ofapproximal lesions

where a contact point

is present.


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Diagnosis of caries on occlusal

surfacesVisual examination and examination of thebitewing radiograph are both important.

On un-cavitated lesions: The active,uncavitated lesion is white, The inactive lesionmay be brown. These enamel lesions are notvisible on a bitewing radiograph.

On cavitated lesions: Cavitated lesions maypresent as microcavities with or without agreyish discoloration of the enamel. Cavitated

lesions are usually visible in dentine on abitewing radiograph.

Cavitated occlusal lesions, whether microcavitiesor cavities that clinically expose dentine, are

usually active because the patient cannot cleanplaque out of the cavity.


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Diagnosis of caries on approximal

surfaces It is difficult to see a carious enamel lesion on an

approximal surface because the lesion forms justcervical to the contact area and vision is obscured by theadjacent tooth.

If the lesion is discovered clinically, it is usually at arelatively late stage when it has already progressed wellinto dentine and is seen as a pinkish grey area shiningup through the marginal ridge.

Bitewing radiographs are of paramount importance indiagnosing approximal caries in both enamel and

dentine. The approximal enamel lesion appears as adark triangular area in the enamel on a bitewingradiograph


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Early enamel lesion

Nine months later :

late enamel lesion


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Twelve months later:marked dentinalspread

Eighteen months later:

approaching cariousexposure.


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Transmitted light can also be of considerable

assistance in the diagnosis of approximal caries,

particularly in anterior teeth. The oper

ating light is reflected through the contact point with

the dental mirror, and a carious lesion appears as adark shadow following the outline of the decay. In

posterior teeth a stronger light source is required

(fibre-optic lights).

The technique has

particular advantages in

1. posterior crowding

2. in pregnant women


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Diagnosis of caries on exposed

smooth surfaces

Caries on smooth surfaces can be seen atthe stage of the white or brown spot lesionbefore cavitation has occurred, provided

that the teeth are clean, dry, and well lit. Uncavitated active lesions are close to

the gingival margin and have a mattsurface.

Inactive lesions may be further from thegingival margin, white or brown in colourwith a shiny surface.


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Root surface caries, in its early stages,

appears as one or more small well-defined

discoloured areas located along the gingivalmargin.

Active lesions are soft, plaque-covered, and

close to the gingival margin.

Arrested lesions are hard and shiny, plaque-

free, and some distance from the gingival

margin.

As with enamel caries, great care should be takenwhen using a probe on these lesions; otherwise,

healing tissue may be damaged

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2.Diagnosis of Dental Caries