Clinical Features & Clinical Features & Diagnosis of Dental Caries Diagnosis of Dental Caries

CHEN ZhiCHEN Zhi

Wuhan University School of StomatologyWuhan University School of Stomatology

Current concepts of CariesCurrent concepts of Caries

• Dental caries is a specific infectious microbiological disease of the teeth that results in localized dissolution and destruction of the calcified tissues.

Germfree animals do not get caries.

Current concepts of caries etiologyCurrent concepts of caries etiology

Micro-organisms

host & tooth

Sub-stratecaries

time

no caries

no caries

no caries

no caries

Current concepts of CariesCurrent concepts of Caries

• The disease process begins with the concentration of mutans streptococcus at specified tooth surfaces and may lead to white spot formation or even cavitation.

Current concepts of CariesCurrent concepts of Caries

The development of dental caries is

a dynamic process of demineralization of the dental hard tissues

by the products of bacterial metabolism,

alternating with periods of remineralization.

Harris and Christen

《 Primary Preventive Dentistry 》 , 1995

ClassificationClassification

according to the progression rate

according to the involving site

according to the severity

according to the previous treatment

Classification according to the progression rate

Acute caries

Rampant caries

Chronic caries

Arrested caries

Secondary caries

Active caries

Arrested caries

Acute Caries

progress fast, often in children and teenagers, light colored cavity.

Rampant Caries

Caries in a patient with impaired salivary function as result of radiation therapy (Drs Jansma and Vissink)

Rampant caries, many tooth involved at same time with acute caries feature often accompanied by systematic disorder, such as Sjogren syndrome or saliva reduction after radiation.

Chronic Caries

progress slowly,

black or brown colored cavity hard remaining dentine

Arrested Caries

caries stop progressing because of the local etiological change

Classification according to the treatment history

Primary caries

Secondary caries or Recurrent caries

Secondary Caries

Classificationaccording to the involving site

Pits & fissures caries

Smooth surface caries

Root surface caries

The first and most susceptible site is the developmental pits and fissures of enamel.

The shape of the pits and fissures contribute to their high susceptibility to caries.

How many types of the fits & fissures in

your text book?

Pits & Fissures Caries

The second site is on certain areas of the smooth surface of enamel.

These include:1. the areas of contacting proximal surface and2. areas gingival to the height of contour of the facial and lingual surface.

Could you explain why the proximal surfaces

are particularly susceptible to caries?

Smooth Surface Caries

The third site where caries may attack is the root surface.

The root surface is rougher than enamel and readily allows plaque formation in the absenceof good oral hygiene.

The another reason ?

Root Surface Caries

Classificationaccording to the Severity

Incipient caries

Moderate caries

Severe caries

Advanced caries

Superfacial caries

Middle caries

Deep caries

Incipient Caries

Moderate Caries

Advanced Caries

Severe Caries

A New Classification

Recommended by Dr. Graham Mount & Dr. Rory HumeIn UCLA

http://www.dent.ucla.edu/pic/members/caries/index.html

DiagnosisDiagnosis

Early detection of incipient caries andlimitation of caries activity prior to significant tooth destruction are primary goals of an effective diagnosisand treatment program.

DiagnosisDiagnosis

• Clinical signs

visual - location, cavitation

tactile - texture

• Clinical symptoms

• Diagnostic test

Diagnosis Test

• Radiographs (film and digital)

• Transillumination (FOTI/DFOTI)

• Electrical conductivity (EC)

• Optical (fluorescence) methods (QLF)

• Fluorescent dye

Diagnostic Test

Only acceptable gold standard presently ishistological assessment.

Most diagnostic tests are limited to specificapplications.

Visual-tactile method remains the mostaccurate and reproducible method ofdiagnosis of dental caries.

Visual Classifications(occlusal surfaces)

0. No or slight changes in enamel

translucency after prolonged air-drying

1. Opacity (white or yellow) hardly visible on the wet surface but distinctly visible after air-drying

2. Opacity (white or yellow) distinctly visible without air-drying

Visual Classifications (continued)

3. Localized enamel breakdown in opaque or

discoloured enamel and/or greyish

discolouration from the underlying

enamel

4. cavitation in opaque or discoloured

enamel exposing the dentine beneath

Ekstrand et al, 1997

Proximal caries lesion is detected with the use of transillumination

Quantitative Light Fluorescence (QLF)

Progression of Dental Caries

demineralization of enamel surface

sub-surface enamel lesion

demineralization of dentine

cavitation of enamel surface

cavitation into the dentine

Treatment Program

Non-surgical - remineralization

Surgical - restoration

Non-cavitated lesions deserve more attentionbecause they:

– are more prevalent than cavitated lesions in economically developed countries

– can validly serve as indicators of caries susceptibility

– appropriately should be treated nonsurgically which is preferable.

Two Difficulties

When to place an initial restoration?

Breakdown of the outer enamel is animportant clinical indicator of treatment

Management of Fissured Surface

No Caries or ArrestedCaries in Fissures withSusceptible Morphology

Enamel Demineralizationor Questionable Caries inDentin

Cavitation orCaries in Dentin

CariesRisk?

No treatment Sealant Enamel PRR Restoration

CariesRisk?

Low High Low Open fissureswith round bur

High

Demineralizationinvolve

enamel dentin

---University of Texas Health Science Center at San Antonio, UTHSCSA

Linking diagnosis to clinical management

Two Difficulties

When to place an initial restoration?

Breakdown of the outer enamel is animportant clinical indicator of treatment

How to deal with severe caries?

Protection of dental pulp is the primary goal

Reference

http://www.dent.ucla.edu/pic/members/caries/index.html

http://www.uic.edu/classes/peri/peri343/main2.htm

《龋病学》 樊明文主编

Homework:

What’s the difference between coronal caries and root caries?

Please make a comparison, such as: surface tissue, composition, etc.