Caries Diagnosis (Art and Science of Operative Dentistry, Studervant; 2005)

To diagnose carious lesions in patients, several factors must be considered. Some general factors are helpful in
assessing a patients risk to caries. These include patient history information and general clinical examination
results.
Assesment Tools
1. Patient History (Anamnesis)
Knowing certain factors pertaining to the patient's history can assist in the diagnosis of caries and identification
of high-risk patients. Such factors include age, gender, fluoride exposure, smoking habits, alcohol intake,
medications, dietary habits, economic and educational status, and general health. Increased smoking, alcohol
consumption, use of medications, and sucrose intake result in increased risks for caries development. Children
and elderly adults have increased risks, and decreased fluoride exposure, lower economic status, and lower
educational attainment also increase risk. Poor general health also increases the risk. However, past caries
experience is the best predictor of future caries activity.
2. Clinical Examination
General information regarding inadequate salivary functioning, plaque accumulation, inflammation of soft
tissues, poor oral hygiene, cavitated lesions, and existing restorations also are instructive in determining
potential risk to caries development. The more any of these factors are present, the greater the risk.
3. Nutrition Analyses
It must be determined if a dietary analysis should be undertaken. Frequent exposure to sucrose increases the
likelihood of plaque development by the more cariogenic Streptoccoccus mutans organisms.
4. Salivary Analyses
Analyzing saliva may provide important information about appropriateness of secretions rates and buffering
capacity as well as the numbers of bacteria.
5. Radiographic Assesment
Dental radiographs provide useful information in diagnosing carious lesions. Radiographs may show caries that
is not visible clinically.
Various diagnostic methods are available to detect caries activity at early stages. These include: (1) identification of
subsurface demineralization (inspection, radiographic, and dye uptake methods); (2) bacterial testing; and (3)
assessment of environmental conditions such as pH, salivary flow, and salivary buffering.
If failure to detect caries in its earliest stage (incipient lesion) occurs, caries is diagnosed by the presence of
cavitation of the tooth surface. The tooth surface is examined visually and tactilely. Visual evidence of caries
includes cavitation, surface roughness, opacification, and discoloration. Tactile evidence of caries includes
roughness and softness of the tooth surface.