Clinical Features & Diagnosis of Dental Caries

BY DR.SIDDHARTH TEVATIA ITS CDSR MURADNAGAR GHAZIBAD

Current 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 etiology

Microorganisms no caries no caries

host & tooth

no caries

caries no caries time

Substrate

Current 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 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

Classification
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 Arrested caries Active 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

Classification according 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 and 2. 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 absence of good oral hygiene.

The another reason ?

Root Surface Caries

Classification according to the Severity

Incipient caries Superfacial caries

Moderate caries
Advanced caries Severe caries Middle caries Deep caries

Incipient Caries

Moderate Caries

Advanced Caries

Severe Caries

A New Classification

Recommended by Dr. Graham Mount & Dr. Rory Hume In UCLA

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

Diagnosis
Early detection of incipient caries and limitation of caries activity prior to significant tooth destruction are primary goals of an effective diagnosis and treatment program.

Diagnosis

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 is
histological assessment.

Most diagnostic tests are limited to specific

applications.

Visual-tactile method remains the most

accurate and reproducible method of diagnosis 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 Surgical remineralization restoration

Non-cavitated lesions deserve more attention because 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 an important clinical indicator of treatment

Management of Fissured Surface

No Caries or Arrested Enamel Demineralization Cavitation or Caries in Fissures with or Questionable Caries in Caries in Dentin Susceptible Morphology Dentin

Low

Caries High Risk?

Low

Caries High Open fissures with round bur Risk?

enamel Demineralization dentin

involve

No treatment

Sealant

Enamel PRR

Restoration

---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 an important clinical indicator of treatment

How to deal with severe caries?

Protection of dental pulp is the primary goal

Homework:
Whats the difference between coronal caries and root caries? Please make a comparison, such as: surface tissue, composition, etc.

BY: DR. siddharth.tevatia ITS CDSR MURADNAGAR GHAZIBAD

THANK YOU