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.
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:
What’s 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