 Dental caries is one of the most common chronic disease of modern times
 Present concept regarding etiology of caries is

based upon Millers chemoparasitic theory  Now dental caries is multifactorial with bacteria , susceptible tooth surface and diet play a major role

Methods of caries detection
In vivo In vitro Single tooth measurements 1 Chemical analysis 2 Cross sectional micro hardness testing 3 Polarized light microscopy 4 Traditional transverse microradiography(TMR) 5 Microprobe analysis

1 Visual examination 2 Tactile examination 3 Radiographic –Conventional , digital and xeroradiography 4 Fiber optic transillumination 5 Optical methodsFluorescence, light scattering 6 Electronic resistance measurements 7Ultrasonics 8Dyes

Methods for sequential measurements on tooth slabs 1 Iodine absorbitometry 2 Longitudinal microradiography 3 Light scattering 4 Surface microhardness

mutans or other bacteria from affected area to unaffected areas  Cost effective .Ideal caries diagnostic test must be :  Accurate  Sensitive  Specific  Reproducible  Reliable  Should not transfer S.

Traditional methods Patient complaint :  Patient itself provide hint about the presence of caries Visual examination :  Brownish discoloration of pit and fissure  Opacity beneath pits and fissures or marginal ridges  Frank cavitation of the tooth surface .

Ekstrands criteria for presence or absence of occlusal caries  V0  V1  V2  V3  V4 No/Slight change in enamel translucency after prolonged air drying Opacity/discoloration hardly visible on wet surface .but distinctly visible after air drying Opacity /discoloration distinctly visible without air drying Local enamel breakdown in opaque or discolored enamel and /or grayish discoloration from underlying dentin Cavitation in opaque /discolored enamel exposing dentin .

 Use visual examination only . known as American method .is known as the European method  Use of blunt or sharp probe in a visual tactile system .for diagnosis of dental caries .

Tactile findings suggestive of caries are  Softness at the base of a pit or fissure and discontinuity of enamel surface  “Binding" or “catch” of the explorer tip  Cavitation at the base of a pit or fissure .Tactile examination  The explorer and the floss used for the tactile examination of the tooth.

Force of application 4. this may depend on factors such as: 1. Sharp of the fissure 2. Path of explorer placement . Sharpness of the explorer 3.Uses of explorer condemned because  Sharp probe tip cause physical trauma to small lesion  Probing may lead to fracture and cavitation in incipient lesion  Mechanical binding of explorer lead to the feeling of catch.

Uses of floss as an adjunct to tactile sensation •Roughness on tooth surface while using floss is suggestive of caries .

Radiographs  In proximal caries detection the radiographs have had a unique place. . .  Intraoral periapical and bitewing radiographs are employed to diagnose dental caries.  The appearance of caries on various surfaces is in the following order:  Interproximal>Occlusal>Buccal > Lingual >Cemental.

Examining many teeth in one radiographs 3. Monitoring the progress or arrest of caries . Detecting incipient proximal caries 2. Checking cervical margins of restorations 4.Uses of bitewing radiographs 1. Noting the size of pulp chambers 5.

 The image is recorded on an aluminum plate coated with selenium particles  When X-rays are passed onto the film . .it causes selective discharge of the particles which forms a latent image .Recent methods of caries diagnosis  Xeroradiography  The image produced by diagnostic X-rays .

Digital radiographic method Two methods  Video recording and digitization of conventional radiograph  Direct digital radiograph First direct digital radiography system in dentistry was Radio Visio Graphy(RVG) It uses charged couple device which works like a miniature video camera Digora image system plate uses phosphorus storage screen .

Visible luminescent spectroscopy  The visible emission spectra for decayed and non decayed regions of teeth differ  Quasi monochromic light from a tungsten source dispersed with grating monochromator is focused on the teeth and emission spectra is recorded and analyzed .

• It provides graphic visualization of the size and progression of caries lesion .Computer aided radiographic method • Uses the measurement potential of computers in assessing and recording the size of carious lesions.  Various softwares have been developed for automatic interpretation of digital radiographs .

 Two standardized radiographs produced with identical exposure geometry are used -reference image and subsequent image  Reference image is superimposed over the subsequent image and difference can be seen as dark area .Digital subtraction radiography  High quality video camera is used to fed computer image .

calculus and soft tissue lesion Principle Depend on difference in index of light transmission for decayed and sound tooth Since decayed tooth has a lower index of light transmission than the sound tooth structure .Fiber Optic Transillumination  Useful for detection of caries .it appear darkened .

Fiber Optic Transillumination .

pen –sized and cordless device that uses fiber optic technology and LEDs to accurately detect both occlusal and interproximal caries .Recent advances of FOTI  Digitally imaged FOTI The DIFOTI unit –early detection of caries without the need to use ionizing radiation  Mini D caries A ligitweight .

Here the tooth is illuminated with a broad beam of blue light(488nm) from an argon in laser. .Quantitative laser fluorescence Quantitative laser fluorescence (QLF) is means by which the laser – induced fluorescence can be measured to quantify tooth demineralization.

 Demineralized enamel appears dark and this can be recorded on a photographic film or measured by means of computer. a commercial laser fluorescence system has been introduced called the kavoDIAGNO dent .  Recently.

  (b) QLF image taken at the same time as  (c) 6 months after the institution of an oral hygiene programme . (a) White light image of early buccal caries effecting the maxillary teeth. . the lesions have resolved.

Quantitative laser fluorescence DIAGNO dent .

Criteria to asses carious progression 0-13 : No caries 14-20 :Enamel caries and preventive care advised 21-30 : Dentinal caries and preventive care advised >30 : Operative advised  Based on the principle of fluorescence .a new optical method is Photon undulatory non-linear conversion .

 Carious enamel has a measurable conductivity which increases with the degree of demineralization.Electrical conductance measurements  Use of electrical conductance measurements is that sound enamel is an insulator due to its high inorganic content. two devices were developed in 1980s. a.  Based on the differences in electrical conductance of sound and carious enamel. Vanguard electronic carious detector b. Caries meter .

a camera can be used to store the image .The integration of an intraoral camera with the endoscope is called videoscope .Endoscopic/Videoscope  This method is based on the theory that when a tooth is illuminated with blue light in wavelength of 400-500nm .white spot lesion appears darker than sound enamel .  Additionally .  When this is viewed through a filter .sound enamel and caries enamel demonstrate different fluorescence .

White light fluorescence (WLE)  A white light source is connected to endoscope by a fiberoptic cable and teeth is viewed with a filter Intraoral television camera (IOTV)  See magnified oral conditions  Very high level of sensitivity .

Scanning acoustic microscope  Depend on elastic properties of demineralised lesion  It uses frequency of 380MHz .image is built by mechanically scanning a focus beam of ultrasound  Gives information about the extent and structure of demineralised lesion .

Alternating current impedance spectroscopy technique(ACIST)  This is more sophisticated method to detect carious lesion  It characterized by the electrical properties of the tooth and lesion by scanning multiple frequencies of alternating current .

Ultrasonic imaging  An ultrasonic probe is used to send and receive sound waves from the surface of the tooth  Normal enamel produce no echoes while initial white spot lesion produce weak surface echoes and areas with cavitation produce echoes of high amplitude  This method is so sensitive .

9Aminoacridine .Zyglo ZL-22  Dentin caries -Fuschin .Acid red system .Dyes for detection of caries  Various dyes have been used in the detection of enamel caries and dentinal caries  Enamel caries – Calcein .

Dyes for detection of caries .

the air abrasive technology can be used to deliver short burst of alpha alumina powder into the pit and grooves .Micro Air Abrasion  This method is of particular advantage in examing darkened areas in the bottom of the pit and grooves  If a suspicious darkened area is detected on visual examination .

Micro Air Abrasion .

Infrared camera  Used to detect subsurface lesion  It is recognized that there exists expanded porosity in subsurface enamel lesion and that water occupies the defect  Infrared camera can be used to measure the temperature drop on the lesion surface caused by evaporation of water in the body of the lesion .

Infra-Red Thermography  This technique has described as method of determining lesion activity rather than determining presence or absence of disease  Thermal radiation energy travel in the form of waves. It is possible to measure changes in the thermal energy when fluid is lost from a lesion by evaporation .

Computer tomography  CT can be use in the detection caries  It is a simple method of passing of x-ray through one side of the tooth and obtaining image on the other side  Digital computer assemble the data and provide a cross-sectional image .

Tuned Aperture Computed Tomography  With TACT .it become to visually progress through slices of the coronal anatomy and observe the region of a clinician can isolate and examine individual projections of a region .limiting information to the depth of interest in the radiographed volume .

if these orientations are perturbed by a pulse of radiofrequency energy .Its use allows a specimen to be re-imaged after further exposure to a clinically relevant environment  When a magnetic field is applied. the nuclear spins align in a finite number of allowed orientations.this energy is absorbed and then retransmitted .  It is this retransmitted energy that is detected and thus correlated to the amount of demineralization .Magnetic Resonance MicroImaging  It is non-invasive and non-destructive .

measure mineral changes in the tooth slice with monochromatic xrays .Photo stimulable phosphor radiography  A latent image is produced by exposing the storage phosphor screen with x ray Micro –radiography  Transverse micro-radiography –used to quantify mineral loss  Longitudinal micro-radiography.

 Similar to ultrasound .OCT uses reflection of infrared light to determine not only presence of decay but also the depth of caries progression .Optical Coherence Tomography  This technique utilizes broad bandwith light sources and advanced fiber optics to achieve images .

Confocal laser scanning microscopy  Operated with argon and Kr ion laser and an appropriate set of filters  The reflected image and fluorescent image are recorded and analyzed .

This wavelength from a short enough to provide a reasonable resolution but long enough to prevent a serious technique loss of signal due to scattering Photoconductive emitters of certain crystal (Zinc telluride )exposed to short pulse seconds of visible infrared light would emit electromagnetic wave with the frequency in the terahertz image .Terahertz Imaging  Terahertz imaging uses waves with terahertz frequency .

Dye –enhanced Laser Fluorescence (DELF)  This technique is base o a hypothesis that if a fluorescent dye penetrates a caries lesion the accuracy of current laser fluorescence for caries detection is enhanced . .

Species specific monoclonal antibodies  To recognize the surface of cariogenic bacteria  The probe are tagged with fluorescence molecules that measure quantitatively with spectrometer .

Conclusion  Inorder to conserve tooth structure and perform minimally invasive dentistry .carious lesions must be detected at the earliest is extremely valuable  Recent advances and application of computers in dentistry will surely make caries detection simpler .

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