Diagnosis of dental caries

PART 3

Dr. Hisham I. Wali

M.Sc. Consevative

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METHODS FOR DIAGNOSES OF DENTAL
CARIES

Ultraviolet Illumination

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Radiographic Methods
Dental radiography is a branch of dentistry.
For detecting carious lesions
radiographically, bitewing radiographs
are used.
Bitewing radiographs take their name
from the original technique which
required the patient to bite on a small
wing attached to an intraoral film
packet.
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Modern techniques use holders which
have eliminated the need for the wing
and digital image receptors can be used
instead of film, but the terminology and
clinical indications have remained the
same.

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Normal dental tissues seen in a bitewing
radiograph are:

RADIOPAQUE Structures that appear white in radiograph

RADIOLUCENT Structures that appear black in radiograph

Enamel It is the most radiopaque structure

Dentin Slightly darker than enamel

Pulp Pulp chamber and canals are

seen as radiolucent lines within
the tooth
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Radiographic detection of caries on different surfaces of teeth
Caries of occlusal surfaces:
X-ray diagnosis of pits and fissures decay is difficult in earlier stages of the
carious process because decalcified radiolucent tooth structure is small in
percentage compared to the healthy surrounding tooth structure.

Since the evolution of enamel decay is

slower and smaller than dentin decay,
occlusal detection is often only possible
when the decay is more advanced in the
dentin and where it has created a greater
damage to the tooth integrity.
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Caries of proximal surfaces:
• Bitewing radiographs are preferably utilized to
detect interproximal caries.
• Lesions confined to enamel may not be
evident radiographically until approximately
30 to 40 percent demineralization has
occurred.

Caries of buccal and lingual surfaces:

• It is difficult to differentiate between buccal and lingual caries on a
radiograph because of overlapping.

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Root surface caries:
• Appear as diffuse radiolucent areas with ill-defined borders on proximal
aspects of teeth in the cervical areas.

Secondary Caries
• Lesion next to a restoration may be
obscured by the radiopaque image of
the restoration.
• Recurrent caries at cervical margins are best observed in bitewing films,
since the central ray is directed along the plane of the cervical areas.
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Panoramic radiography
Panoramic radiography or dental panoramic
tomography has become a very popular
technique in dentistry. The main reasons for this
include:

• All the teeth and their supporting structures

are shown on one image.
• The technique is relatively simple.

• The radiation dose is relatively low.

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Generally, the technique of panoramic radiography depends on the
synchronized circular movement of the X ray machine tube head and the
cassette carrier or sensor in the other side.

Diagram showing the gradual build-up of a panoramic tomograph 10

Panoramic radiography
Advantages
• Relatively low patient radiation dose.
• Convenience, ease and speed of performance.

• Useful in patients with limited mouth opening.

Disadvantages
• Lack of fine anatomic detail

• Overlapping of hard and soft tissues

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 Chemical
Electrical Conductance Measurementcomposition of
The principle of this method enamel
depends on the measurement of
the electrical conductivity of the Inorganic
tooth. crystalline Organic matrix
lattice
Sound tooth enamel is a good
electrical insulator due to its high Hydroxyapatite
inorganic content. crystals 90-92% Water 4-12%
by volume
Electrical conductivity is directly
proportional to the amount of
Proteins 1-2%
demineralization.
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Electrical Conductance Measurement
Demineralized tooth has more pores filled with water or saliva, and this is
more conductive than intact tooth surface.
Electrical resistance refers to measuring the electrical conductivity through
these pores.
Demineralized sites and sites with high pore volume and cavities can be
detected by measuring the conductance.

Two instruments based on the difference in electrical conductance of carious

and sound enamel were developed. These are:
 Vanguard electronic caries detector
 Caries meter
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Both instruments measure the electrical conductance between the tip of a
probe placed in the fissure and a connector attached to an area of high
conductivity (e.g. gingiva or skin).

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Vanguard electronic caries detector
It uses an electrical current of 25 Hz.
Measured conductance is then
converted to an ordinary scale of 0–
9. Moisture and saliva should be
removed by a continuous stream of
air to prevent surface conductance.

Surface
Site specific
specific

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Advantages
 Very effective in detecting early pit and fissure caries
 It can also monitor the progress of caries.
Disadvantages
 Can only recognize demineralization and not caries specifically.
 Presence of enamel cracks may lead to false positive diagnosis.
 A sharp metal explorer is utilized which is pressed into the fissure
causing traumatic defects.
 Separate measurements are required for different sites making full
mouth examination quite time consuming.
 Area of diagnosis is confined to the dimensions of the probe.
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Quantitative Laser
Fluorescence
The term "laser" is the acronym for "light
amplification by stimulated emission of
radiation’’.

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Quantitative Laser
Fluorescence
Fluorescence is based on two
wavelengths. The excitation
wavelength which is
absorbed by the tissue and
emitted at a longer
wavelength called emission
wavelength.

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Quantitative Laser
Fluorescence
When a tooth is exposed to red light , the light penetrates the enamel deeply
into dentine, and back scattered light of a longer wavelength is measured by a
detector to measure the fluorescence of carious dentine.

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Quantitative Laser Fluorescence

Two devices have been made and they depend on the principle of quantitative
laser fluorescence. These are:

 DIAGNOdent device (launched in  DIAGNOdent pen (launched in the

the market in 1998) market in 2006)

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• The devices do not produce an image of the tooth; instead they display a
numerical value on LED display.
• The devices give a digital numeric read-out (0-99) to indicate the amount of
fluorescence transmitted back to the detector in the presence of caries. The
amount of detected fluorescence is expressed as a digital number from 1-99.
• Based upon in vivo studies, the following correlations can be made.

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Advantages
 Good reproducibility
 For detection of non preparation occlusal carious lesions, diagnodent is
considered as superior to other aids in terms of both correlation with
histopathology and specificity/ sensitivity.

 Because of its good reproducibility, it can be used to monitor caries

regression or progression.

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Disadvantages
 Increased likelihood of false positive diagnosis

 Sensitive to the presence of stains

 Any changes in the physical structure of enamel-like hypoplasia may give

false readings.

 It cannot detect secondary caries.

THE END

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