Diagnosis of Dental Caries

By Kishan Soni
3rd BDS
833
DENTAL CARIES

 It is defined as a preventable,
chronic and biofilm mediated
disease modulated by diet. these
multifactorial, oral disease is
caused primarily by an imbalance
of the oral flora(biofilm) due to
the presence of fermentable
dietary carbohydrates on the
tooth surface overtime.
What is Diagnosis?
 Diagnosis is a art or act of identifying a
disease from its signs and symptoms.

 The ideal diagnostic test should be

sensitive and specific
.
 “Specificity” means ability of the test
to clearly differentiate one disease
from the other.

 “Sensitivity” means ability of the test

or observation to detect the disease
whenever it is truly present.
Various diagnostic tools.

 1) Visual examination
 2) Tactile examination
 3) Dental floss
 4) Tooth separators
 5) Radiographic examination
a) conventional radiography
b) xeroradiography
c) orthopantomography (OPG)/dental panoramic
technique

 6) Dye penetration method

1) Visual examination
 It is the most commonly used method for detecting caries lesion,
because it is an easy technique.
 Visual examination includes looking for cavitation, surface roughness,
chalkiness around pits and fissures, opacification & discoloration.
 First the teeth are dried with compressed air and illuminated under
adequate light source.
 The examination takes about 10 minutes.
 Problem with using this method is that discoloration of the pits and
fissures may be a universal finding in normal healthy adult teeth, which
may be mistaken for the presence of caries.
 Visual Scoring System-by ICDAS(International
Caries Detection & Assessment)

The ICDAS uses a two

stage process to record
the status of the carious
lesion.

First code – severity

Second code –
restorative status of
tooth
Disadvantages

 Reliability
 Caries Depth
 Discolouration of pits in healthy tooth diagnosed as caries
2) Tactile examination
 Tactile examination includes examination of roughness or softness of the tooth surface with a
sharp explorer (diameter of 200 micro meters).

 Explorer is used to explore the pits and fissures.

 With the explorer tooth surface is checked for “catch” or binding of explorer, that means that area
is involved with caries.

 Tactile examination has to be done carefully as excessive pressure with a sharp explorer tip can
cause cavitation where it was not present earlier . That`s why CPITN ( Community Periodontal
Index Of Treatment Needs) probe recommended for assesment of surface roughness because it is
having 0.5mm sphere at the tip.

 It is economical & no radiation exposure chances.

3) Visual-tactile examination
Dental floss
 Dental floss is also used to
detect dental caries.
 After the tooth has been
cleaned, floss is inserted
through the contact area &
dragged occlusally against one
proximal surface.
 If it is shreds , the caries is
present.
 Disadvantage :-In case of
overhanging restoration proximal
side has same features.
 Tooth separators
 Tooth separators (orthodontic
separators) & wedges are used to
separate tooth to detect
proximal caries.

 it requires second visit after

period of 3-7 days.

 Limitations:-
- requires second visit.
- discomfort to the patient.
4) Radiographic examination
 Radiographic examination includes:-

a) Conventional radiography
- Intraoral periapical radiograph (IOPA)
- Bitewing radiographs

b) Xeroradiography

c) Orthopantomography / Dental panoramic technique

Intraoral Periapical Radiograph (IOPA)
 It is mainly used for detecting
the changes around the roots
and in between teeth.

 It is used for minor surgical

procedures.

 Advantages:-
- lower cost
- less radiation exposure
- easy availability
Bitewing Radiography
 They are used to detect
incipient lesions at the contact
points,

 These radiographs shows

approx. 8 teeth, cervical margin
of the restoration, alveolar
crest height, size of pulp
chambers.

 Mainly it is used to detect

interproximal caries.
Orthopantomography (OPG)
 It is used for detecting both the
anterior and posterior teeth.

 It is a full mouth x-ray.

 Disadvantage:-
- Images are not sharp as IOPA
and bitewing radiographic images.
- The sharpness and clarity are
reduced, so it is not widely used for
diagnosis of dental caries.
 Xeroradiography
 It is a highly accurate electrostatic imaging technique.

 In these technique image is recorded on the aluminium

plate coated with a layer of selenium particles.

This forms a latent image and is converted into positive

image by developing.
 Xero-radiography is twice as sensitive as conventional D-
speed films.
The phenomenon of `Edge Enhancement ` is possible with
this technique.
 Disadvantage:-
- the electric charge over the film many a times causes discomfort
to the patient.
- development takes about 15 minutes.

 Advantages:-
- edge enhancement- means differentiating areas of different
densities especially at the margins or caries
- economical & less radiation exposure.
- Less Radiation Exposure
Dye Penetration Method
 Various dyes are also used for detection of caries.

 Dyes should fulfil the following criteria before clinical use.

1) It should be safe for intraoral use.
2) It should stain only the area to be stained.
3)It should be easily removed & not lead to permanent staining.

 (A) Dyes for examined enamel caries.

- Procion : dyes stain the enamel lesions but staining becomes
irreversible because the dye reacts with nitrogen and hydroxyl groups of
enamel & act as a fixatives.
- Calcein : dye makes the complex with a ca but is also remains bound
to the enamel.
Dyes For Examination Of Dentin Caries

 Histopathologically, carious dentin is divided into 2 layers- outer & inner

layer.
 Outer layer is layer of decalcification, which is soft and can’t be
remineralized.
 Inner decalcified layer, which is hard and can be remineralized.
 The dyes are use to differentiate these 2 layers of dentin caries.
 0.5% basic fuchsin in propylene glycol has proved to be successful.
 Basic fuchsin dye was considered to be carcinogenic so it is replaced by
acid red and methylene blue.
 Methylene blue is also slightly toxic so acid red is preferred.
Newer Caries Detection Technologies
 In addition to the traditional methods of caries detection several new
technologies have emerged and show promising results for the clinical
detection and diagnosis of caries lesion .

 this devices may have the potential to replace the tactile portion of
caries detection ,where explorers are used to try to estimate the depth
of the caries lesion into the pits and fissures.

 Limitations:
1. They are only indicated for use on unrestored pits and fissures.
2. Their diagnostic accuracy has not been firmly established.
 1. Laser – induced fluorescence

- Diagnodent dent device uses laser fluroscence technology,with the

intension of detecting and measuring bacterial products and changes in
tooth structure in caries lesion.

- Requires clean,dry occlusal surface.

- Device more sensitive than traditional diagnostic methods, but the

increased likehood of false-positive diagnoses limits its usefullness as a
principal diagnostic method.
 2. Light induced fluorescence

- CamX Spectra Caries Detection Aid

- This system claims to dental caries lesion by measuring increased light-induced

fluorescence. Special LEDs project high energy violet or blue light onto the tooth
surface.light of this wavelength supposedly stimulates porphyrins to appear
distinctly red, whereas healthy enamel fluoresces to appear green.

- Data captured by the spectra system are analyzed by imaging software,which

highlights the lesion in different colour ranges and defines the potential caries
activity on a scale of 0-5.
3. Alternating current impedence spectroscopy (ACIST)

- The Cariescan PRO is a device for the detection and monitoring of caries by the
application and analysis of ACIST technology .

- The Cariescan PRO claims to enable clinicians to evaluate demineralized tooth

structure using ACIST by providing information about tissue being healthy,in the
early stages of demineralization or already significantly decayed.
Thank you