Clinical Features & Diagnosis of Dental Caries

1. Clinical Features & Diagnosis of Dental Caries CHEN Zhi Wuhan University School of Stomatology

2. 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.

3. Current concepts of caries etiology Micro- organisms no caries no caries host & tooth Sub- strate caries no caries no caries time

4. 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.

5. Current concepts of Caries The development of dental caries is a dynamic process of demineralization ofthe dental hard tissues by the products of bacterial metabolism, alternatingwith periods of remineralization. Harris and Christen 《 Primary Preventive Dentistry》, 1995

6. Classification • according to the progression rate • according to the involving site • according to the severity • according to the previous treatment

7. Classification according to the progression rate Acute caries Active caries Rampant caries Chronic caries Arrested caries Arrested caries Secondary caries

8. Acute Caries progress fast, often in children and teenagers, light colored cavity.

9. Rampant Caries Caries in a patient with impaired salivary function as result of radiation therapy (Drs Jansma and Vissink)

10. 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.

11. Chronic Caries progress slowly, black or brown colored cavity hard remaining dentine

12. Arrested Caries caries stop progressing because of the local etiological change

13. Classification according to the treatment history Primary caries Secondary caries or Recurrent caries

14. Secondary Caries

16. Classificationaccording to the involving site Pits & fissures caries Smooth surface caries Root surface caries

17. 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.

18. How many types of the fits & fissures in your text book?

19. Pits & Fissures Caries

20. 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.

21. Could you explain why the proximal surfaces are particularly susceptible to caries?

22. Smooth Surface Caries

25. 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 ?

26. Root Surface Caries

27. Classificationaccording to the Severity Incipient caries Superfacial caries Moderate caries Advanced caries Middle caries Severe caries Deep caries

28. Incipient Caries

29. Moderate Caries

30. Advanced Caries

31. Severe Caries

32. A New Classification Recommended by Dr. Graham Mount & Dr. Rory Hume In UCLA http://www.dent.ucla.edu/pic/members/caries/index.html

34. 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.

35. Diagnosis • Clinical signs visual - location, cavitation tactile - texture • Clinical symptoms • Diagnostic test

36. Diagnosis Test • Radiographs (film and digital) • Transillumination (FOTI/DFOTI) • Electrical conductivity (EC) • Optical (fluorescence) methods (QLF) • Fluorescent dye

37. 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.

38. 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

39. 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

41. Proximal caries lesion is detected with the use of transillumination

42. Quantitative Light Fluorescence (QLF)

43. Progression of Dental Caries demineralization of enamel surface sub-surface enamel lesion demineralization of dentine cavitation of enamel surface cavitation into the dentine

48. Treatment Program Non-surgical - remineralization Surgical - restoration

49. 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.

50. Two Difficulties When to place an initial restoration? Breakdown of the outer enamel is an important clinical indicator of treatment