5 ways to classify caries
by extent
by cavitation
by activity
by site
by location
2 classifications of caries by extent
D1
D3
D1 caries classification
enamel only, not breached the ADJ
(cavitated or non-cavitated)
all visibly detectable lesions
D3 caries classification
lesions extending into dentine
cavitated
shadowing
- school dental visits focus on these
treatment if cavitated caries
restoration
cavity can’t reheal itself
not-cavitated caries treatment
should be able to remineralise damage
how to detect a cavity?
use a ball ended probe or perio probe along the surface
- probe will drop in
nerve probe with a sharp probe as even a micro-cavity can be made worse
how to treat a small cavity
fissure seal over the top or thin layer of composite
appearance of active caries
soft, light brown lesion
demineralising
appearance of non-active caries
dark brown, leather like
4 site classifications of caries
smooth surface
- most worrying as should be able to clean well
occlusal
- most common, especially in young
- harder to clean pits properly
approximal
- on surface approaching
root surface
- recession and exposed dentine can get caries easier than enamel
when can remineralisation occur?
once the patient is able to cleanse tooth surface
2 classifications of caries by location
primary
- de novo/new
secondary
- adjacent to a restoration
2 types of caries scoring systems
DMFS - surfaces, each considered separately
DMFT - teeth, worst surface dictates tooth code
accuracy
measures what is claimed
- how good an operator is at measuring decay
split into sensitivity and specificity
precision
consistency of measurement
- measuring at the same level all the time
accuracy sensitivity
% of disease found correctly
e.g. only detect 1 out of 2 decayed teeth = 50%
accuracy specificity
% of healthy teeth found correctly
e.g. how many times correct if 30 healthy and 2 caries
risk of incorrectly detecting decay
want a high specificity score
4 basic requirements for clinical examination
- good light
- dry the tooth
- take your time systematically
- don’t use a sharp probe
4 ways accuracy can be improved
- ICCMS
- radiographs
- magnification
- FOTI
ICCMS
international caries care and management system
- Carefully drying for 30 seconds
- And looking at each surface carefully
caused
- increase in sensitivity
- decrease in specificity (bad as more false positive for decay)
advantage and disadvantages of taking radiographs for caries diagnosis
Advantage
- Permanent record at certain time
Disadvantages
- Ionising radiation
- Not good for all surfaces – approximal areas good, occlusal harder
Panoramic OPT – not ideal
Bitewing good take on both sides – see enamel, dentine and approximal clearly
Periapical – good
what does caries look like on radiographs?
Lesions come as darker shadows as less mineral so more X-rays get through
secondary caries can be seen as shadows around radiopaque material
advantages and disadvantages of magnification for caries diagnosis
Advantages
- Easy
- Relatively cheap
Disadvantages
- Time to adjust to them
- Field of view and depth of view gets smaller
