Clinical Features

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

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

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Current concepts of Caries

• The development of dental caries is
• a dynamic process of demineralization of the
  dental hard tissues
• by the products of bacterial metabolism,
• alternating with periods of remineralization.
• Harris and Christen
• Primary Preventive Dentistry, 1995

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Classification

• according to the progression rate

• according to the involving site

• according to the severity

• according to the previous treatment

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Classification according to the progression rate
Acute caries
Active caries
Rampant caries
Chronic caries
Arrested caries
Arrested caries
Secondary caries
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Acute Caries
progress fast, often in children and teenagers,
light colored cavity.
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Rampant Caries
Caries in a patient with impaired salivary
function as result of radiation therapy (Drs
Jansma and Vissink)
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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.
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Chronic Caries
progress slowly, black or brown colored
cavity hard remaining dentine
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Arrested Caries
caries stop progressing because of the local
etiological change
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Classification according to the treatment history
Primary caries
Secondary caries or Recurrent caries
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Secondary Caries
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Classificationaccording to the involving site
Pits fissures caries
Smooth surface caries
Root surface caries
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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.
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How many types of the fits fissures in your
text book?
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Pits Fissures Caries
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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.
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Could you explain why the proximal surfaces are
particularly susceptible to caries?
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Smooth Surface Caries
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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 ?
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Root Surface Caries
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Classificationaccording to the Severity
Incipient caries
Superfacial caries
Moderate caries
Advanced caries
Middle caries
Severe caries
Deep caries
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Incipient Caries
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Moderate Caries
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Advanced Caries
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Severe Caries
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A New Classification
Recommended by Dr. Graham Mount Dr. Rory
Hume In UCLA
http//www.dent.ucla.edu/pic/members/caries/index.
html
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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.
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Diagnosis

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

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Diagnosis Test

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

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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.

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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

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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
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Proximal caries lesion is detected with the use
of transillumination
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Quantitative Light Fluorescence (QLF)
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Progression of Dental Caries
demineralization of enamel surface
sub-surface enamel lesion
demineralization of dentine
cavitation of enamel surface
cavitation into the dentine
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Treatment Program
Non-surgical - remineralization
Surgical - restoration
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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.
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Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an important
clinical indicator of treatment
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Management of Fissured Surface
No Caries or Arrested Caries in Fissures
with Susceptible Morphology
Enamel Demineralization or Questionable Caries
in Dentin
Cavitation or Caries in Dentin
High
Caries Risk?
High
Open fissures with round bur
Low
Low
Caries Risk?
Demineralization involve
enamel
dentin
No treatment
Sealant
Enamel PRR
Restoration
---University of Texas Health Science Center at
San Antonio, UTHSCSA
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Linking diagnosis to clinical management
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Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an important
clinical indicator of treatment
How to deal with severe caries?
Protection of dental pulp is the primary goal
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Reference
http//www.dent.ucla.edu/pic/members/caries/index.
html
http//www.uic.edu/classes/peri/peri343/main2.htm
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Homework Whats the difference between coronal
caries and root caries? Please make a
comparison, such as surface tissue,
composition, etc.
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Acknowledgement