DIAGNOSIS OF DENTAL CARIES & CARIES RISK ASSESSMENT

Dr.M.Ganesh,MDS(Pediatric Dentistry)

DIAGNOSIS

Why is diagnosis important?

Caries diagnosis and treatment has traditionally been

limited to the detection and restoration of cavitated lesions. Undoubtedly, unaffected teeth are superior to restored teeth. Therefore early detection of incipient caries and limitation of caries activity prior to significant tooth destruction are primary goals of an effective diagnosis and treatment programme Cavitation is preceded by a lengthy period of subsurface demineralization that presents the dentist an opportunity to detect the disease and start preventive measures prior to the advent of significant tooth damage.

VISUAL INSPECTION

REQUISITES
Plaque should be removed to obtain reliable

diagnosis of caries visually Tooth must be properly dried Strict isolation Sequential examination Adequate lighting

VISUAL INSPECTION
Can be direct or indirect
Magnification loupes, Slides, Temporary

separation as adjuncts for better vision Crude tool for diagnosis

TACTILE EXAMINATION
Explorer and Floss
Right angle probe Back action probe

Shepherds crook
Cow horn with curved ends

Procedure used
In the examination of the patient, the occlusal

surfaces of the teeth are examined first. A small sharp explorer is placed in the main areas of pits and fissures or in areas of discoloration if present, the point is then placed in the grooves that radiate from the fossae to see if any of the areas are soft and cannot support the weight of the explorer. Care should be taken to withdraw the explorer along the same path as it was inserted. This is essential to prevent false catch felt by the explorer due to lateral shift of the same.

Use is condemned at times

Physical damage to intact surfaces

Fracture and cavitation of incipient lesions

False catch due to mechanical binding

RADIOGRAPHS
Conventional Film Radiography

Bite wing Radiography

Intra Oral Periapical Radiographs DIGITAL RADIOGRAPHY

Increasing knowledge about the limitations of conventional caries diagnostic methods and changes in lesion morphology act as a spur to the development of new diagnostic aids.

INTRA ORAL DENTAL XERORADIOGRAPHY

Xerographic copying Record images No wet processing Uses photoconductors or semiconductors

DYES IN CARIES DETECTION

Widespread use in medicine, biology & dentistry Discrimination & easy identification of objects

CARIOUS ENAMEL DETECTION

DETECTION OF CARIOUS DENTIN

Infected Vs Affected Dentin

FIBER OPTIC TRANSILLUMINATION

Alternative for bite wing In medicine since 1960s Used for surgical retraction in dentistry, caries detection, calculus, soft tissue lesions Especially proximal lesions Ease & flexibility

FIBER-OPTICS

THE UNIT

DIAGNOSTIC PROCEDURE

ADVANTAGES
Several angles- 3 D picture Cracks & Fissures Vitality testing Subgingival calculus Food pockets Root canals Sinus involvement Fast; no processing Cost effective Field use or screening

DIFOTI

USE OF LASER FLUORESCENCE

PRINCIPLE

DIAGNODENT
Chairside, battery-powered quantitative diode laser fluorescence device 655nm light beam Changes assigned a numeric value, which is displayed on the monitor

OPERATION

DIAGNODENT VALUES
Between 5 and 25 - initial lesions in the enamel Greater than this range indicate early dentinal caries Advanced dentin caries is said to yield values greater than 35

ELECTRONIC RESISTANCE MEASUREMENTS

Depth dependent gradient of enamel solubility or permeability- unique pattern of demineralization

PRINCIPLE & OPERATION

CARIES METER
Electronic caries detector Solid Probe on dried occlusal surface

Green- sound surface Yellow- enamel caries Orange- Dentinal caries Red- Pulpal involvement

ULTRASONIC CARIES DETECTOR

 The first component in risk assessment involves

identifying the childs risk and protective factors. use information obtained in the interview,observation of parent-child interaction, oral exam, and diagnostic procedures to identify the potential risks to full attainment of good oral health outcomes. identifies the protective factors that can reduce the negative impact of risk factors and contribute to attaining those outcomes.

 The second part of risk assessment involves

weighing the risk and protective factors to determine an oral health supervision plan.

Low Risk Optimal fluoride exposures both systemic and topical Consumption of simple sugars or limiting to mealtime High caregiver socioeconomic status (financially stable) Regular dental visits

Moderate Risk Suboptimal systemic fluoride exposure with optimal topical exposure Between meal snacking (1-2) Midlevel caregiver socioeconomic status (eligible school lunch/SCHIP) Irregular use of dental services
High Risk Suboptimal topical fluoride exposure Frequent between meal snacking (3 or more) Low level caregiver socioeconomic status No usual source of dental care Active caries present in the mother Children with special health care needs Conditions decreasing saliva flow (medications)

Interactive Cariogram program for estimation of individual caries risk