Clinical Features & Diagnosis of Dental Caries CHEN Zhi Wuhan University School of Stomatology 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. Current concepts of caries etiology Micro- organisms no no caries caries host Sub- & tooth caries strate no no caries caries time 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. 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 Classification according to the progression rate according to the involving site according to the severity according to the previous treatment Classification according to the progression rate Acute caries Active caries Rampant caries Chronic caries Arrested caries Arrested caries Secondary caries Acute Caries progress fast, often in children and teenagers, light colored cavity. Rampant Caries Caries in a patient with impaired salivary function as result of radiation therapy (Drs Jansma and Vissink) 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. Chronic Caries progress slowly, black or brown colored cavity hard remaining dentine Arrested Caries caries stop progressing because of the local etiological change Classification according to the treatment history Primary caries Secondary caries or Recurrent caries Secondary Caries Classification according to the involving site Pits & fissures caries Smooth surface caries Root surface caries 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. How many types of the fits & fissures in your text book? Pits & Fissures Caries 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. Could you explain why the proximal surfaces are particularly susceptible to caries? Smooth Surface Caries 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 ? Root Surface Caries Classification according to the Severity Incipient caries Superfacial caries Moderate caries Advanced caries Middle caries Severe caries Deep caries Incipient Caries Moderate Caries Advanced Caries Severe Caries A New Classification Recommended by Dr. Graham Mount & Dr. Rory Hume In UCLA http://www.dent.ucla.edu/pic/members/caries/index.html 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. Diagnosis • Clinical signs visual - location, cavitation tactile - texture • Clinical symptoms • Diagnostic test Diagnosis Test • Radiographs (film and digital) • Transillumination (FOTI/DFOTI) • Electrical conductivity (EC) • Optical (fluorescence) methods (QLF) • Fluorescent dye 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. 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 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 Proximal caries lesion is detected with the use of transillumination Quantitative Light Fluorescence (QLF) Progression of Dental Caries demineralization of enamel surface sub-surface enamel lesion demineralization of dentine cavitation of enamel surface cavitation into the dentine Treatment Program Non-surgical - remineralization Surgical - restoration 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. Two Difficulties When to place an initial restoration? Breakdown of the outer enamel is an important clinical indicator of treatment Management of Fissured Surface No Caries or Arrested Enamel Demineralization Cavitation or Caries in Fissures with or Questionable Caries in Caries in Dentin Susceptible Morphology Dentin Low Caries High Low Caries High Open fissures Risk? Risk? with round bur enamel Demineralization dentin involve No treatment Sealant Enamel PRR Restoration ---University of Texas Health Science Center at San Antonio, UTHSCSA Linking diagnosis to clinical management 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 Reference http://www.dent.ucla.edu/pic/members/caries/index.html http://www.uic.edu/classes/peri/peri343/main2.htm 《龋病学》 樊明文主编 Homework: What’s the difference between coronal caries and root caries? Please make a comparison, such as: surface tissue, composition, etc.
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