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Clinical Features Diagnosis of Dental Caries by cali0998

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									   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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