Diagnosis of occlusal caries: Part I. Conventional methods.
Accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. The diagnosis of non-overt occlusal decay is challenging and can be highly subjective, and its inherent uncertainties can lead to widely differing treatment decisions. The development of more sensitive, specific and reproducible diagnostic tools for occlusal surfaces would contribute greatly to more precise planning of preventive and operative therapy. The purpose of this 2-part paper is to review current knowledge concerning conventional and new diagnostic methods for occlusal caries. Part I looks at established diagnostic methods for occlusal surfaces. Conventional visual, tactile and radiographic examinations provide less-than-ideal diagnostic sensitivity. Neither fissure discolouration (black or brown) nor the use of an explorer has been shown to improve diagnostic accuracy. However, the combination of careful visual examination with optimal radiographic examination affords better diagnostic performance. The best visual indicators involve precise features associated with the presence of disease, such as opaque fissure demineralization and the presence and extent of localized breakdown of the enamel. For best results, teeth should be clean, thoroughly dry and well illuminated. Part II will examine new and emerging technologies, including the DIAGNOdent laser fluorescence device, which are being developed for the diagnosis of occlusal decay. (+info)
Diagnosis of occlusal caries: Part II. Recent diagnostic technologies.
Accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. The diagnosis of non-overt occlusal decay is challenging and can be highly subjective, and its inherent uncertainties can lead to widely differing treatment decisions. The purpose of this 2-part paper is to review current knowledge concerning conventional and new diagnostic methods for occlusal caries. Part I looked at established methods for diagnosing occlusal decay. These methods have several limitations, particularly in their ability to diagnose early carious lesions. Part II examines new and emerging technologies that are being developed for the diagnosis of occlusal decay. Electrical conductance measurements and quantitative laser- or light-induced fluorescence represent significant improvements over conventional diagnostic methods, especially for in vitro applications and particularly with regard to sensitivity and reproducibility. Proponents of the DIAGNOdent laser fluorescence system claim that it evaluates the fluorescence that develops when laser light is incident on areas of demineralization. This noninvasive device is simple to use and provides quantitative data. Studies supporting its validity are limited but do suggest good sensitivity and excellent reproducibility. However, the DIAGNOdent system requires more scientific scrutiny. Although it offers a high rate of disease detection, it has little ability to indicate the extent of decay. In all treatment decisions, clinicians must be aware of the limitations of the diagnostic methods that have been used. Clinical judgment based on the patient s case history, visual cues, review of radiographs and probability of disease is still the most important aspect of optimum patient care. New technologies may provide supplemental information, but they cannot yet replace established methods for the diagnosis of occlusal caries. (+info)
Clinical diagnosis of dental caries: a European perspective.
The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice. (+info)
Clinical diagnosis of dental caries: a North American perspective.
This paper summarizes current trends in the clinical diagnosis of occlusal caries in response to the RTI/UNC review and reflects the dilemma felt by many dentists who understand the difficulty in accurately assessing the extent and activity of pit and fissure caries in many of their patients. They are unsure if they should be aggressive in instrumenting suspicious lesions and provide small restorations, some of which may not be indicated. Alternatively, should they wait until signs are more clear-cut and provide larger restorations? Discussed here is the advantage of practicing dentists who obtain immediate false-positive feedback when they instrument a tooth with no clinical caries and false-negative feedback when a recall patient exhibits progression of an equivocal lesion. They should be encouraged to use this feedback as part of their diagnostic procedure and explain to their patients the difficulty of providing an accurate and precise diagnosis with existing tests. (+info)
The diagnosis of root caries.
The most commonly used clinical signs of root caries are visual (color, contour, surface cavitation) and tactile (surface texture) descriptions of a lesion. The traditional methods of visual-tactile diagnosis for root caries can produce a correct diagnosis but usually not until the lesion is at an advanced stage. Despite the subjectivity inherent in interpreting the clinical signs of root caries diagnosis, good to excellent inter-examiner reliability has been reported in clinical studies; however, the presence of filled surfaces dramatically enhances the agreement. When only untreated root caries is diagnosed, examiner reliability is reduced considerably. Clinicians look to diagnostic tests in the hope that they will perform better (that is, be more reliable) than clinical diagnosis and, therefore, can be used to replace clinical diagnosis. From the limited data available on diagnostic tests for root caries, tests determining the presence or absence of mutans streptococci and Lactobacilli are the most clinically helpful, producing calibrated efficiency scores exceeding 40 percent. The risk assessment approach to root caries diagnosis involves the determination of a patient's risk through the interpretation of clinical signs and the selection and application of an appropriate diagnostic test if the clinician is unsure of the diagnosis. (+info)
Do we need to be concerned about dental caries in the coming millennium?
Dental caries continues to be a pubic health problem despite claims that 50% of schoolchildren are caries-free. There are widespread variations in the prevalence of caries worldwide. Caries lesions are the clinical manifestation of a pathogenic process that may have been occurring on the tooth surface for months or years. Acid production by bacteria embedded in a biofilm termed "dental plaque" is a key aspect of the pathogenesis of dental caries; nevertheless, the ability of micro-organisms to survive in a hostile acid milieu and the influence of fluoride and additional agents on this acid tolerance receive scant attention. Study of cariogenic micro-organisms largely has been limited to observations made on them in the planktonic state; clearly dental caries is essentially a surface phenomenon, and micro-organisms behave distinctively when grown on a surface. Although significant progress has been made in our understanding of the etiology, pathogenesis, and prevention of dental caries, it still remains a scientific and clinical enigma worthy of the attention of the best scientists. (+info)
Effect of a Brazilian regional basic diet on the prevalence of caries in rats.
The aim of the present study was to determine the effect of a regional basic diet (RBD) on the prevalence of caries in the molar teeth of rats of both sexes aged 23 days. The animals were divided into six groups of 10 rats each receiving the following diets for 30 and 60 days after weaning: RBD, a cariogenic diet, and a commercial diet. The prevalence and penetration of caries in the molar teeth of the rats was then analyzed. The RBD produced caries in 37.5% of the teeth of animals fed 30 days, and in 83.4% of animals fed 60 days, while the cariogenic diet produced caries in 72.5% and 77.5% of the teeth of animals fed 30 and 60 days, respectively. Rats fed the RBD for 30 days had caries in the enamel in 38% of their teeth, 48% had superficial dentin caries, and 7.5% moderate dentin caries. The effect of the RBD did not differ significantly from that of the cariogenic diet in terms of the presence of caries in rats fed 60 days. The penetration depth of the caries produced by the RBD was the same as that produced by the cariogenic diet. Our results show that the RBD has the same cariogenic potential as the cariogenic diet. Since the RBD is the only option for the low-income population, there should be a study of how to compensate for the cariogenicity of this diet. (+info)
The intra- and inter-examiner reliability of quantitative light-induced fluorescence (QLF) analyses.
OBJECTIVE: To assess the reliability of the analysis stage of quantitative light-induced fluorescence (QLF). The QLF analysis involves subjective input from the user and this study examines the influence of this on the reproducibility of the QLF data. METHOD: QLF images were taken of 20 human molar teeth that had been previously subjected to a demineralizing solution (phosphoric acid 37%) to create artificial white spot lesions on their buccal surfaces. Following examination of the images, 16 were chosen to represent a range of lesion size and severity. Three copies were made of the images and each was allocated a different filename. 10 examiners in three centres were asked to analyse each of the 16 images on three occasions, with at least seven days between each attempt. Simple instructions describing the analysis procedure were supplied and examiners were asked to adhere to these directions. Examiners were asked to rate each of the 16 teeth on their first attempt both quantitatively (5 point scale) and qualitatively in terms of difficulty of analysis. Data reported were the delta Q at 5% threshold for each tooth on each of three attempts. RESULTS: Using ANOVA and paired t-tests to detect statistical differences, the three attempts of each examiner were used to determine intra-examiner reliability. Only one examiner (a novice at the technique) demonstrated differences between all three attempts and two demonstrated difference between one attempt. When the mean scores were compared to determine the inter-examiner reliability, only one examiner's results were statistically different when compared with two others. CONCLUSION: This study has demonstrated that the analysis stage of QLF is reliable between examiners and within multiple attempts by the same examiner, when analysing in vitro lesions. Novices at the technique should be trained before analysing experimental data. (+info)