4. Diagnosis of Hard Tissue Diseases and Abnormalities Dental caries

Part 1. Diagnosis of Dental Caries and Sequelae (Dental Decay, Carious Lesions and their Complications)

“Management of dental caries demands early detection of carious lesions to identify patients who require intensive preventive intervention. It is not to justify premature restorative intervention”.

Therefore, it is essential to link patient’s systemic health status for diagnosis and management of dental caries and its sequelae.

oral diagnosis process

Where are we in the diagnostic process  for the diagnosis of hard tissue diseases and abnormalities?

Health history, physical examination, and specialized exams

Caries and its sequelae are the most common hard tissue diseases in dentistry

Need to differentiate caries and its sequelae from other hard tissue diseases or abnormalities, e.g. dental fluorosis, erosion, attrition, tooth fracture (traumatic (S02.5), cracked tooth (nontraumatic) (K03.81), and others. S02.5 must have extension e.g.,S02.5XXA

fracture is not same as tooth fracture

Often use specialized examination methods (radiographic examination)

traumatic vs non traumatic fracture

traumatic: ball to the face, fall on the floor

non-traumatic: bruxism, hard occlusion

Definition of trauma

acute injury

Symptoms and Signs of Dental Caries

What are patient’s CC and HPI?

What does it look like?

Is there any pattern? (characteristics: smooth surface vs pit and fissure lesions)

What are the contributing factors?

What is the complete diagnosis for each lesion?

What is the comprehensive diagnostic list for a dental patient regarding his/her dental caries?

 (Whole Person Healthcare-diagnosis for a person)

ICD-10-CM Names and codes for Dental Caries

Dental Caries limited to Enamel; Caries on pit and fissure surface limited to enamel

Caries on pit and fissure surface limited to enamel

No symptom because enamel is not live tissue

Signs (findings):

Inspection with or without instrumentation with traditional methods

Stained or discolored fissure and/or pit, matted enamel (not glossy) when the surface is cleaned and dried, shepherd’s explore sink to a hole.

Inspection with modern illumination methods

Important- the tooth surface must be clean and dry.

Dental Caries limited to Enamel; Caries on smooth surface limited to enamel-K02.61

Caries on smooth surface limited to enamel-K02.61

No symptom

Signs (findings):

Traditional Inspection with or without instrumentation Stained or discolored tooth surface, matted enamel (not glossy) when the surface is cleaned and dried, shepherd’s explore side-soft on touch. Hard on touch? Arrested decay.

Inspection with modern illumination methods

Bitewings may help for proximal surface caries limited to enamel

Important- the tooth surface must be clean and dry.

Detection by color change and with or without tactile sensation

for tactile sensation (use shepherd’s explore), use the side of it dont jab

to diagnose you must have symptoms you cannot say it is one of these without that

different illumination methods

Dental Caries Penetrating into Dentin: Dental caries on pit and fissure surface penetrating into dentin

Dental caries on pit and fissure surface penetrating into dentin

Symptom(s):sensitive to or painful on cold, hot, or sweet. (physical or chemical stimuli), stimuli induced sensitivity can be a finding as well by reproducing it

Signs (findings):

Inspection with or without instrumentation

Stained or discolored fissure and/or pit, matted enamel (not glossy) when the surface is cleaned and dried, shepherd’s explore sink to a hole.

Visible hole(s) and greyish or chalky discoloration of enamel.

Bite-wing radiograph may show D1 or D2 below enamel

Important- the tooth surface must be clean and dry.

Dental Caries Penetrating into Dentin: Caries on smooth surface penetrating into dentin

Caries on smooth surface penetrating into dentin

Symptom(s):sensitive to or painful on cold, hot, or sweet. (physical or chemical stimuli) Transient pain on stimuli.

Signs (findings):

Inspection with or without instrumentation

Stained or discolored tooth surface, matted enamel (not glossy) when the surface is cleaned and dried, shepherd’s explore sink to a hole.

Visible hole(s) and greyish or chalky discoloration of enamel.

Bitewings may help for proximal surface caries D1, D2

Radiograph is not helpful for other smooth surface caries penetrating into dentin, e.g. cervical surface decay.

Important- the tooth surface must be clean and dry.

Arrested Dental Carious

White or brown spots which are hard on instrumentation on the tooth surface can be caries lesions that have self-arrested as part of the natural process of the disease or have arrested owing to a change in the local environment.

These lesions can be considered scars from disease activity occurring years or even decades earlier.

Arrested lesions are more resistant to subsequent cariogenic challenges than sound enamel and, thus, should not receive restorative treatment unless the patient has esthetic concerns.

smooth surface limited to enamel

use instrument to see if it is arrested (hard) or not (soft)

• chalky white is arrested

for this pt it is due to hyposalivation

• get pts information to determine risk factor

caries into pulp

characteristic