DTP 3 - Caries Detection

Define the following:

A biofilm mediated - diet modulated process that can lead to an imbalance in the cycle of demineralization and remineralization causing localized destruction of tooth structure

Dental caries

Extended low pH = Microbiome in _______

Dysbiosis

What caries classification system do we use at TUSDM?

ICDAS (ADA CCS)

What is the classification?

- Clinical presentation: No evidence of visible caries (no or questionable change in enamel translucency)

Sound

What is the classification?

- Clinical presentation: A carious opacity or visible discoloration (white spot lesion and/or brown carious discoloration) not consistent with clinical appearance of sound enamel and which show no evidence of surface breakdown or underlying dentin shadowing

Initial

What is the classification?

- Clinical presentation: A white or brown spot lesion with localized enamel breakdown, without visible dentin exposure, or an underlying dentin shadow, which obviously originated on the surface being evaluated

Moderate

What is the classification?

- Clinical presentation: A distinct cavity with visible dentin

Advanced

Active or inactive?

- Opaque, whitish or brownish, rough, in plaque stagnation area

Active (initial or moderate)

Active or inactive?

- Translucent, smooth, shiny, not in plaque stagnation area

Inactive (initial or moderate)

Active or inactive?

- Dentin is soft or leathery on gentle probing

Active (advanced)

Active or inactive?

- Dentin is shiny and hard on gentle probing

Inactive (advanced)

What is the radiographic interpretation of a tooth classified as sound?

No radiolucency

What is the radiographic interpretation of a lesion classified as initial?

Radiolucency may extend to the DEJ or outer 1/3 of dentin

What is the radiographic interpretation of a lesion classified as moderate?

Radiolucency extends into the middle 1/3 of dentin

What is the radiographic interpretation of a lesion classified as advanced?

Radiolucency extends into the inner 1/3 of dentin

DA Caries Classification System (ADA CCS) categorizes caries lesions according to what two criteria?

- Extent/severity

- Activity status

What occlusal surfaces are common for caries on mandibular molars?

Buccal pits

What occlusal surfaces are common for caries on maxillary molars?

Lingual pits

What locations are considered smooth surface caries sites?

- Proximal surfaces

- Buccal/lingual smooth surfaces

Root surface caries is most strongly associated with what three factors?

- Gingival recession

- Exposed root surfaces

- Older adults

What is the classification?

- First visible evidence of mineral loss

- White or brown opacity

- No cavitation

Initial

What is the classification?

Initial

T/F: Severity describes how much tooth structure is involved (NOT whether the lesion is active)

True

What is the classification?

- More advanced enamel breakdown

- Localized enamel surface discontinuity

- (Dentin involvement - not visually - but histologically and radiographically)

Moderate

What is the classification?

Moderate

What is the classification?

- Cavitation with dentin involvement

- Structural compromise

- Difficult to maintain plaque control

Advanced

What is the classification?

Advanced

Active or inactive?

- Chalky/matte appearance

Active

Active or inactive?

- Soft - whitish/yellowish

Active

Active or inactive?

- Rough enamel surface

Active

Active or inactive?

- Plaque stagnation area

Active

Active or inactive?

- Near gingival margin

- Recent change in size/appearance

Active

Active or inactive?

- The disease process is currently progressing

Active

Active or inactive?

- Shiny appearance

Inactive

Active or inactive?

- Blackish/darker brown

Inactive

Active or inactive?

- Smooth surface

Inactive

Active or inactive?

- Hard texture

Inactive

Active or inactive?

- Not associated with plaque stagnation

Inactive

Active or inactive?

- The lesion has stopped progressing

Inactive

Active or inactive?

Active

What tool can you use to visually detect and assess caries?

- A mouth-mirror

- Reflected light

- Air-water syringe on a clean tooth surface

- Bite-wing

- Fiber-optic transillumination (especially for proximal caries)

- Quantitative Light-Induced Fluorescence (QLF)

What type of radiograph is useful to detect and assess caries?

Bite-wings

What type of tool to detect caries?

Measures the amount of fluorescence emitted by tooth structure when exposed to a specific wavelength of light (often blue or violet light). Healthy enamel emits a measurable amount of fluorescence, while carious lesions emit less. The system quantifies this difference and displays it as a grayscale image, with darker areas indicating higher fluorescence (often sound enamel) and lighter areas indicating lower fluorescence (often carious tissue)

Quantitative Light-Induced Fluorescence (QLF)

What type of tool to detect caries?

An advanced diagnostic tool used primarily in dentistry to detect cavities and monitor dental health without exposing patients to harmful radiation

NIRI technology (Near Infra-Red Imaging)

(NIRI technology shines near-infrared light through the teeth. Healthy enamel is transparent to this light, appearing darker on the scan, while dentin and decayed areas scatter the light, making them appear brighter. This contrast helps dentists identify areas of concern effectively)

What is the classification?

- Occlusal

- Primary

- Moderate

What is the classification?

- Occlusal

- Primary

- Advanced

What is the classification?

- Occlusal

- Primary

- Initial

What is the classification?

- Buccal

- Sound

What is the classification?

- Occlusal

- Primary

- Moderate

What is the classification?

- Occlusal

- Sound

What is the classification?

- Buccal

- Primary

- Advanced

What is the classification?

- Occlusal

- Sound

What is the classification?

- Occlusal

- Primary

- Moderate

What is the classification?

- Occlusal

- Primary

- Advanced

What is the classification?

- Occlusal

- Secondary

- Advanced

What is the classification?

- Occlusal

- Primary

- Initial

What is the classification?

- Buccal

- Primary

- Advanced

What is the classification?

- Lingual

- Primary

- Advanced

What is the classification?

- Occlusal

- Secondary

- Initial

What is the classification of #19?

- Occlusal: Moderate

- Buccal: Moderate

What is the classification?

Occlusal: Moderate

What is the classification?

- Distal: Advanced

- Occlusal: Moderate

- Buccal: Advanced

What is the classification?

Occlusal: Moderate

What is the classification for #13?

Occlusal: Moderate

What is the classification for #12?

Occlusal: Initial

What is the classification?

Buccal: Advanced

What is the classification for #30?

- Occlusal: Moderate

- Buccal: Initial

What is the classification for #29?

- Occlusal: Initial

- Buccal: Moderate

What is the classification for #28?

Occlusal: Moderate

What is the classification?

- Occlusal: Moderate

- Buccal: Moderate

What is the classification for #19?

- Occlusal: Moderate

- Buccal: Moderate

What is the classification for #18?

Occlusal: Moderate

What is the classification for #30?

- Occlusal: Moderate

- Buccal: Moderate

What is the classification for #31?

Occlusal: Moderate

What is the classification for #18?

Occlusal: Moderate

What is the classification for #19?

Occlusal: Moderate

What is the classification for #21?

Occlusal: Sound

What is the classification for #14?

Occlusal: Initial

What is the classification for #15?

Occlusal: moderate

What is the classification for #11?

Facial: initial

What is the classification?

Occlusal: Initial

What is the classification?

Occlusal: Advanced

What is the classification?

Occlusal: Sound

What is the classification?

Occlusal: Moderate

What is the classification?

Occlusal: Advanced

What is the classification?

Occlusal: Advanced

What is the classification?

Occlusal: Advanced

What is the classification?

Occlusal: Initial

What is the classification?

Occlusal: Moderate

T/F: Untreated dental caries (tooth decay) in permanent teeth is the most common health condition according to the Global Burden of Disease 2021.

True

T/F: The cavity is the disease

False (Cavity is the visible manifestation)

The disease is multifactorial:

- Biofilm dysbiosis (it becomes cariogenic)

- Frequent sugar exposure

- Susceptible tooth surfaces (deep grooves, cavitations, chips)

- Inadequate fluoride exposure

- Host susceptibility that can lead to an imbalance in the cycle of demineralization and remineralization causing localized destruction of tooth structure

What is caries risk determined by?

The balance between pathological (risk) factors and protective factors

What is the goal of caries management?

Reduce pathological factors while strengthening protective factors to shift the balance toward oral health.

Do these factors favor remineralization or demineralization?

- White spot lesions

- Restorations < 3 years

- Enamel lesions

- Caries/dentin

Demineralization

Do these factors favor remineralization or demineralization?

- Pathogenic bacteria

- Absence of saliva

- Destructive lifestyle habits

Demineralization

Do these factors favor remineralization or demineralization?

- Saliva and sealants

- Antibacterials Fluoride/Ca/PO

- Effective lifestyle habits

- Risk-based reassessment

Remineralization

What are the 4Ds of the caries care 4D cycle?

1) Determine caries risk

2) Detect and assess lesions

3) Decide on a personalized care plan

4) Do preventive and tooth-preserving care

- Risk-based recall interval

Risk factors are biological, behavioral, or environmental factors that __________ the likelihood of developing or progressing dental caries

Increase

What type of caries risk factors are the following?

- Visible plaque accumulation

- Frequent exposure to fermentable carbohydrates

- Reduced salivary flow (hyposalivation/xerostomia)

- Exposed root surfaces

- Deep pits and fissures

- Orthodontic appliances or other plaque-retentive factors

Biological

What type of caries risk factors are the following?

- Frequent consumption of sugary foods or drinks (especially between meals)

- Poor oral hygiene

- Inadequate fluoride exposure

- Irregular dental attendance

- Low adherence to preventive recommendations

Behavioral