Caries Risk Assessment

lecture given 1/13/2026

what are the general types of carious lesions?

pit and fissure, smooth surface, root

how should you diagnose pit and fissure caries?

air dry and dental explorer

how should you diagnose smooth surface caries?

visual inspection and dental explorer

how should you diagnose root caries?

visual inspection and dental explorer

incipient lesions

lesions less than half way through enamel

what are disease indicators for caries?

white spots, restorations <3 years old, enamel lesions, cavities in the dentin

what are risk factors for caries?

bad bacteria, absence of saliva, destructive lifestyle habits

what are protective factors for caries?

saliva and sealants, antibacterials, fluoride, Ca2+, Po4³-, effective lifestyle habits, risk based reassessment

visual-tactile examination

the core of caries diagnosis, supported by other diagnostic methods like bitewings, fiberoptic transillumination, and laser fluorescence

what factors are involved in the categorization of diagnoses?

activity of the lesion, extent of the lesion, location of the lesion, available therapeutic options, patient-related factors, dentist’s opinion

where do caries lesions start developing?

plaque stagnation areas- interproximal and cervical regions

white spot lesion

first clinical signs of caries, can be seen when plaque is removed from the enamel surface and dried with compressed air for a few seconds

at a more advanced stage the are visible when the enamel surface is wet

t/f lesion progression of white spot lesions within enamel roughly follows the rod/prism direction

true- seen to move in a cone shape towards the DEJ

what are risk factors for root caries?

gingival recession and the accumulation of plaque

caries arrest is possible only when _____

the surface conditions change (sufficient plaque removal)

clinically, caries are (deeper/more shallow) than on x-rays

deeper

radiographic images visualize caries lesions due to a _____

decreased radiopacity of demineralized dentin and enamel

for a low caries risk/pt with no visible caries, how often should a child w primary teeth, child w mixed dentition, adolescent w secondary dentition, and adults receive x-rays?

child w primary teeth- 12-24 months

child w mixed dentition- 12-24 months

adolescent w secondary dentition- 18-36 months

adults- 24-36 months

for a high caries risk/pt with visible caries, how often should a child w primary teeth, child w mixed dentition, adolescent w secondary dentition, and adults receive x-rays?

child w primary teeth- 6-12 months

child w mixed dentition- 6-12 months

adolescent w secondary dentition- 6-12 months

adults- 6-18 months

fiber optic transillumination

method based on visible light for detecting and evaluatig approximal and occlusal caries lesions

fluorescence for caries detection

most widespread clinical method is DIAGNOdent

method is based on the measurement of fluorescence of certain chromophores that occur in caries lesions

uses relative values (0-99)

electrical conductivity for caries detection

based on the greater conductivity or reduced electrical resistance of demineralized, porous in comparison to sound enamel

what is the goal of treatment?

induce healing, alleviate symptoms, restore the functions of the teeth

non-invasive measures

all therapies that do not destroy the enamel and dentin, and directly address causal factors

includes measures for influencing biofilm, diet, and mineralization

what is sugar clearance determined by?

consistency of the food as well as salivary flow rate

SDF

colorless liquid that at pH 10 is 24.4% to 28.8% silver and 5% to 5.9% fluoride

cleared for use in treatment of tooth sensitivity which is the same type of clearance as fluoride varnish and must be professionally applied

arrests caries lesions

when should you use SDF?

high or extreme caries risk, behavior or medical management challenges, more lesions than treatable at 1 visit, difficult to treat lesions, patients without access to care

what are relative contraindications to SDF?

significant desquamative processes

what are microinvasive measures of treatment?

sealing fissures and smooth surfaces and the infiltration of caries

sealing fissures and pits

originally used for the primary prevention of caries in healthy occlusal surfaces

also creates a diffusion barrier between the potential biofilm and enamel which further limits the demineralization of the enamel

caries infiltration

arrests noncavitated caries lesions by infiltrating the pores on the lesion body using special low-viscosity, light curing resins

the diffusion barrier is not created on the lesion surface, it is created inside the lesion which results in the stablization and arrest of caries progression

what are some individual risk factors increasing risk for developing caries?

active caries in previous 12 months, high titers of cariogenic bacteria, poor oral hygiene, drug/alcohol abuse, poor family dental health, cariogenic diet, genetic abnormality of teeth, many multi-surface restorations, chemo or H/N radiation therapy

eating disorders, ortho, irregular dental care, suboptimal fluoride exposure, developmental or acquired enamel defects, prolonged nursing, presence of exposed root surfaces, restoration overhangs and open margins, physical and mental disability with inability or unavailability of performing proper oral health care, xerostomia

international caries detection and assessment system

evidence based, preventively oriented strategy that classifies the visual appearance of a lesion, characterizing/monitoring of the lesion once detected, and culminates in diagnosis

system is scored on clean, dry teeth and cautions against using sharp explorers or probes in order to prevent iatrogenic damage to the tooth

what variables DO NOT reliably predict active caries adjacent to a filling?

ditching around an amalgam restoration, staining around an amalgam restoration, staining around a tooth-colored restoration

dental fluorosis

occurs on contralateral teeth, opacities do not change color or size with water or air-drying

*what is the characteristic shape and color of a caries lesion?

follow the extension of plaque

more opaque than sound enamel (chalky/dull), if not colored secondarily

*what is the characteristic shape and color of mild forms of fluorosis?

follow incrimental lines

slightly more opaque than sound enamel (frosted appearance)

*what is the characteristic shape and color of a nonfluoride opacities?

often round or oval

creamy yellow to dark reddish orange, can be pigmented at time of eruption

*what is the characteristic shape and color of molar incisor hypomineralization?

from very localized to involving most of the surface

creamy yellow to brownish

*what is the characteristic shape and color of an erosion lesion?

related to the exposition to acid

initial stages- normal color

more mature stages- color of the dentin

why is xylitol beneficial?

it is a sugar not metabolized by s mutans so the salivary pH is not reduced

inhibits s mutans adherence to the teeth

helps increase salivary flow by the mechanical chewing action

increased concentration of bicarbonate (buffering), mineral supersaturation (remineralization), enhance clearance of food debris and microorganisms

what are examples of minimally invasive dentistry?

RMGI fluoride release, preventive resin restorations/sealants, composite more conservative preparation, slot preparations