Lecture_54.Cariology._Caries_Activity_Nanda__D28

Introduction to Caries Activity

  • Instructor: Shubha Nanda

  • Institution: Tufts University School of Dental Medicine

  • Date: November 2024

Learning Objectives

  • Describe caries activity

  • Differentiate between active and inactive caries lesions

Understanding Dental Caries

  • Definition: Dental caries is a biofilm-mediated, diet-modulated, multifactorial, non-communicable, dynamic disease leading to net mineral loss of dental hard tissues.

  • Risk Factors: Influenced by several factors such as diet and oral hygiene practices.

CariesCare 4D Cycle

  • A systematic approach to caries management including detection and assessment, planning, intervention, and monitoring.

Caries Assessment

  • Focuses on identifying characteristics of detected carious lesions.

Classification System at Tufts University School of Dental Medicine (TUSDM)

  • ADA CCS Classification:

    • Sound (ICDAS 0): No visible caries.

    • Initial (ICDAS 1): Carious opacity visible without caries.

    • Moderate (ICDAS 2): White or brown spot lesion without visible dentin.

    • Advanced (ICDAS 3-6): Distinct cavity with visible dentin exposure.

Clinical Presentation

  • Activity Status:

    • Active: Dentin is soft or leathery.

    • Inactive: Dentin is shiny and hard.

What is Caries Activity?

  • Patient Level: Presence of caries indicates caries activity.

  • Tooth/Surface Level: Refers to progression of existing lesions and new lesion development.

Factors Influencing Caries Lesion Activity

  • Demineralization vs. Remineralization: Ongoing balance influences the progression of caries lesions.

  • Caries Risk Factors: Include poor dietary habits, absence of saliva, and dysbiosis.

Enamel Lesions and Their Assessment

  • Initial enamel lesions show increased enamel porosity.

  • Assessment techniques: Visual-tactile, bitewing radiographs, and additional tools like Lumicare, Calcivis, and QLF.

Visual-Tactile Assessment

  • Inactive Lesions:

    • Color: Whitish to brownish

    • Texture: Smooth

    • Appearance: Shiny

    • Translucence: Semi-transparent

  • Active Lesions:

    • Color: Whitish, no or minimal stain

    • Texture: Rough

    • Appearance: Dull and chalky

    • Translucence: Opaque

Advanced Lesion Assessment

  • Inactive Lesions:

    • Color: Brownish to black

    • Texture: Firm to hard

    • Appearance: Shiny

    • Translucence: Semi-transparent

  • Active Lesions:

    • Color: Orangish

    • Texture: Soft or leathery

    • Appearance: Wet

    • Translucence: Opaque

Summary Table of Visual Indicators

Indicator

Active Lesion

Arrested Lesion

Color

White/yellow/orangish

Dark brown to black

Texture

Soft, leathery, rough

Firm, smooth, polished

Translucence

Opaque

Semi-transparent

Location

Plaque-retentive areas

Plaque-free areas

Borders

Diffuse, undefined

Well-defined, distinct

Bite-Wing Radiographs Comparison

  • Visible changes over time can identify inactive lesions if size is stable.

Caries Detection Technologies

  • LumiCare: Uses fluorescent dye to visualize active lesions.

  • Calcivis: Luminescence indicates areas with active lesions.

  • QLF: Quantitative method to assess mineral loss and bacterial presence using fluorescence.

Caries Activity Assessment Considerations

  • Factors to consider:

    • Duration of caries presence

    • Lesion location and health of surrounding tissues

    • Plaque stagnation areas increase activity risk

Summary of Caries Activity Assessment

  • Assessment indicates whether existing lesions are progressing or inactive.

  • Characteristics and tools for assessing enamel and dentin lesions are crucial for effective management.

Conclusion

  • Thank You: Open floor for questions.