CARIES

DIAGNOSIS
DIAGNOSIS ?

• Diagnosis is a determination and judgement of variations from normal. During the clinical
examination, the dentist must be keenly sensitive to subtle sign, symptoms and variations from
normal to detect pathological conditions and etiological factors.
[sturdevents]
CARIES

• Dental caries is a infectious microbiologic disease of the teeth that

results in localized dissolution and destruction of calcified tissues.
CARIES DIAGNOSIS-

The process of caries diagnosis involves risk assessment and the application
of diagnostic criteria to determine diseased state.
[sturdevents]
caries diagnosis implies deciding whether a lesion is active, progressing
rapidly, slowly or whether is already arrested.
DIAGNOSTIC TOOLS-

CONVENTIONAL RECENT
• a) Visual-Tactile Examination ADVANCES
• b) Conventional radiography
a)Co2 laser
• a) Digital Radiography
• b) Enhanced Visual Techniques b)Terahertz frequency

• c) Fluorescent Technique c)Optical coherence tomography

• d) Electric-Based Detection Systems
d)LED technology
• e) Ultrasound Techniques
• f) Chemical Dyes e)Caries Scan
CONVENTIONAL
Visual- cavitation
surface roughness
opacification
discolouration
TACTILE- DENTAL EXPLORER-
A delicate pointed instrument used for examination of teeth.
Examines restorations, margins
Three factors should be determined while selecting the explorer-
1)Sharpness of point
2)Resilience and stiffness
3)Design of shank and handle
• PIT AND FISSURE CARIES- The visual examination is conducted in dry, well illuminated field
shows chalkiness or appearing softening or cavitation of tooth forming the fissure or pit.

Smooth surface caries-

Proximal surface caries- detected by visual examination after tooth separation.
radiographic examination
probing with an explorer
transillumination

Caries on facial and lingual surface of teeth, particularly in gingival areas

• Incipient caries- its an early carious lesion appears as “white spot”.
on wetting the carious lesion disappears while the developmental defect
persist.

• Arrested caries- involving the dentin shows marked brown pigmentation and induration of
lesion so called eburnation of dentin.
 ROOT SURFACE CARIES

• Active root surface caries is detected by presence of softening and cavitation.

• Rapidly progressing lesion can be diagnosed using vertical bitewing radiograph.
 radiographic methods

conventional technique

IOPA BITEWING

occlusal caries detection proximal caries detection

RADIOVISIOGRAPHY

• Radio: conventional Xray system +

sensor

• Visio: recieves and stores incoming

signals and stores them to 256
discrete grey levels
video monitor and display
processing unit

• Graphy: storage apparatus connected

to printer
 XERORADIOGRAPHY

It is the process of recording a latent radiographic image on a selenium coated

aluminium plate, the image is then transferred to a specially treated paper for
visualization. The whole process is fully automatic, taking 90 seconds to complete
• ADVANTAGES-
• Soft tissue, bone, teeth and air passages are clearly visible because of a large
recording latitude, high resolution and edge enhancement phenomenon.
• More pronounced definition and contrast.
COMPUTER IMAGE ANALYSIS

• It provides graphic visualization of size and progression of carious lesion

especially approximal caries.
ADVANTAGES-
• Useful for monitoring carious lesion
• Observation of smaller lesions which are not
percepitable to human eye
 DIGITAL SUBSTRACTION RADIOGRAPHY-
• It is a technique by which structured noise is reduced. In order to increase the detectable changes in
radiographic technique.
Taking a picture of radiograph using high quality video camera

This is fed to computer imaging device called ‘Digitizer’

2 standardized radiographs produced with identical exposure geometry are used

reference image subsequent image

The difference between original and subsequent images can be seen as “DARK AREAS”
EL ECT R I CA L R ES IS TA NC E

• Sound tooth enamel – good electrical insulator

• caries/ enamel demineralization-increased porosity
saliva fills these pores and forms conductive pathways for electric current.
Electrical resistance is measuring the electrical conductivity through these pores.
2 devices were developed

Vanguard electronic caries detector caries meter

measures electric conductance

ADVANTAGES-
• most accurate in diagnosing early occlusal caries than any other method.
• Monitor the progress of caries.
OPTICAL CARIES MONITOR

• Comprises of light source, measuring & reference units & detection part

• The light is transported through a fiber bundle to tip of handpiece

• The tip is placed against the tooth surface & reflected light is collected by different fibers of same tip
• When collected scattering is weak- sound tooth structure
strong-carious tooth

• DISADVANTAGES-
used only for smooth surface lesions
FIBRE OPTIC TRANSILLUMINATION

• FOTI works under the principle that since a carious lesion has a lowered index of light transmission, an area of
caries appears as a darkened shadow that follows the spread of decay through dentin.
DIGITAL IMAGING FIBEROPTIC TRANSILLUMINATION

FOTI + digital CCD camera

• This technique uses digital imaging fibreoptic transillumination where by transient light image is
recorded by a CCD digital camera.
• The resultant changes in the light distribution captured by the camera are send to computer for analysis.
• ADVANTAGE- more accurate in assessing shadow of caries and more sensitive in detecting early lesions.
CONE BEAM COMPUTED TOMOGRAPHY

• CBCT is an x-ray imaging approach that provides high resolution 3 dimensional images of jaws and
teeth.

USES IN OPERATIVE DENTISTRY-

 Heavily restored dentition in adjacent area.
 Pathosis of adjacent tooth
 Unclear depiction of anatomical structure
ULTRAVIOLET TRANSILLUMINATION

• It is used to increase the optical contrast between carious tooth region and surrounding sound tissue.
• It is decreased in areas of demineralisation,carious lesions.
• Advantages-
more sensitive

Disadvantages-
The carious lesions and other defect with demineralisation appears same.
QU A NTA TI VE L A SER FL UOR ES CENC E

The application of light induced fluorescence in detecting carious lesions and quantifying mineral loss are
based on this concept.
ADVANTAGES-
Measures actual loss of minerals
Ability to detect bacterial products
Access the lesion activity
DIAGNODENT

• Diagnodent device uses laser fluorescence technology presumably to detect and measure bacterial
products in a carious lesion.
ENDOSCOPE/VIDEOSCOPE

• Endoscope technique is based on observing the fluorescence that occurs when tooth is illuminated with
blue light in a wavelength range of 400-500nm.

• Difference is seen in fluorescence of sound enamel and carious enamel

• This technique allows visualization of small carious lesions in enamel that are difficult to detect with
naked eye.
DYE PENETRATION METHOD

• Dye penetration is non-destructive method which is used to detect surface breaking discontinuities in metals,
plastics and ceramics.

• This technique is performed by cleaning the test surface thoroughly and then applying the penetrate followed by
application of developer.

• Dyes for detection of carious enamel

 Procian dyes
 Calcein dyes
 Brilliant blue
DYES FOR DETECTION OF CARIOUS DENTIN-

carious dentin

outer layer of decalcification inner layer of decalcification

soft hard

cannot be remineralised can be remineralised

 Dyes differentiate between these 2 zones dental caries-
0.5% basic fuschin in propylene glycol has
proved to be successful for purpose
RECENT/NEWER TECHNIQUES

CO2 LASER-
Radiation of wavelength 10.6 µm
• It is used as a diagnostic tool is based on assumption that subsurface layer of early carious lesion has more
organic content when compared with adjacent sound enamel.

• Photo-vaporization by a co2 laser of this organic material in the receipient carious lesion will leave a
carbonized residue, which will appear black.
T ER A H ER TZ I M A G I NG

• It is non-destructive, insulating method

• This method imaging uses waves with terahertz frequency

In this technique tooth samples are arranged in rows

scanning was done by focus of terahertz beam

2D image 3D image
Is generated by acquiring generated by collecting the
the intensity of THz radiation amplitude of reflected signal
at each pixel At each pixel
 L ED T ECH NO LO GY

• It uses infrared red light emitting diodes

A fibreoptic distribute light to observed area present at a probe tip

Another fibreoptic collects light from observed area to a photo detector that
measures returned collected light

This photodetector then transmits signal to a microprocessor and compares

signal

when result is positive when result is negative

the processor deactivates the green LED is dominant on healthy tooth

3rd green LED & pulses at higher red illuminant-caries
intensity than red LED
A L TER N A TI NG C UR R ENT I M P EDENC E SP EC TR OS CO PY [ CA R IES SCA N ]

• This device is based on the proven technology of alternating current impedence spectroscopy.

• It involves the passing of insensitive level of electrical current through the tooth to identify the presence of decay

• For assessment of caries, while tufted sensor brush contacts the tooth surface being examined a soft tissue
contact, which is disposable metal clip that is placed over lip in the corner of patient mouth, connects to caries
scan via a soft tissue cable to complete the circuit.

• Green color- sound tooth

• Red color- caries
 CONCLUSION

• Diagnosis is the prime requisite for establishing adequate treatment

plan for the patient.

• With the art of differential diagnosis; diagnostic aids in endodontics

provides with a definitive approach to eliminate other causes leading to
the factual etiology.

• The final decision by the operator on the treatment plan for a patient
should be governed by the level of his/her own skill and knowledge.