Clinical Features &
Diagnosis of Dental Caries
CHEN Zhi
Wuhan University School of Stomatology
Current concepts of Caries
? Dental caries is a specific infectious
microbiological disease of the teeth that
results in localized dissolution and
destruction of the calcified tissues,
Germfree animals do not get caries,
Current concepts of caries etiology
Micro-organisms
host
& tooth Sub-stratecaries
time
nocariesnocaries
nocaries nocaries
Current concepts of Caries
? The disease process begins with the
concentration of mutans streptococcus
at specified tooth surfaces and may
lead to white spot formation or even
cavitation.
Current concepts of Caries
The development of dental caries is
a dynamic process of demineralization
of the dental hard tissues
by the products of bacterial metabolism,
alternating with periods of remineralization.
Harris and Christen
,Primary Preventive Dentistry》,1995
Classification
?according to the progression rate
?according to the involving site
?according to the severity
?according to the previous treatment
Classification
according to the progression rate
Acute caries
Rampant caries
Chronic caries
Arrested caries
Secondary caries
Active caries
Arrested caries
Acute Caries
progress fast,often in
children and teenagers,
light colored cavity.
Rampant Caries
Caries in a patient with
impaired salivary function
as result of radiation therapy
(Drs Jansma and Vissink)
Rampant caries,many tooth involved at
same time with acute caries feature
often accompanied by systematic
disorder,such as Sjogren syndrome or
saliva reduction after radiation.
Chronic Caries
progress slowly,
black or brown colored
cavity hard remaining
dentine
Arrested Caries
caries stop progressing
because of
the local etiological
change
Classification
according to the treatment history
Primary caries
Secondary caries or Recurrent caries
Secondary Caries
Classification
according to the involving site
Pits & fissures caries
Smooth surface caries
Root surface caries
The first and most susceptible site is
the developmental pits and fissures of enamel.
The shape of the pits and fissures contribute to
their high susceptibility to caries.
How many types of
the fits & fissures in
your text book?
Pits & Fissures Caries
The second site is on certain areas of
the smooth surface of enamel.
These include:
1,the areas of contacting proximal surface and
2,areas gingival to the height of contour of the
facial and lingual surface,
Could you explain why
the proximal surfaces
are particularly
susceptible to caries?
Smooth Surface Caries
The third site where caries may attack
is the root surface,
The root surface is rougher than enamel and
readily allows plaque formation in the absence
of good oral hygiene,
The another
reason?
Root Surface Caries
Classification
according to the Severity
Incipient caries
Moderate caries
Severe caries
Advanced caries
Superfacial caries
Middle caries
Deep caries
Incipient Caries
Moderate Caries
Advanced Caries
Severe Caries
A New Classification
Recommended by
Dr,Graham Mount & Dr,Rory Hume
In UCLA
http://www.dent.ucla.edu/pic/members/caries/index.html
Diagnosis
Early detection of incipient caries and
limitation of caries activity prior to
significant tooth destruction are
primary goals of an effective diagnosis
and treatment program.
Diagnosis
? Clinical signs
visual - location,cavitation
tactile - texture
? Clinical symptoms
? Diagnostic test
Diagnosis Test
? Radiographs (film and digital)
? Transillumination (FOTI/DFOTI)
? Electrical conductivity (EC)
? Optical (fluorescence) methods (QLF)
? Fluorescent dye
Diagnostic Test
?Only acceptable gold standard presently is
histological assessment.
?Most diagnostic tests are limited to specific
applications.
?Visual-tactile method remains the most
accurate and reproducible method of
diagnosis of dental caries.
Visual Classifications
(occlusal surfaces)
0,No or slight changes in enamel
translucency after prolonged air-drying
1,Opacity (white or yellow) hardly visible on the
wet surface but distinctly visible after air-drying
2,Opacity (white or yellow) distinctly visible
without air-drying
Visual Classifications (continued)
3,Localized enamel breakdown in opaque or
discoloured enamel and/or greyish
discolouration from the underlying
enamel
4,cavitation in opaque or discoloured
enamel exposing the dentine beneath
Ekstrand et al,1997
Proximal caries lesion is detected
with the use of transillumination
Quantitative Light Fluorescence (QLF)
Progression of Dental Caries
demineralization of enamel
surface
sub-surface enamel lesion
demineralization of dentine
cavitation of enamel surface
cavitation into the dentine
Treatment Program
Non-surgical - remineralization
Surgical - restoration
Non-cavitated lesions deserve more attention
because they:
– are more prevalent than cavitated lesions in
economically developed countries
– can validly serve as indicators of caries
susceptibility
– appropriately should be treated nonsurgically
which is preferable.
Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment
Management of Fissured Surface
No Caries or Arrested
Caries in Fissures with
Susceptible Morphology
Enamel Demineralization
or Questionable Caries in
Dentin
Cavitation or
Caries in Dentin
Caries
Risk?
No treatment Sealant Enamel PRR Restoration
Caries
Risk?
Low High Low Open fissures
with round bur
High
Demineralization
involve
enamel dentin
---University of Texas Health Science Center at San Antonio,UTHSCSA
Linking diagnosis to clinical management
Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment
How to deal with severe caries?
Protection of dental pulp is the
primary goal
Reference
http://www.dent.ucla.edu/pic/members/caries/index.html
http://www.uic.edu/classes/peri/peri343/main2.htm
,龋病学, 樊明文主编
Homework:
What’s the difference between
coronal caries and root caries?
Please make a comparison,
such as,surface tissue,composition,
etc.
Diagnosis of Dental Caries
CHEN Zhi
Wuhan University School of Stomatology
Current concepts of Caries
? Dental caries is a specific infectious
microbiological disease of the teeth that
results in localized dissolution and
destruction of the calcified tissues,
Germfree animals do not get caries,
Current concepts of caries etiology
Micro-organisms
host
& tooth Sub-stratecaries
time
nocariesnocaries
nocaries nocaries
Current concepts of Caries
? The disease process begins with the
concentration of mutans streptococcus
at specified tooth surfaces and may
lead to white spot formation or even
cavitation.
Current concepts of Caries
The development of dental caries is
a dynamic process of demineralization
of the dental hard tissues
by the products of bacterial metabolism,
alternating with periods of remineralization.
Harris and Christen
,Primary Preventive Dentistry》,1995
Classification
?according to the progression rate
?according to the involving site
?according to the severity
?according to the previous treatment
Classification
according to the progression rate
Acute caries
Rampant caries
Chronic caries
Arrested caries
Secondary caries
Active caries
Arrested caries
Acute Caries
progress fast,often in
children and teenagers,
light colored cavity.
Rampant Caries
Caries in a patient with
impaired salivary function
as result of radiation therapy
(Drs Jansma and Vissink)
Rampant caries,many tooth involved at
same time with acute caries feature
often accompanied by systematic
disorder,such as Sjogren syndrome or
saliva reduction after radiation.
Chronic Caries
progress slowly,
black or brown colored
cavity hard remaining
dentine
Arrested Caries
caries stop progressing
because of
the local etiological
change
Classification
according to the treatment history
Primary caries
Secondary caries or Recurrent caries
Secondary Caries
Classification
according to the involving site
Pits & fissures caries
Smooth surface caries
Root surface caries
The first and most susceptible site is
the developmental pits and fissures of enamel.
The shape of the pits and fissures contribute to
their high susceptibility to caries.
How many types of
the fits & fissures in
your text book?
Pits & Fissures Caries
The second site is on certain areas of
the smooth surface of enamel.
These include:
1,the areas of contacting proximal surface and
2,areas gingival to the height of contour of the
facial and lingual surface,
Could you explain why
the proximal surfaces
are particularly
susceptible to caries?
Smooth Surface Caries
The third site where caries may attack
is the root surface,
The root surface is rougher than enamel and
readily allows plaque formation in the absence
of good oral hygiene,
The another
reason?
Root Surface Caries
Classification
according to the Severity
Incipient caries
Moderate caries
Severe caries
Advanced caries
Superfacial caries
Middle caries
Deep caries
Incipient Caries
Moderate Caries
Advanced Caries
Severe Caries
A New Classification
Recommended by
Dr,Graham Mount & Dr,Rory Hume
In UCLA
http://www.dent.ucla.edu/pic/members/caries/index.html
Diagnosis
Early detection of incipient caries and
limitation of caries activity prior to
significant tooth destruction are
primary goals of an effective diagnosis
and treatment program.
Diagnosis
? Clinical signs
visual - location,cavitation
tactile - texture
? Clinical symptoms
? Diagnostic test
Diagnosis Test
? Radiographs (film and digital)
? Transillumination (FOTI/DFOTI)
? Electrical conductivity (EC)
? Optical (fluorescence) methods (QLF)
? Fluorescent dye
Diagnostic Test
?Only acceptable gold standard presently is
histological assessment.
?Most diagnostic tests are limited to specific
applications.
?Visual-tactile method remains the most
accurate and reproducible method of
diagnosis of dental caries.
Visual Classifications
(occlusal surfaces)
0,No or slight changes in enamel
translucency after prolonged air-drying
1,Opacity (white or yellow) hardly visible on the
wet surface but distinctly visible after air-drying
2,Opacity (white or yellow) distinctly visible
without air-drying
Visual Classifications (continued)
3,Localized enamel breakdown in opaque or
discoloured enamel and/or greyish
discolouration from the underlying
enamel
4,cavitation in opaque or discoloured
enamel exposing the dentine beneath
Ekstrand et al,1997
Proximal caries lesion is detected
with the use of transillumination
Quantitative Light Fluorescence (QLF)
Progression of Dental Caries
demineralization of enamel
surface
sub-surface enamel lesion
demineralization of dentine
cavitation of enamel surface
cavitation into the dentine
Treatment Program
Non-surgical - remineralization
Surgical - restoration
Non-cavitated lesions deserve more attention
because they:
– are more prevalent than cavitated lesions in
economically developed countries
– can validly serve as indicators of caries
susceptibility
– appropriately should be treated nonsurgically
which is preferable.
Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment
Management of Fissured Surface
No Caries or Arrested
Caries in Fissures with
Susceptible Morphology
Enamel Demineralization
or Questionable Caries in
Dentin
Cavitation or
Caries in Dentin
Caries
Risk?
No treatment Sealant Enamel PRR Restoration
Caries
Risk?
Low High Low Open fissures
with round bur
High
Demineralization
involve
enamel dentin
---University of Texas Health Science Center at San Antonio,UTHSCSA
Linking diagnosis to clinical management
Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment
How to deal with severe caries?
Protection of dental pulp is the
primary goal
Reference
http://www.dent.ucla.edu/pic/members/caries/index.html
http://www.uic.edu/classes/peri/peri343/main2.htm
,龋病学, 樊明文主编
Homework:
What’s the difference between
coronal caries and root caries?
Please make a comparison,
such as,surface tissue,composition,
etc.
