clinical features & diagnosis of dental caries chen zhi wuhan university school of stomatology
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Clinical Features & Clinical Features & Diagnosis of Dental Caries Diagnosis of Dental Caries
CHEN ZhiCHEN Zhi
Wuhan University School of StomatologyWuhan University School of Stomatology
Current concepts of CariesCurrent 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 etiologyCurrent concepts of caries etiology
Micro-organisms
host & tooth
Sub-stratecaries
time
no caries
no caries
no caries
no caries
Current concepts of CariesCurrent 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 CariesCurrent 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
ClassificationClassification
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
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.
Classification according to the treatment history
Primary caries
Secondary caries or Recurrent caries
Classificationaccording 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.
The second site is on certain areas of the smooth surface of enamel.
These include:1. the areas of contacting proximal surface and2. areas gingival to the height of contour of the facial and lingual surface.
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 absenceof good oral hygiene.
The another reason ?
Classificationaccording to the Severity
Incipient caries
Moderate caries
Severe caries
Advanced caries
Superfacial caries
Middle caries
Deep caries
A New Classification
Recommended by Dr. Graham Mount & Dr. Rory HumeIn UCLA
http://www.dent.ucla.edu/pic/members/caries/index.html
DiagnosisDiagnosis
Early detection of incipient caries andlimitation of caries activity prior to significant tooth destruction are primary goals of an effective diagnosisand treatment program.
DiagnosisDiagnosis
• 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 ishistological assessment.
Most diagnostic tests are limited to specificapplications.
Visual-tactile method remains the mostaccurate and reproducible method ofdiagnosis 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
Progression of Dental Caries
demineralization of enamel surface
sub-surface enamel lesion
demineralization of dentine
cavitation of enamel surface
cavitation into the dentine
Non-cavitated lesions deserve more attentionbecause 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 animportant clinical indicator of treatment
Management of Fissured Surface
No Caries or ArrestedCaries in Fissures withSusceptible Morphology
Enamel Demineralizationor Questionable Caries inDentin
Cavitation orCaries in Dentin
CariesRisk?
No treatment Sealant Enamel PRR Restoration
CariesRisk?
Low High Low Open fissureswith round bur
High
Demineralizationinvolve
enamel dentin
---University of Texas Health Science Center at San Antonio, UTHSCSA
Two Difficulties
When to place an initial restoration?
Breakdown of the outer enamel is animportant 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.