1. DIAGNOSTIC METHODS FOR DENTAL CARIES
CARIOLOGY
DIAGNOSTIC METHODS FOR DENTAL CARIES
Dr. Shahzadi Tayyaba Hashmi

2. DIAGNOSTIC METHODS FOR DENTAL CARIES
Clinical methods
Visual methods
Radiography
Transillumination
Tooth separators

3. 1) Clinical method
Caries occurs on the occlusal, approximal and buccal / lingual surfaces of teeth
On smooth surfaces, the lesions normally develop close to the gingival margin and are often covered in plaque
Those developing in fissures and approximal surfaces are more difficult to detect and diagnosis usually involves indirect methods
On the buccal and lingual surfaces, the optimal assessment is the visual appearance of the surface
A white spot lesion can be seen when enamel has been cleaned and dried
On those surfaces hidden from direct visual examination, radiographic examination is the most commonly used diagnostic technique

5. 2) Visual method

6. 2) Visual method
The Ekstrand system utilizes the knowledge that as demineralization progresses in enamel, it spreads laterally
The progression can be examined using a simple process
A clean and well dried enamel surface is assessed for surface integrity and enamel demineralization and whitening
The enamel surface must be thoroughly cleaned and dried
An intact surface without demineralization indicates a non-advancing lesion

7. 2) Visual method
White demineralization and a break in the enamel surface show that dentine is involved
Probably the most difficult lesion to assess is recurrent caries occurring around existing restorations
Marginal gap and ditches are common around most amalgam restorations
Marginal gaps are sticky to probing and are wider than the width of periodontal probe would generally mean that caries is present and there is a need for operative management
However pure ditching ( which is a breakdown of the amalgam at the tooth surface) does not require restoration
Shadowing a blue-brown discoloration within the tooth and surrounding the restoration can indicate an active lesion

8. 3) radiography
Bitewing radiographs are relatively reliable for detecting approximal lesions but less so for occlusal lesions
The advancing lesion is therefore relatively under diagnosed by radiographs
A bitewing radiograph needs to be taken correctly to have the most diagnostic yield
Approximaly, caries will occur below the contact areas and above the alveolar bone
The extent of the lesion spread is more difficult to visualise as the bulk of the enamel and dentine partly obscures the x-rays

9. 4) Transillumination
This is a rarely used technique to assess caries on molars and premolars but more commonly used on anterior teeth
Direct light reflected by dental mirrors on to the teeth can highlight darkened shadows present between the approximal surfaces of upper anterior teeth

10. 5) Tooth separators
Orthodontic separators have been reported to be useful for direct examining the approximal areas between contacting teeth
Orthodontic elastic bands are placed between teeth and over a few days gradually separate the teeth so that direct visual inspection of the surfaces can be undertaken
This procedure is rarely used in dental practice