Caries ManagementCaries Management

( Diagnosis & Treatment strategies).

Professor Dr. Inas Al- Rawi

Caries in pits or fissuresNon-cavitated

Enamel: Light or dark brown discoloration at the baseof the pit or fissure with or without white

demineralization at the sides of the pit or fissure thatcould be detected visually after cleaning and drying the

teeth. No breakdown in enamel (no cavity) but thearea is soft (sticky) upon gentle exploring.

Dentin: Non-cavitated lesions in dentin have signs ofenamel undermining that show as opacity or

discoloration inside the surface.

CavitatedAn actual hole in the tooth in which an explorer caneasily enter the space. An active cavity should have

soft walls or floors.

Sound

A pit or fissure that is "retentive" to a sharp explorershould not be classified as carious unless there areother signs of dental caries

Non-cavitatedEnamel: Light or dark brown discoloration at the base

of the pit or fissure with or without whitedemineralization at the sides of the pit or fissure that

could be detected visually after cleaning and drying theteeth. No breakdown in enamel (no cavity) but the

area is soft (sticky) upon gentle exploring.

Dentin: Non-cavitated lesions in dentin have signs ofenamel undermining that show as opacity or

discoloration inside the surface.

CavitatedAn actual hole in the tooth in which an explorer caneasily enter the space. An active cavity should have

soft walls or floors.

Sound

A pit or fissure that is "retentive" to a sharp explorershould not be classified as carious unless there areother signs of dental caries

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Caries in pits and fissures• Since it is difficult to diagnose in its early stages

and fissures are susceptible sites, the dentist maydecide to fissure seal susceptible teeth as soonafter eruption as possible

• The occlusal lesion which shows on a bite-wingradiographs should be restored. These lesions arelarger than they appear on radiographs and rate oftheir progression may be rapid.

Caries in pits and fissures• Since it is difficult to diagnose in its early stages

and fissures are susceptible sites, the dentist maydecide to fissure seal susceptible teeth as soonafter eruption as possible

• The occlusal lesion which shows on a bite-wingradiographs should be restored. These lesions arelarger than they appear on radiographs and rate oftheir progression may be rapid.

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Pit and fissure sealantsWhen active fissure caries has been diagnosed orif a high risk has been established and fissureshave susceptible morphologic characteristics,sealants with a low filled resin is indicated

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Preventive resin restorationIf additional preparation is needed to the pits andfissures other than opening of the fissure,posterior resin composite is placed in that areaand remaining fissures and surface of resincomposite restoration is sealed with sealantmaterial

Preventive resin restorationIf additional preparation is needed to the pits andfissures other than opening of the fissure,posterior resin composite is placed in that areaand remaining fissures and surface of resincomposite restoration is sealed with sealantmaterial

Caries in smooth enamel surfaces

Non-cavitatedEnamel Color: chalky white or light brown demineralization.. The

discolored area has no signs of cavitation after a visual or a gentle tactileexamination The lesion is located in areas where dental plaque mayaccumulate (close to the gingival margin). The surface of the area is

matted (not glossy) when a tooth is dried.

Dentin: Non-cavitated lesions in dentin have signs of enamel underminingthat show as opacity or discoloration inside the surface.

Cavitated

Visual breakdown in the tooth surface (i.e. hole) and the area has softwalls or floor.

Sound

No questionable, non-cavitated or cavitated lesions.

Non-cavitatedEnamel Color: chalky white or light brown demineralization.. The

discolored area has no signs of cavitation after a visual or a gentle tactileexamination The lesion is located in areas where dental plaque mayaccumulate (close to the gingival margin). The surface of the area is

matted (not glossy) when a tooth is dried.

Dentin: Non-cavitated lesions in dentin have signs of enamel underminingthat show as opacity or discoloration inside the surface.

Cavitated

Visual breakdown in the tooth surface (i.e. hole) and the area has softwalls or floor.

Sound

No questionable, non-cavitated or cavitated lesions.

Caries in smooth enamel surfacesActive non-cavitated carious lesions on smooth enamel surfaces havethe following clinical characteristics:

Cavitation: no signs of cavitation after visual or gentle tactile examination.

Location: located in areas where dental plaque accumulates (close to the gingivalmargin).

Surface characteristics: Matted (not glossy) when a tooth is dried.

Areas of demineralization that are not in close proximity to the gingival margin;are not covered by plaque; are smooth and glossy; and are non-cavitated shouldnot be classified as active non-cavitated carious lesions.

If there is visual enamel opacity under an ostensibly sound marginalridge then the enamel is undermined because of dental caries and thetooth surface is classified with a non-cavitated carious lesion in dentinshown below:

Where there is visual breakdown of a tooth surface, it is classified as cavitatedcarious lesion. An active cavity on a smooth surface has soft walls or floors shown below:

Root caries

Lesion DescriptionQuestionable

Hard discolored area with no cavitation.

Early carious root lesions

Soft/leathery lesions that cover small areas of the root (anarea less than 5 square mm) and are not cavitated.

Advanced carious root lesions

Soft/leathery with a large surface area or a cavity (5 squaremm or larger).

Sound

Not questionable, non-cavitated,.

Root caries

Lesion DescriptionQuestionable

Hard discolored area with no cavitation.

Early carious root lesions

Soft/leathery lesions that cover small areas of the root (anarea less than 5 square mm) and are not cavitated.

Advanced carious root lesions

Soft/leathery with a large surface area or a cavity (5 squaremm or larger).

Sound

Not questionable, non-cavitated,.

Recurrent caries

Lesion DescriptionQuestionable

Stained margins that do not have thecharacteristics of the other lesions.

Early recurrent carious area

Soft marginal areas where the part of the tip ofa periodontal probe (WHO probe or PSR probe)could enter the defect without any resistance(< 0.5 mm in diameter in all directions).

Advanced recurrent carious

Soft marginal areas where the whole tip of aperiodontal recurrent carious probe (WHOprobe or PSR probe) could enter the defectarea without any resistance (>= 0.5 mm indiameter in all directions).

Sound

Not questionable, non-cavitated, or cavitated.

Recurrent caries

Lesion DescriptionQuestionable

Stained margins that do not have thecharacteristics of the other lesions.

Early recurrent carious area

Soft marginal areas where the part of the tip ofa periodontal probe (WHO probe or PSR probe)could enter the defect without any resistance(< 0.5 mm in diameter in all directions).

Advanced recurrent carious

Soft marginal areas where the whole tip of aperiodontal recurrent carious probe (WHOprobe or PSR probe) could enter the defectarea without any resistance (>= 0.5 mm indiameter in all directions).

Sound

Not questionable, non-cavitated, or cavitated.

Indication for restorative treatment1. The tooth is sensitive to hot, cold or sweet……

2. Occlusal and proximal lesions extend into dentin

3. The pulp is endangered

4. Previous attempts to arrest the lesion have failedand the lesion is progressing

5. The pt. Ability to provide effective home care isimpaired

6. Drifting might occur due to loss of proximalcontact

7. Esthetic reasons

Indication for restorative treatment1. The tooth is sensitive to hot, cold or sweet……

2. Occlusal and proximal lesions extend into dentin

3. The pulp is endangered

4. Previous attempts to arrest the lesion have failedand the lesion is progressing

5. The pt. Ability to provide effective home care isimpaired

6. Drifting might occur due to loss of proximalcontact

7. Esthetic reasons

New caries detection Devices:

1- Electronic caries monitors.

2-Direct digital radiography.

3-Intra oral camera.

4-Various optical methods including Laser systems.

5-New ultrasonic devices.

6-Caries detector dyes.

New caries detection Devices:

1- Electronic caries monitors.

2-Direct digital radiography.

3-Intra oral camera.

4-Various optical methods including Laser systems.

5-New ultrasonic devices.

6-Caries detector dyes.

New technologies for caries removal&cavity preparation:

1-Air abrasion.

2- Chemo-mechanical method.

3- Laser devices.

4-Ozone treatment. Here is the Cur Ozone generator and the intraoraldelivery system:

New technologies for caries removal&cavity preparation:

1-Air abrasion.

2- Chemo-mechanical method.

3- Laser devices.

4-Ozone treatment. Here is the Cur Ozone generator and the intraoraldelivery system:

Applications of Ozone to several major restorative problems:

1. Class I incipient lesions where caries reversal will totallyeliminate drill and fill, rather a sort of "natural healing".

2. Larger class I lesions where caries, even into the pulp, can bereversed on the inner 3-5 mm.

3. Class V lesions, which are easily accessed, can also be a no-drillsituation.

4. Crown margins to reverse margin caries.

5. Sterilization of root canals prior to fill.

6. Very fast internal bleaching.

Applications of Ozone to several major restorative problems:

1. Class I incipient lesions where caries reversal will totallyeliminate drill and fill, rather a sort of "natural healing".

2. Larger class I lesions where caries, even into the pulp, can bereversed on the inner 3-5 mm.

3. Class V lesions, which are easily accessed, can also be a no-drillsituation.

4. Crown margins to reverse margin caries.

5. Sterilization of root canals prior to fill.

6. Very fast internal bleaching.