cbabdental caries 4-caries diagnosis and risk assessment

8/2/2019 Cbabdental Caries 4-Caries Diagnosis and Risk Assessment

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DIAGNOSIS OF DENTALCARIES & CARIES RISK

ASSESSMENT

Dr.M.Ganesh,MDS(Pediatric Dentistry)


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DIAGNOSIS


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Why is diagnosis important?

Caries diagnosis and treatment has traditionally beenlimited to the detection and restoration of cavitatedlesions.

Undoubtedly, unaffected teeth are superior to

restored teeth. Therefore early detection of incipientcaries and limitation of caries activity prior tosignificant tooth destruction are primary goals of aneffective diagnosis and treatment programme

Cavitation is preceded by a lengthy period ofsubsurface demineralization that presents the dentistan opportunity to detect the disease and startpreventive measures prior to the advent of significanttooth damage.


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VISUAL INSPECTION


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REQUISITES

Plaque should be removed to obtain reliablediagnosis of caries visually

Tooth must be properly dried Strict isolation

Sequential examination

Adequate lighting


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VISUAL INSPECTION

Can be direct or indirect

Magnification loupes, Slides, Temporary

separation as adjuncts for better visionCrude tool for diagnosis


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TACTILE EXAMINATION

Explorer and Floss

Right angle probe

Back action probe Shepherds crook

Cow horn with curved ends


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Procedure used

In the examination of the patient, the occlusalsurfaces of the teeth are examined first. A smallsharp explorer is placed in the main areas of pits and

fissures or in areas of discoloration if present, thepoint is then placed in the grooves that radiate fromthe fossae to see if any of the areas are soft andcannot support the weight of the explorer.

Care should be taken to withdraw the explorer alongthe same path as it was inserted. This is essential toprevent false catch felt by the explorer due to lateralshift of the same.


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Use is condemned at times

Physical damage to intact surfaces

Fracture and cavitation of incipient lesions

False catch due to mechanical binding


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RADIOGRAPHS

Conventional Film Radiography

Bite wing Radiography

Intra Oral Periapical Radiographs

DIGITAL RADIOGRAPHY


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Increasing knowledge about the limitations ofconventional caries diagnostic methods

and changes in lesion morphology act as aspur to the development of new diagnostic aids.


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INTRA ORAL DENTAL XERORADIOGRAPHY

Xerographic copying Record images

No wet processing

Uses photoconductors or semiconductors


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DYES IN CARIES DETECTION

Widespread use in medicine,

biology & dentistry

Discrimination & easyidentification of objects


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CARIOUS ENAMEL DETECTION


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DETECTION OF CARIOUS DENTIN

Infected Vs Affected Dentin
http://images.google.co.in/imgres?imgurl=http://www.cda-adc.ca/jcda/vol-65/issue-10/graphics/Bryant9.jpg&imgrefurl=http://www.cda-adc.ca/jcda/vol-65/issue-10/566.html&h=116&w=170&sz=35&tbnid=5t7K-yjH_T763M:&tbnh=64&tbnw=94&hl=en&start=6&prev=/images%3Fq%3Dcaries%2Bdetection%2Bdyes%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.fu-berlin.de/zahnerhaltung/bilder/ip001.jpg&imgrefurl=http://www.fu-berlin.de/zahnerhaltung/b_2.html&h=325&w=538&sz=52&tbnid=ab8w0WeyI7geZM:&tbnh=78&tbnw=130&hl=en&start=2&prev=/images%3Fq%3Dcaries%2Bexcavation%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.scielo.br/img/revistas/jaos/v12n3/21673f2.gif&imgrefurl=http://www.scielo.br/scielo.php%3Fpid%3DS1678-77572004000300002%26script%3Dsci_arttext%26tlng%3Den&h=428&w=664&sz=59&tbnid=A0TMgYJWhovIGM:&tbnh=87&tbnw=136&hl=en&start=2&prev=/images%3Fq%3Dinfected%2Bdentin%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.scielo.br/img/revistas/jaos/v12n3/21673f8.jpg&imgrefurl=http://www.scielo.br/scielo.php%3Fpid%3DS1678-77572004000300002%26script%3Dsci_arttext%26tlng%3Den&h=479&w=664&sz=65&tbnid=wSuAC06H1r_aGM:&tbnh=98&tbnw=136&hl=en&start=1&prev=/images%3Fq%3Dinfected%2Bdentin%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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FIBER OPTIC TRANSILLUMINATION

Alternative for bite wing

In medicine since 1960s

Used for surgical retraction indentistry,caries detection,calculus, soft tissue lesions

Especially proximal lesions

Ease & flexibility
http://images.google.co.in/imgres?imgurl=http://www.inspektor.nl/dental/Images/premolf_aangepaste_kleur.jpg&imgrefurl=http://www.inspektor.nl/dental/qlfmain.htm&h=232&w=200&sz=9&tbnid=ntG8-CL_N2g0vM:&tbnh=103&tbnw=88&hl=en&start=8&prev=/images%3Fq%3DFLUORESCENCE%2Bof%2Bteeth%26svnum%3D10%26hl%3Den%26lr%3D


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FIBER-OPTICS


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THE UNIT


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DIAGNOSTIC PROCEDURE


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ADVANTAGES

Several angles- 3 D picture

Cracks & Fissures

Vitality testing

Subgingival calculusFood pockets

Root canals

Sinus involvement

Fast; no processingCost effective

Field use or screening


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DIFOTI


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USE OF LASER FLUORESCENCE


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PRINCIPLE


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DIAGNODENT

Chairside, battery-powered quantitative diode laserfluorescence device655nm light beamChanges assigned a numeric value, which is displayed

on the monitor
http://images.google.co.in/imgres?imgurl=http://www.centrelavallee.com/IMAGE/Diagnodent%2520copy.jpg&imgrefurl=http://www.centrelavallee.com/technologie.php&h=228&w=288&sz=27&tbnid=aFBxgeOTi0pyCM:&tbnh=87&tbnw=110&hl=en&start=6&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.bittnerjrdds.com/assets/photos/diagnodent.jpg&imgrefurl=http://www.bittnerjrdds.com/pages/library/diagnodent.htm&h=230&w=350&sz=42&tbnid=7AQ-jkQEqDo9tM:&tbnh=76&tbnw=116&hl=en&start=1&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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OPERATION
http://images.google.co.in/imgres?imgurl=http://www.moresmiles.com/images/Diag003.jpg&imgrefurl=http://www.moresmiles.com/technology.html&h=155&w=189&sz=12&tbnid=NspJzmgU9rPioM:&tbnh=79&tbnw=97&hl=en&start=16&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.cranews.com/additional_study/2000/00-12/diagnodent/images/2_3ini.jpg&imgrefurl=http://www.cranews.com/additional_study/2000/00-12/diagnodent/example_cases.htm&h=217&w=238&sz=11&tbnid=h4t-Ey-fpo1ziM:&tbnh=94&tbnw=104&hl=en&start=14&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.dent.med.uni-muenchen.de/~kkunzelm/infokollegen/interview-kariesdiagnose-bilder-Dateien/image007.jpg&imgrefurl=http://www.dent.med.uni-muenchen.de/~kkunzelm/infokollegen/interview-kariesdiagnose.html&h=300&w=300&sz=36&tbnid=ZmnZ-OwYV3gH8M:&tbnh=111&tbnw=111&hl=en&start=4&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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DIAGNODENT VALUES

Between 5 and 25 - initial lesions in theenamelGreater than this range indicate early

dentinal cariesAdvanced dentin caries is said to yield valuesgreater than 35


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ELECTRONIC RESISTANCE

MEASUREMENTS

Depth dependent gradient of enamel solubility orpermeability- unique pattern of demineralization
http://images.google.co.in/imgres?imgurl=http://www.uic.edu/classes/peri/peri343/carilec4/enamcar2.gif&imgrefurl=http://www.uic.edu/classes/peri/peri343/carilec4/enamhel4.htm&h=317&w=298&sz=5&tbnid=78kepUclj5U63M:&tbnh=113&tbnw=106&hl=en&start=1&prev=/images%3Fq%3Dwhite%2Bspot%2Blesion%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG


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PRINCIPLE & OPERATION


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CARIES METER

Electronic caries detector

Solid Probe on dried occlusal surface

Green- sound surface

Yellow- enamel caries Orange- Dentinal caries

Red- Pulpal involvement


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ULTRASONIC CARIES DETECTOR


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The first component in risk assessment involvesidentifying the childs risk and protective factors.

use information obtained in theinterview,observation of parent-child interaction, oral

exam, and diagnostic procedures to identify thepotential risks to full attainment of good oral healthoutcomes.

identifies the protective factors that can reduce thenegative impact of risk factors and contribute to

attaining those outcomes.


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The second part of risk assessment involvesweighing the risk and protective factors todetermine an oral health supervision plan.


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L Ri k


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Low Risk Optimal fluoride exposures both systemic and topical Consumption of simple sugars or limiting to mealtime High caregiver socioeconomic status (financially stable)

Regular dental visits

Moderate Risk Suboptimal systemic fluoride exposure with optimal topical

exposure Between meal snacking (1-2)

Midlevel caregiver socioeconomic status (eligible schoollunch/SCHIP)

Irregular use of dental services

High Risk

Suboptimal topical fluoride exposure Frequent between meal snacking (3 or more) Low level caregiver socioeconomic status No usual source of dental care Active caries present in the mother Children with special health care needs

Conditions decreasing saliva flow (medications)


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Interactive Cariogram program for

estimation of individual caries risk


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cbabdental caries 4-caries diagnosis and risk assessment

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