Tuesday, May 6, 2014

Detection Activity Assessment and Diagnosis of Dental Caries Lesions

Braga, Mariana M., et al.
Dent Clin N Am 54 (2010) 479-493
Resident: Anna Abrahamian, DMD

Caries examination and evaluation should not be limited to physical criteria like size, depth, and presence/absence of cavitation (caries lesion detection). Rather, the diagnosis of caries should take these elements together with examination of  otheretiologic factors like oral hygiene (OH), count of cariogenic microorganisms in plaque and saliva, use of fluoride, sugar intake, and socioeconomic factors.

Visual Inspection:
-       High specificity (proportion of sound sites correctly identified) but low sensitivity (proportion of carious sites correctly identified) because of it’s subjective nature.
-       Use of detailed visual indices like the International and Caries Detection Assessment System (ICDAS) may improve sensitivity by identifying stages in the caries disease process
o   ICDAS in primary teeth cannot distinguish accurately between lesions related to the outer or inner half of the enamel (because primary enamel is thinner).
o   Nyvad’s System: scoring system (0-9) to identify depth of caries visually

Other Methods:
-       BW radiographs improve sensitivity and specificity of caries detection (from 0.63 to 0.9); monitoring is more reliable and accurate.
-       Transillumination: fiber optic transillumination (FOTI) makes carious enamel and dentin appear as shadows; not quantitative, treatment decisions depend on the dentist’s interpretation.
-       Electronic Caries Monitor (ECM): uses alternating current and measures the bulk resistance of tooth tissue; porosity of caries lesions is filled with fluids with high concentration of ions from the oral environment, and this more porous tissue decreases electrical resistance more than sound tissue (high sensitivity, low specificity).
-       Fluorescence: DIAGNOdent is a a diode laser fluorescence device that emits a red light that is absorbed by bacterial by-products (porphyrins) that partially re-emit light as near-infrared fluorescence – device captures this and translates it into a number (0-99); the higher the number, the deeper the caries.

No comments:

Post a Comment