1. Clinical Features & Diagnosis of Dental Caries
CHEN Zhi
Wuhan University School of Stomatology

2. Current 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.

3. Current concepts of caries etiology
Micro-
organisms no
caries no
caries
host
& tooth
Sub-
strate
caries no
caries no
caries
time

4. Current 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.

5. Current 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

6. Classification according to the progression rate
according to the involving site
according to the severity
according to the previous treatment

7. Classification according to the progression rate
Acute caries
Active caries
Rampant caries
Chronic caries
Arrested caries
Arrested caries
Secondary caries

8. Acute Caries
progress fast, often in children and teenagers, light colored cavity.

9. Rampant Caries
Caries in a patient with impaired salivary function as result of radiation therapy
(Drs Jansma and Vissink)

10. 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.

11. Chronic Caries progress slowly, black or brown colored
cavity hard remaining dentine

12. Arrested Caries caries stop progressing because of
the local etiological change

13. Classification according to the treatment history
Primary caries
Secondary caries or Recurrent caries

14. Secondary Caries

16. Classification according to the involving site
Pits & fissures caries
Smooth surface caries
Root surface caries

17. 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.

18. How many types of the fits & fissures in your text book?

19. Pits & Fissures Caries

20. The second site is on certain areas of
the smooth surface of enamel.
These include:
1. the areas of contacting proximal surface and
2. areas gingival to the height of contour of the
facial and lingual surface.

21. Could you explain why the proximal surfaces are particularly susceptible to caries?

22. Smooth Surface Caries

25. 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 absence
of good oral hygiene.
The another reason ?

26. Root Surface Caries

27. Classification according to the Severity
Incipient caries
Superfacial caries
Moderate caries
Advanced caries
Middle caries
Severe caries
Deep caries

28. Incipient Caries

29. Moderate Caries

30. Advanced Caries

31. Severe Caries

32. A New Classification Recommended by Dr. Graham Mount & Dr. Rory Hume
In UCLA

34. Diagnosis Early detection of incipient caries and
limitation of caries activity prior to
significant tooth destruction are
primary goals of an effective diagnosis
and treatment program.

35. Diagnosis Clinical signs visual - location, cavitation
tactile - texture
Clinical symptoms
Diagnostic test

36. Diagnosis Test Radiographs (film and digital)
Transillumination (FOTI/DFOTI)
Electrical conductivity (EC)
Optical (fluorescence) methods (QLF)
Fluorescent dye

37. Diagnostic Test Only acceptable gold standard presently is
histological assessment.
Most diagnostic tests are limited to specific
applications.
Visual-tactile method remains the most
accurate and reproducible method of
diagnosis of dental caries.

38. 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

39. 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

41. Proximal caries lesion is detected with the use of transillumination

42. Quantitative Light Fluorescence (QLF)

43. Progression of Dental Caries
demineralization of enamel surface
sub-surface enamel lesion
demineralization of dentine
cavitation of enamel surface
cavitation into the dentine

48. Treatment Program Non-surgical - remineralization
Surgical restoration

49. Non-cavitated lesions deserve more attention because 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.

50. Two Difficulties When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment

51. Management of Fissured Surface
No Caries or Arrested
Caries in Fissures with
Susceptible Morphology
Enamel Demineralization
or Questionable Caries in
Dentin
Cavitation or
Caries in Dentin
Low
Caries
Risk?
High
Low
High
Open fissures
with round bur
Caries
Risk?
enamel
Demineralization
involve
dentin
No treatment
Sealant
Enamel PRR
Restoration
---University of Texas Health Science Center at San Antonio, UTHSCSA

52. Linking diagnosis to clinical management

53. Two Difficulties When to place an initial restoration?
Breakdown of the outer enamel is an
important clinical indicator of treatment
How to deal with severe caries?
Protection of dental pulp is the
primary goal

54. Reference http://www.dent.ucla.edu/pic/members/caries/index.html
《龋病学》 樊明文主编

55. Homework:
What’s the difference between coronal caries and root caries?
Please make a comparison,
such as: surface tissue, composition, etc.

56. Acknowledgement