CLINICAL DIAGNOSIS OF CARIES

By one or all of the following:
1)Visual changes in tooth surface texture or color
2) tactile sensation with judicious use of explorer
3) radiographs
4) transillumination
Aided by the knowledge of the probability of overall caries risk and patterns of susceptibility.


A) DIAGNOSIS OF PIT AND FISSURE CARIES


Any one or more of the following:
1)Softening at the base of pit and fissure
2)Opacity surrounding the pit or fissure, indicating demineralization of enamel
3) brown-gray discoloration radiating peripherally from the pit or fissure
4) softened enamel that may be flaked away by explorer radiolucency beneath the occlusal enamel surface



B) DIAGNOSIS OF PROXIMAL SURFACE CARIES

1)Visual – white chalky appearance or shadow under the marginal ridge
2) tactile- probing with explorer on proximal surface may detect cavitation, which is defined as the break in the surface contour of enamel
3) radiographic diagnosis- made with bitewing radiographs which show radiolucency beneath the enamel surface in the proximal area (should not be confused with cervical burnout!)


ARRESTED LESIONS ON PROXIMAL SURFACE
1)Appears as brown spots
2) on probing, surface is intact and hard
3) radiograph shows decreased radiographic density in the affected region
4) usually seen in old patients

PROXIMAL CARIES IN ANTERIOR TOOTH
1)transillumination- in which light source directed through the tooth from the lingual side. Proximal surface caries, other than incipient caries, appear as a dark area along the marginal ridge
2) tactile- exploration to detect any cavitation
3) radiographs – may detect any small incipient lesion as well.


C) DIAGNOSIS OF SMOOTH-SURFACE CARIES ON THE FACIAL AND LINGUAL SURFACES OF TOOTH (USUALLY GINGIVAL)


Initial phase :
1) CHALKY-WHITE, OPAQUE AREAS (“WHITE SPOTS”) over the smooth surface of the tooth, that is visually different from adjacent translucent enamel , which is revealed only when the tooth surface is clean and dry and disappears partially or totally when the tooth is wet . This initial phase of caries in enamel is k/a “incipient caries”.
The tooth at this stage appears to have lost its translucency because of extensive subsurface porosity due to demineralization.
2) Undetectable tectilely since surface is hard , intact and smooth.


ADVANCED PHASE
1)White to dark brown discoloration
2) demineralized and softness to penetration



ARRESTED LESION
1)dark, discolored areas mostly due to extrinsic staining
2) hardening of lesion (due to remineralization)
3) sclerotic or eburnated dentin



D) DIAGNOSIS OF ROOT-SURFACE CARIES


1)Look for the following features at CEJ or more apically on cementum
early stage-
a) well-defined discoloration adjacent to gingival margin,
typically near the CEJ
b) softened cemental tissue compared with adjacent structure
advanced stage- softening on exploration
and cavitation.


2)Usually in older individuals , or
in patients who has undergone perio- surgery , with the following predisposing factors
a) cemental exposure
b) dietary changes
c) systemic diseases
d) medications that affect amount and character of saliva.