Clinical visual-tactile method

Visual method used in general practiceThe visual method, a combination of light, mirror, and the probe for detailed examination of every tooth surface, is by far the most commonly applied method in general practice worldwide. Although sensitivity is low and specificity is high, it may be possible to detect:1. Noncavitated enamel lesions (D1) on the free smooth surfaces (buccal and lingual), most anterior approximal surfaces, and the opening of some fissures 2. Clinically detected "cavities" limited to the enamel (D1, D2)3.

Diagnosis and Registration of Carious LesionsIntroductionThe coronal carious lesion starts as a clinically undetectable subsurfacedemineralization. With further progression, it will eventually become clinicallydetectable, and can then be classified according to type, localization, size, depth, andshape (see Table 15).Apart from for the occult fissure lesion penetrating deeply into the dentin, dilemmasin clinical detection and registration arise not with the advanced lesion, but primarilywith the early lesion (confined to the outer enamel), the noncavitated lesion of dentin,recurrent caries (around the margins of restorations), and subgingival root caries.

Root cariesAccording to Hix and O'Leary (1976), root surface caries is defined as "a cavitationor softened area in the root surface which might or might not involve adjacent enamelor existing restorations (primary and recurrent lesions)." Nyvad and Fejerskov (1987)introduced the definitions of active and inactive carious lesions of the root. Rootcaries may be classified as primary or secondary, cementum or dentin, active orinactive, and with or without cavitation (see Table 15). The lesions can also beclassified according to the texture (soft, leathery, or hard) and the color (yellow, lightbrown, dark brown, or black).

Dentin cariesWhether or not an active, noncavitated carious lesion in enamel will progress into thedentin and the rate of progression are determined by many factors:1. The overall estimated caries risk (C1 to C3) of the individual2. The rate at which the enamel lesion has developed3. The size, depth, and site of the enamel lesion4. The posteruptive age of the enamel5. The future efficacy of self-care and supplementary needs-related preventiveprogramsOn the approximal surfaces of the posterior teeth, the progression of a carious lesionthrough the enamel into the dentin can easily be followed on serial bitewingradiographs.

ArrestFluoride and plaque controlArrest of enamel carious lesions is a reality, as shown in the studies by Backer-Dirks (1966) and von der Fehr et al (1970). In vitro as well as in vivo studies have shown that carious lesions in enamel can successfully be arrested by plaque control or topical use of fluoride. The most efficient means is a combination of both, as exemplified in Fig 156. On the left is an active, noncavitated enamel lesion on the mesiolingual surface of a mandibular second molar.