Development and Diagnosis of Carious Lesions – Introduction

Development and Diagnosis of Carious Lesions
A carious lesion should be regarded not as a disease entity, but as tissue damage or a wound caused by the disease dental caries. The coronal lesion begins as clinically undetectable subsurface demineralization of enamel, visible only at microscopic level, and gradually progresses, first to visible demineralization of the enamel surface and to cavitation of the dentin, and finally to complete destruction of the tooth crown despite restoration, but without prevention (Fig 145). 
On the tooth crown, primary carious lesions are usually supragingival and particularly common on the occlusal surfaces of the molars and the approximal surfaces of the posterior teeth. In highly caries-active individuals, lesions may also develop on the approximal surfaces of the incisors, the buccal surfaces of the posterior teeth, and the lingual surfaces of the mandibular molars.
In elderly people and other adult caries-risk patients with root surfaces exposed by periodontal disease, root caries may also develop. In most industrialized countries with well-organized dental care, primary caries accounts for almost all lesions up to the age of 20 years. In adults older than 40 years, about 90% of lesions are secondary caries.
According to the World Health Organization (WHO) system, the shape and the depth of the carious lesion can be scored on a four-point scale (D1 to D4):
· D1: clinically detectable enamel lesions with intact (noncavitated) surfaces
· D2: clinically detectable “cavities” limited to the enamel
· D3: clinically detectable lesions in dentin (with and without cavitation of dentin)
· D4: lesions into pulp
For diagnosis and assessment of treatment need, it is important to note that enamel,
dentin, and root caries may be detected clinically at the noncavitated stage, as well as
with cavitation. In state-of-the-art dental practice, all noncavitated lesions can and
should be arrested; ie, a preventive, noninvasive approach is required.
It is also important to determine whether the lesion is active or inactive. This is of
particular importance with respect to visible enamel and root surface lesions. Table 15
shows the clinical diagnosis related to the type, localization, size, depth, and shape of
the carious lesion.
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Articles for theme “caries”:
ConclusionsCaries riskFrom a cost-effectiveness aspect caries-preventive measures should be applied strictly according to predicted caries risk. In populations with very high caries prevalence and caries incidence (where almost everyone develops new lesions every year) the traditional whole population strategy would be cost effective. The number of such populations is dwindling, however, particularly in the industrialized countries where caries prevalence was high 20 to 30 years ago.
Cariogram ModelA new model, the Cariogram, was presented in 1996 by Bratthall for illustration of the interactions of caries-related factors. The model makes it possible to single out individual risk or resistance factors. A special interactive version for the estimation of caries risk has been developed.The original Cariogram was a circle divided into three sectors, each representing factors strongly influencing carious activity: diet, bacteria, and susceptibility. The development of the model was based on a need to explain why, in certain individuals, carious activity could be low in spite of, for example, high sucrose intake, poor oral hygiene, high mutans streptococci load, or nonuse of fluorides.
Detailed risk profiles for dental cariesIf a patient is at high risk predominantly for either caries or periodontal disease, a more detailed risk profile is available for the specific disease. Box 19 shows a list of abbreviations for the most important variables related to caries risk.  Figure 138 illustrates how a high-risk patient (C3) has been transformed to a low-risk patient (C1) by improved self-care supplemented by professional preventive measures. The greater the difference between the solid line and the dotted line, the greater the improvement.
Risk ProfilesIntroductionBy combining the symptoms of disease (prevalence, incidence, treatment needs, etc); etiologic factors; external modifying risk indicators, risk factors, and prognostic risk factors; internal modifying risk indicators, risk factors, and prognostic risk factors; and preventive factors, it is possible to present risk profiles for tooth loss, dental caries, and periodontal diseases in graphic form. This can be done manually or by computer. The degree of risk, 0, 1, 2, or 3, is visualized using green, blue, yellow, and red, respectively.
Key-risk surfacesAs mentioned earlier, depending on the age and caries prevalence of the population, there may be pronounced variations in the pattern of both lost teeth and decayed or filled surfaces. Figure 130 shows caries prevalence and the pattern of decayed or filled surfaces in 12-year-old children in the county of Varmland, Sweden, in 1964, 1974, 1984, and 1994. The molars are clearly the key-risk teeth. In a toothbrushing population, the key-risk surfaces are the fissures of the molars and the approximal surfaces, from the mesial aspect of the second molars to the distal aspect of the first premolars.