caries risk assesement and prediction.pptx
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About This Presentation
caries risk assesement and prediction.pptx
Slide Content
Caries Risk Assessment
& Diagnostic Aids
WW WW
Prsented By
Dr Susmita Shah
NO o COQ. MOS Part
la (9) a 1
F + PT 6 4 Baw? O fpptcom
& Diagnostic Aids
WW WW
Prsented By
Dr Susmita Shah
NO o COQ. MOS Part
la (9) a 1
F + PT 6 4 Baw? O fpptcom
Contents
“Part |
+ Introduction
“Risk predictors & Risk indicators
+ Caries Risk Assessment
+ Caries Activity Tests
< Conclusion
+ Bibliography
fppt.com
“Part |
+ Introduction
“Risk predictors & Risk indicators
+ Caries Risk Assessment
+ Caries Activity Tests
< Conclusion
+ Bibliography
fppt.com
+ Part Il
+ Introduction
“ Importance of diagnosis
* Criteria for diagnosis
+ Traditional Methods
+ Recent Advances
“ Conclusion
+ Bibliography
3
fppt com
+ Introduction
“ Importance of diagnosis
* Criteria for diagnosis
+ Traditional Methods
+ Recent Advances
“ Conclusion
+ Bibliography
3
fppt com
“ INTRODUCTION
« DENTAL CARIES:- Acc to Shafers in 1993
Dental caries is an irreversible microbial disease of the calcified
tissue of the teeth, characterized by demineralization of inorganic portion and
destruction of organic substance of tooth which often leads to cavitation.
+ Risk assessment is based on past caries experience, Socioeconomic
factors & biological factors.
* To identify who will most likely develop dental caries
+ Provide these individuals proper preventive & treatment measures
4
ippt.com
« DENTAL CARIES:- Acc to Shafers in 1993
Dental caries is an irreversible microbial disease of the calcified
tissue of the teeth, characterized by demineralization of inorganic portion and
destruction of organic substance of tooth which often leads to cavitation.
+ Risk assessment is based on past caries experience, Socioeconomic
factors & biological factors.
* To identify who will most likely develop dental caries
+ Provide these individuals proper preventive & treatment measures
4
ippt.com
+,
e
CARIES RISK PREDICTORS & INDICATORS
Predictors Indicators
* White spots
« Caries
« Enamel lesion
« Restorations> 3 years
« Key Age Groups
- Risk Individuals
+ Key risk teeth
+ Key risk surface
os
Pie} à
- x = ©
Per Axelson: Diagnosis al risk, 5
PP. @ fo. re) a
e
CARIES RISK PREDICTORS & INDICATORS
Predictors Indicators
* White spots
« Caries
« Enamel lesion
« Restorations> 3 years
« Key Age Groups
- Risk Individuals
+ Key risk teeth
+ Key risk surface
os
Pie} à
- x = ©
Per Axelson: Diagnosis al risk, 5
PP. @ fo. re) a
+ CARIES RISK ASSESSMENT
Can be defined as procedure to predict future dental
caries development before the clinical onset of disease.
Determines caries incidence i.e number of new cavitated
or incipient lesions.
Involves probability that there will be change in size or
activity of lesion.
Caries-risk4ssessment and Management for Infants, Childfen, and Adolescents. REFERENCE
( 2)
ö_ A ra — ar O fpptcom
Can be defined as procedure to predict future dental
caries development before the clinical onset of disease.
Determines caries incidence i.e number of new cavitated
or incipient lesions.
Involves probability that there will be change in size or
activity of lesion.
Caries-risk4ssessment and Management for Infants, Childfen, and Adolescents. REFERENCE
( 2)
ö_ A ra — ar O fpptcom
« Risk assessment:
1. fosters the treatment of the disease process
instead of treating the outcome of the disease.
2. gives an understanding of the disease factors for a
specific patient and aids in individualizing preventive
discussions.
3. individualizes, selects, and determines frequency
of preventive and restorative treatment for a patient.
4. anticipates caries progression or stabilization
{ppt.com
1. fosters the treatment of the disease process
instead of treating the outcome of the disease.
2. gives an understanding of the disease factors for a
specific patient and aids in individualizing preventive
discussions.
3. individualizes, selects, and determines frequency
of preventive and restorative treatment for a patient.
4. anticipates caries progression or stabilization
{ppt.com
Caries Risk assessment Methods
1. Caries Questionnaire in combination with
Clinical Observations
2. AAPD’s Caries-risk Assessment Form.
3. The Cariogram Model
4. Caries Assessment and Risk Evaluation (CARE)
test.
5. Caries management by risk assessment
(CAMBRA)
6. Traffic Light Matrix (TLM)
Caries-ri las; nt and Manager 164 infants, Chil Adolescents. REFERENCE
618/
>. A 3 o. A 7 oe
fppt.com
1. Caries Questionnaire in combination with
Clinical Observations
2. AAPD’s Caries-risk Assessment Form.
3. The Cariogram Model
4. Caries Assessment and Risk Evaluation (CARE)
test.
5. Caries management by risk assessment
(CAMBRA)
6. Traffic Light Matrix (TLM)
Caries-ri las; nt and Manager 164 infants, Chil Adolescents. REFERENCE
618/
>. A 3 o. A 7 oe
fppt.com
« Caries-risk assessment models currently involve a
combination of factors including diet, fluoride exposure, a
susceptible host, and microflora that interplay with a
variety of social, cultural, and behavioral factors.
9
tppl.com
combination of factors including diet, fluoride exposure, a
susceptible host, and microflora that interplay with a
variety of social, cultural, and behavioral factors.
9
tppl.com
1. Caries questionnaire in combination
with clinical observation
+ Featherstone ef al. evolved a consensus statement to
assess individual caries risk from a questionnaire that
addresses issues such as maternal dental history, family
dynamics, socioeconomic factors, oral hygiene measures,
fluoride exposure, and frequency of sugar exposures.
« clinical observations were made by visual, tactile, and
radiographic examination of teeth.
a 2
à 0
D De ,
) indon B, Philip'N, An Overview of Cari Assessment: Rationale, Risk
Indias ment Methods, and Risk-based Carles Managejnent Protocols. Indian Journal 10
FR Y O of Dental Sciences 2097, my! ) fppteom
with clinical observation
+ Featherstone ef al. evolved a consensus statement to
assess individual caries risk from a questionnaire that
addresses issues such as maternal dental history, family
dynamics, socioeconomic factors, oral hygiene measures,
fluoride exposure, and frequency of sugar exposures.
« clinical observations were made by visual, tactile, and
radiographic examination of teeth.
a 2
à 0
D De ,
) indon B, Philip'N, An Overview of Cari Assessment: Rationale, Risk
Indias ment Methods, and Risk-based Carles Managejnent Protocols. Indian Journal 10
FR Y O of Dental Sciences 2097, my! ) fppteom
2. AAPD’s Caries Risk
Assessment form
11
‚ala ts. REFERENCE
fpptcom
Assessment form
11
‚ala ts. REFERENCE
fpptcom
Table 3. Caries-risk Assessment Form for 26 Years Olds“
(For Dental Providers}
Patient is of low sociocconomíc status
Patient has >3 between meal sugar contain snacks or heverages por day
Parienz has special health case needs
Patient ba recent immigrat
Protvstive
Patient erocives optimally-Huoridated drinking water
Parken bruches sth daily with Booridared vouchguste
Patient rrocives wpkal fluoride from health profesional
Additional home measures (eg. aplico, MI pase, ancinsicrabial)
Patient has deal home regular demal care
‘Clinical Findings
Patient bas 21 intenproniemal lesions
Patient has active white sport lesions ot enamel defects
Patient has low sulrvary Bow
Patient has defective rotation
Patient wearing an intraoral appliance
Gircing hose condicions chat apply co a mel patient helps the practitioner and patienc/pasens understand the Faces that coneibune
tor putect frown casi, Risk acera cateporiation of low, moder, or high is based on preponderance of faces fat the individual.
Hoeweves, clinical jaxgment mar jeufy the we of ome factor (cg 21 Iterpreuimal lions hw salivary Mon in deverminig weal isk
Overall assessment of the dental caries risk: High I Moderate I Low A
¿E a
ROA
mE
Fon ans Magécmant tr PP
(For Dental Providers}
Patient is of low sociocconomíc status
Patient has >3 between meal sugar contain snacks or heverages por day
Parienz has special health case needs
Patient ba recent immigrat
Protvstive
Patient erocives optimally-Huoridated drinking water
Parken bruches sth daily with Booridared vouchguste
Patient rrocives wpkal fluoride from health profesional
Additional home measures (eg. aplico, MI pase, ancinsicrabial)
Patient has deal home regular demal care
‘Clinical Findings
Patient bas 21 intenproniemal lesions
Patient has active white sport lesions ot enamel defects
Patient has low sulrvary Bow
Patient has defective rotation
Patient wearing an intraoral appliance
Gircing hose condicions chat apply co a mel patient helps the practitioner and patienc/pasens understand the Faces that coneibune
tor putect frown casi, Risk acera cateporiation of low, moder, or high is based on preponderance of faces fat the individual.
Hoeweves, clinical jaxgment mar jeufy the we of ome factor (cg 21 Iterpreuimal lions hw salivary Mon in deverminig weal isk
Overall assessment of the dental caries risk: High I Moderate I Low A
¿E a
ROA
mE
Fon ans Magécmant tr PP
Table 4. Example of a Caries Management Protocol for 1-2 Year Olds
= Recall every six 1012 months
- Bascline MS”
Interventions
Fluoride
— Twice daily brushing with
Buoridated toothpaste
~ Surveillance?
= Recall every six months
Busine MS”
Twice daily brushing with
uoridated toothpaste?
= Fluoride supplerments®
— Profemioal topical treatment
every six months
— Active surveillance of
incipient lesions
High risk
parent engaged
= Recall every six months
- Bascline MS”
Twice daily brushing with
Buocidated toothpaste?
Profenional topical treatment
every six months
— Active mrveilläncet of
incipient lesions
= Recall every thee mooths
= Budine and follow
up MS*
Trice daily brushing with
uoridated twothpaste?
= Fluoride supplements?
— Exafeional topical treatment
every three months
— Active munwillance® of
incipicat lesions
= Restore cavitatd lesions
with ITR® or definitive
restorations
= Recall every cree mothe
Bascline and follow
5 20e
Trice daily brushing with
Buotidated toothpaste”
Professional topical treatment
every three months
©
Counseling,
wich limited
expectations
— Active survcillance® of
incipient cier
= Restore cavitated lesions
‘with PR or definitive
restorations
fo Inagua Open Le à Le REFERENCE | |?
rn fppt com
= Recall every six 1012 months
- Bascline MS”
Interventions
Fluoride
— Twice daily brushing with
Buoridated toothpaste
~ Surveillance?
= Recall every six months
Busine MS”
Twice daily brushing with
uoridated toothpaste?
= Fluoride supplerments®
— Profemioal topical treatment
every six months
— Active surveillance of
incipient lesions
High risk
parent engaged
= Recall every six months
- Bascline MS”
Twice daily brushing with
Buocidated toothpaste?
Profenional topical treatment
every six months
— Active mrveilläncet of
incipient lesions
= Recall every thee mooths
= Budine and follow
up MS*
Trice daily brushing with
uoridated twothpaste?
= Fluoride supplements?
— Exafeional topical treatment
every three months
— Active munwillance® of
incipicat lesions
= Restore cavitatd lesions
with ITR® or definitive
restorations
= Recall every cree mothe
Bascline and follow
5 20e
Trice daily brushing with
Buotidated toothpaste”
Professional topical treatment
every three months
©
Counseling,
wich limited
expectations
— Active survcillance® of
incipient cier
= Restore cavitated lesions
‘with PR or definitive
restorations
fo Inagua Open Le à Le REFERENCE | |?
rn fppt com
Table 5. Example of a Caries Management Protocol for 3-5 Year Olds
Interventions
E word Diet Sealants”
2 Recall every six to El months | — Twice dally brushing with No
= Radiograph every Hisoridated toothpaste”
12 40:24 manıhr
= Baseline MS?
~ Taie daily ci with — Active auveilunse of
inch loto
= Restoration of cavitsted
= Banline MS® = Profesional wpical treatment ot enlarge laa
‘every tix month
- Resall every six months = ‘Tor daily brwshing with Courasting, = Active surveillance of
Aisoridsted toothpaste! swith limited incipiene lesions
— Professional topical ‘expectations = Restoration of cavitated
= Baseline MS treatment every six months ‘or enlarging lesions
Recall every three manche | —Bewihing with 0.5 percent Counseling — Active survedlance™ of
= Rudingrapk every fluoride (with caution) ncipiens loves
si months = Fluocide supplements? = Restoeation of cavitated
= Baseline and follow Profesional topical cor enlarging lesions
up MS" treatment every three moaths
— Recall every three months | — Brunhing with 0:5 percent ing, ie = Restore incipient
= Raaflographu every fluoride (with caution) emitarcd, of enlarging
six menda - Profeuional topical En
active and follow treatment every thie months
up MS"
© .
ent and Magagementior D à Le REFERENCE
NOG 18/19 a D" 4 {ppt.com
Interventions
E word Diet Sealants”
2 Recall every six to El months | — Twice dally brushing with No
= Radiograph every Hisoridated toothpaste”
12 40:24 manıhr
= Baseline MS?
~ Taie daily ci with — Active auveilunse of
inch loto
= Restoration of cavitsted
= Banline MS® = Profesional wpical treatment ot enlarge laa
‘every tix month
- Resall every six months = ‘Tor daily brwshing with Courasting, = Active surveillance of
Aisoridsted toothpaste! swith limited incipiene lesions
— Professional topical ‘expectations = Restoration of cavitated
= Baseline MS treatment every six months ‘or enlarging lesions
Recall every three manche | —Bewihing with 0.5 percent Counseling — Active survedlance™ of
= Rudingrapk every fluoride (with caution) ncipiens loves
si months = Fluocide supplements? = Restoeation of cavitated
= Baseline and follow Profesional topical cor enlarging lesions
up MS" treatment every three moaths
— Recall every three months | — Brunhing with 0:5 percent ing, ie = Restore incipient
= Raaflographu every fluoride (with caution) emitarcd, of enlarging
six menda - Profeuional topical En
active and follow treatment every thie months
up MS"
© .
ent and Magagementior D à Le REFERENCE
NOG 18/19 a D" 4 {ppt.com
Table 6. Example of a Caries Management Protocol for 26 Year-Olds
Intervention
Diagnostics Huoride Diet ‘Sealants
— Recall every str io? monto. | = Twice dy brung with No Yes — Surveillance"
— Radiographs eves Buocidated toothpaste
1210 24 months
= Recall every six months Twice daily bring with Y — Active surveillance! of
Radiographs very Suaeidlated toothpaste incipient lesions
six to 12 months Floor mappiensent À - Restoration of cavitarad
Profesional topical treatment ar enlarging Lien
very six mana
= Recall every sx mondo ice daily brshing with | — Counseling, = Aktive surveillance of
= Radiographs every toothpaste” swith limited incipient lions
six to 12 months Professional topical treatment | expectations Restoration of cavitated
very ct months or enlarging ksom
= Recall every three months Brushing wish 0,5 percent | ~ Coumsling Active surveillance® of
— Radiographs every Buorido = Xslitol incipient lesions
six mom Flooride sapplemsents Restoration wf cavitated
Prosenional topical treiment ae colin Les
every three months
= Recall every three monchs | — Brushing wich 0.5 perecer | —Counaéling, Y Restore incipient,
- Raaliographs every Buoeide rich limited saritated or
six monta. = Professional topical treatment expectations enlarging lesions
every thtee months - Klin
7 €
O4 P- ©
O REFERENCE ">
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Intervention
Diagnostics Huoride Diet ‘Sealants
— Recall every str io? monto. | = Twice dy brung with No Yes — Surveillance"
— Radiographs eves Buocidated toothpaste
1210 24 months
= Recall every six months Twice daily bring with Y — Active surveillance! of
Radiographs very Suaeidlated toothpaste incipient lesions
six to 12 months Floor mappiensent À - Restoration of cavitarad
Profesional topical treatment ar enlarging Lien
very six mana
= Recall every sx mondo ice daily brshing with | — Counseling, = Aktive surveillance of
= Radiographs every toothpaste” swith limited incipient lions
six to 12 months Professional topical treatment | expectations Restoration of cavitated
very ct months or enlarging ksom
= Recall every three months Brushing wish 0,5 percent | ~ Coumsling Active surveillance® of
— Radiographs every Buorido = Xslitol incipient lesions
six mom Flooride sapplemsents Restoration wf cavitated
Prosenional topical treiment ae colin Les
every three months
= Recall every three monchs | — Brushing wich 0.5 perecer | —Counaéling, Y Restore incipient,
- Raaliographs every Buoeide rich limited saritated or
six monta. = Professional topical treatment expectations enlarging lesions
every thtee months - Klin
7 €
O4 P- ©
O REFERENCE ">
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3. Cariogram
+ Cariogram is a new way in which to illustrate the interaction
between caries related factors.
+ This educational interactive program has been developed
for better understanding of the multifactorial aspects of
dental caries and to act as a guide in the attempts to
estimate the caries risk.
a 2
> 9
o © ( O!
el Petersson, Gariogram — a multifactor: et model for a
ase, Community Dent Oral Epkemiäjjängs: 332256-6;
L ur LE
od ippt.com
+ Cariogram is a new way in which to illustrate the interaction
between caries related factors.
+ This educational interactive program has been developed
for better understanding of the multifactorial aspects of
dental caries and to act as a guide in the attempts to
estimate the caries risk.
a 2
> 9
o © ( O!
el Petersson, Gariogram — a multifactor: et model for a
ase, Community Dent Oral Epkemiäjjängs: 332256-6;
L ur LE
od ippt.com
Aim
« lllustrates the interaction of caries related factors.
« lllustrates the chance to avoid caries.
« Expresses caries risk graphically.
« Recommends targeted preventive actions.
(3)
o]
O © ( 5)
el Petersson, Cariogram — a,multifactori et model for a
ase. Commugity Dent Oral Epidem ; 338566;
~ ‘i. FC 4
ee fppt.com
« lllustrates the interaction of caries related factors.
« lllustrates the chance to avoid caries.
« Expresses caries risk graphically.
« Recommends targeted preventive actions.
(3)
o]
O © ( 5)
el Petersson, Cariogram — a,multifactori et model for a
ase. Commugity Dent Oral Epidem ; 338566;
~ ‘i. FC 4
ee fppt.com
~~ © Le]
el Petersson, Cariogram — a mulifacio ré ssessment model for a
, E ity Dent Oral Epic L ; 33-256-64 7
ASB. mme ent a Pi ler Lane; i= fppt com
el Petersson, Cariogram — a mulifacio ré ssessment model for a
, E ity Dent Oral Epic L ; 33-256-64 7
ASB. mme ent a Pi ler Lane; i= fppt com
Table 1, Caries related factors and the data needed to create a Cariogram
Factor
Comment
Info/data needed:
Caries experience
Related diseases
Diet, contents
Dict, frequency
Plaque amount
Mutans streptococci
Fluoride programme
Saliva secretion
Saliva buffer capacity
Past caries experience, including cavities,
fillings and missing teeth because of caries. Several
new cavities definitely appearing during preceding
year should give a high score even if number of
fillings is low
‘General disease of conditions associated
with dental caries
Estimation of the cariogenicity of the food,
in particular sugar contents
Estimation of number of meals and snacks per day,
mean for ‘normal days’
Estimation of hygiene, for example according.
to Silness-Lôe Plaque Index (PI). Crowded teeth
leading to difficulties in removing plaque
interproximally should be taken into account
Estimation of levels of mutans streptococci
(Streptococcus mutans, Streptococcus sobrinus)
in saliva, for example using Strip mutans test
Estimation of to what extent fluoride is
available in the oral cavity over the
coming period of time
Estimation of amount of saliva, for example
using paraffin-stimulated secretion and expressing,
results as milliliter saliva per minute
Estimation of capacity of saliva to buffer acids,
for example using the Dentobuff test
DMFT, DMFS, new caries
experience in the past I ycar
Medical history, medications
Diet history, Lactobacillus test count
Questionnaire results, 24 h recall or
dictary recall (3 days!
Plaque index
Strip mutans test or other laboratory
tests giving comparable results
Fluoride exposure, interview patient
Stimulated saliva test - secretion rate
Dentobuff test or other laboratory
tests giving comparable results
*For each factor, the exam
saliva tests. The information is
ner has to gather information by interviewing and examining the patient, including some
then given a score of a scale ranging from 0 to 3 (0-2 for some factors) according to
predetermined criteria. The score 1)’ is the most favorable value and the maximum score ‘¥ (or 2") indicates a high,
unfavorable risk v; uo
—a multi
torial diseaserGemmunty Den
= F-
ro 7
sessment model for a
qee
Factor
Comment
Info/data needed:
Caries experience
Related diseases
Diet, contents
Dict, frequency
Plaque amount
Mutans streptococci
Fluoride programme
Saliva secretion
Saliva buffer capacity
Past caries experience, including cavities,
fillings and missing teeth because of caries. Several
new cavities definitely appearing during preceding
year should give a high score even if number of
fillings is low
‘General disease of conditions associated
with dental caries
Estimation of the cariogenicity of the food,
in particular sugar contents
Estimation of number of meals and snacks per day,
mean for ‘normal days’
Estimation of hygiene, for example according.
to Silness-Lôe Plaque Index (PI). Crowded teeth
leading to difficulties in removing plaque
interproximally should be taken into account
Estimation of levels of mutans streptococci
(Streptococcus mutans, Streptococcus sobrinus)
in saliva, for example using Strip mutans test
Estimation of to what extent fluoride is
available in the oral cavity over the
coming period of time
Estimation of amount of saliva, for example
using paraffin-stimulated secretion and expressing,
results as milliliter saliva per minute
Estimation of capacity of saliva to buffer acids,
for example using the Dentobuff test
DMFT, DMFS, new caries
experience in the past I ycar
Medical history, medications
Diet history, Lactobacillus test count
Questionnaire results, 24 h recall or
dictary recall (3 days!
Plaque index
Strip mutans test or other laboratory
tests giving comparable results
Fluoride exposure, interview patient
Stimulated saliva test - secretion rate
Dentobuff test or other laboratory
tests giving comparable results
*For each factor, the exam
saliva tests. The information is
ner has to gather information by interviewing and examining the patient, including some
then given a score of a scale ranging from 0 to 3 (0-2 for some factors) according to
predetermined criteria. The score 1)’ is the most favorable value and the maximum score ‘¥ (or 2") indicates a high,
unfavorable risk v; uo
—a multi
torial diseaserGemmunty Den
= F-
ro 7
sessment model for a
qee
Te
Advantages
Model is affordable
User friendly
Easy to understand
Tool for motivating patients
Also serves as support for clinical decision making while
selecting preventive strategies.
[a
2
‘ x = [©
k entistry By NikhilMarwah. Jaypee Broth: Rgglication. ‘3rd edition.
O
il ~ dé > a
20
fppt.com
Advantages
Model is affordable
User friendly
Easy to understand
Tool for motivating patients
Also serves as support for clinical decision making while
selecting preventive strategies.
[a
2
‘ x = [©
k entistry By NikhilMarwah. Jaypee Broth: Rgglication. ‘3rd edition.
O
il ~ dé > a
20
fppt.com
Caries related factors according to the program
Caries experience
Comment
Infa/dota needed
Past caries experience, including cavities, fillings and missing teeth
due to caries, Several new cavities definitely appearing during
preceding year should score '3' even if number of filling is low.
DMFT, OMFS, new caries experience in the
past one year.
Related general diseases | General disease or conditions associated with dental caries.
Medical history, medications.
Diet, contents Estimation of the cariogenicity of the food, in particular fermentable | Diet history, (lactobacillus test count},
carbohydrate content.
Diet, frequency Estimation of number of meals and snacks per day, mean for a | Questionnaire results (24 hours recall or 3 days
normal day. dietary recall).
Pleoue amount Estimation of hygiene, for example according to Silness-Lóe Plaque | Plaque index.
Index Crowded teeth leading to difficulties in removing plaque
interproximally should be taken into account
Estimation of levels of mutans streptococci (Streptococcus mutans,
Streptococcus sobrinus) in saliva, for example using Strip mutans test.
Strip mutans test or other similar test.
F je program Estimation of as to what extent fluoride is available in the oral cavity
over the coming period of time.
Selva secretion Estimation of amount of saliva, for example using paraffin-
stimulated secretion and expressing results as ml saliva per minute.
Fluoride exposure. interview the patient.
Stimulated saliva test—secretion rate.
Estimation of capacity of saliva to buffer acids, for example using
the Dentobuff test.
Dentobuff test or other similar test.
Opinion of dental examiner, ‘clinical feeling’. Examiners own clinical
and personal score for the individual patient.
Opinion of dental examiner, ‘clinical feeling’, A
pre-set score of 1 comes automatically,
diatric Denis br Nikhil à TA é
9
Fr ee
B rethers Publication. 3rd edition.
¿03
21
fppt.com
Caries experience
Comment
Infa/dota needed
Past caries experience, including cavities, fillings and missing teeth
due to caries, Several new cavities definitely appearing during
preceding year should score '3' even if number of filling is low.
DMFT, OMFS, new caries experience in the
past one year.
Related general diseases | General disease or conditions associated with dental caries.
Medical history, medications.
Diet, contents Estimation of the cariogenicity of the food, in particular fermentable | Diet history, (lactobacillus test count},
carbohydrate content.
Diet, frequency Estimation of number of meals and snacks per day, mean for a | Questionnaire results (24 hours recall or 3 days
normal day. dietary recall).
Pleoue amount Estimation of hygiene, for example according to Silness-Lóe Plaque | Plaque index.
Index Crowded teeth leading to difficulties in removing plaque
interproximally should be taken into account
Estimation of levels of mutans streptococci (Streptococcus mutans,
Streptococcus sobrinus) in saliva, for example using Strip mutans test.
Strip mutans test or other similar test.
F je program Estimation of as to what extent fluoride is available in the oral cavity
over the coming period of time.
Selva secretion Estimation of amount of saliva, for example using paraffin-
stimulated secretion and expressing results as ml saliva per minute.
Fluoride exposure. interview the patient.
Stimulated saliva test—secretion rate.
Estimation of capacity of saliva to buffer acids, for example using
the Dentobuff test.
Dentobuff test or other similar test.
Opinion of dental examiner, ‘clinical feeling’. Examiners own clinical
and personal score for the individual patient.
Opinion of dental examiner, ‘clinical feeling’, A
pre-set score of 1 comes automatically,
diatric Denis br Nikhil à TA é
9
Fr ee
B rethers Publication. 3rd edition.
¿03
21
fppt.com
TITLE
Validating
the Usage
of
Cariogram
in 5- and
12-year-
old
School-
going
Children
in Paonta
Sahib,
Himachal
Pradesh,
India: A
12-month
Prospectiv
Study
AUTHORS
JOURNAL
Garg A,
Madan M,
Dua, Saini
S, Mangla
R, Singhal
P, Dupper
A. Int J Clin
Pediatr
Dent. 2018
Mar-Apr;
11(2): 110-
115.
LO AIM
E
lb To validate
the caries
risk profiles in
5- and 12-
year-old
school-going
children and
to single out
main
contributing
factor, if any,
using
cariogram
over a period
of 1 year
MATERIAL AND
METHODODOLGY
A cariogram model
was used to create
caries risk profiles
on 499 children
aged 5 and 12 years
+6 months. They
were divided into 2
groups. The group |
and group II
consisted of 250 and
249 children
respectively. Re-
examination was
done after 1 year
and caries increment
was recorded. The
caries risk profiles
generated by the
cariogram software
amara cAmnoarad unth
CONCLUSION
The risk of
developing new
carious lesions
consistently
reduced from high-
risk category to
low-risk category,
reflecting the
cariogram ability in
accurately
estimating future
caries. Hence,
cariogram can be
said to be a useful
tool for caries
Prediction.
Validating
the Usage
of
Cariogram
in 5- and
12-year-
old
School-
going
Children
in Paonta
Sahib,
Himachal
Pradesh,
India: A
12-month
Prospectiv
Study
AUTHORS
JOURNAL
Garg A,
Madan M,
Dua, Saini
S, Mangla
R, Singhal
P, Dupper
A. Int J Clin
Pediatr
Dent. 2018
Mar-Apr;
11(2): 110-
115.
LO AIM
E
lb To validate
the caries
risk profiles in
5- and 12-
year-old
school-going
children and
to single out
main
contributing
factor, if any,
using
cariogram
over a period
of 1 year
MATERIAL AND
METHODODOLGY
A cariogram model
was used to create
caries risk profiles
on 499 children
aged 5 and 12 years
+6 months. They
were divided into 2
groups. The group |
and group II
consisted of 250 and
249 children
respectively. Re-
examination was
done after 1 year
and caries increment
was recorded. The
caries risk profiles
generated by the
cariogram software
amara cAmnoarad unth
CONCLUSION
The risk of
developing new
carious lesions
consistently
reduced from high-
risk category to
low-risk category,
reflecting the
cariogram ability in
accurately
estimating future
caries. Hence,
cariogram can be
said to be a useful
tool for caries
Prediction.
4. Caries Assessment & Risk Evaluation Test
Tabla 1: Carles risk Indicators: Pathological va. protective factors
Protective factory
Day oes
Fraguas bere weil dp
Preicngad rapto or wil bora her had of ies
Maig agar apa song the ey
tas Ready radar of canagenie wach
Secret rum freer
Mag raras mk cage paar
Child ben méscsasmetts depends spent
Ha acerss te zruensuma spell paa! ene: poca wen
permanent melon apt dale pot arpa mame ne
Medical faces
‘Special cad CL had wth a scale, es medicay
compr comin that may eer otal beat came masa: m
sa ha cid mer sure cane: Y
‘leary dysfunc cowed by madaranens, dixon tara ot
(pean dem combos ©
arly cnlenazanos ef fmt: me by MS
Presence of deal apples m vaste
(Dang ste sad ise
Saw cavum: Meson: a wont ar rames pow # mantis
andon B, Phil PN, An Overview.
sment Methods, and Risk-ba
Sage eo me end e mi ee
Preteesce fs ann concen mach
Ma dales: baa ont ing of a bs
(Geo oes! hype A A
Baal à pertes
(Regular secs a a walsh deal Lame"
Frvceace of conta. low cuccentaten ef fe ns armed tanh,
entre dc of me a ae y ren A the
ere]
Se mann
Avram mpm thes medicines
‘ary ators ha wd ala sends
ler prem: anal pes hat fren poc À rowers vo sance
Saba Calera Phorpise com: can bases remananassat À day
pres
Et one planen coral pe dre
tt af atari! coma la el ela, prions
ns code rom) lion wok are cares ran’
Manners to ars wa vera etes ne ch) cnica of
cage bares
jes RisksAssessme:
nagement;
Rationale, Risk
Is. Indian Journal
23
{fppt.com
Tabla 1: Carles risk Indicators: Pathological va. protective factors
Protective factory
Day oes
Fraguas bere weil dp
Preicngad rapto or wil bora her had of ies
Maig agar apa song the ey
tas Ready radar of canagenie wach
Secret rum freer
Mag raras mk cage paar
Child ben méscsasmetts depends spent
Ha acerss te zruensuma spell paa! ene: poca wen
permanent melon apt dale pot arpa mame ne
Medical faces
‘Special cad CL had wth a scale, es medicay
compr comin that may eer otal beat came masa: m
sa ha cid mer sure cane: Y
‘leary dysfunc cowed by madaranens, dixon tara ot
(pean dem combos ©
arly cnlenazanos ef fmt: me by MS
Presence of deal apples m vaste
(Dang ste sad ise
Saw cavum: Meson: a wont ar rames pow # mantis
andon B, Phil PN, An Overview.
sment Methods, and Risk-ba
Sage eo me end e mi ee
Preteesce fs ann concen mach
Ma dales: baa ont ing of a bs
(Geo oes! hype A A
Baal à pertes
(Regular secs a a walsh deal Lame"
Frvceace of conta. low cuccentaten ef fe ns armed tanh,
entre dc of me a ae y ren A the
ere]
Se mann
Avram mpm thes medicines
‘ary ators ha wd ala sends
ler prem: anal pes hat fren poc À rowers vo sance
Saba Calera Phorpise com: can bases remananassat À day
pres
Et one planen coral pe dre
tt af atari! coma la el ela, prions
ns code rom) lion wok are cares ran’
Manners to ars wa vera etes ne ch) cnica of
cage bares
jes RisksAssessme:
nagement;
Rationale, Risk
Is. Indian Journal
23
{fppt.com
+ The CARE test is probably the only CRA method that
can potentially promote caries prevention at the primary
level itself (before any carious lesions have appeared),
by identifying high caries risk children early and
instituting a preemptive aggressive preventive regimen in
them.
ce
2 9
Le >= ©
Si E 'andon B, Philip N; An Overview of, Caries is! sessment: Rationale, Risk 24
si ameno Methods, and Risk-ba nal entProfocols. Indian Journal
$ PARA eL E, fppt.com
can potentially promote caries prevention at the primary
level itself (before any carious lesions have appeared),
by identifying high caries risk children early and
instituting a preemptive aggressive preventive regimen in
them.
ce
2 9
Le >= ©
Si E 'andon B, Philip N; An Overview of, Caries is! sessment: Rationale, Risk 24
si ameno Methods, and Risk-ba nal entProfocols. Indian Journal
$ PARA eL E, fppt.com
5. Caries Management by Risk Assessment
« The science of CAMBRA deals with caries
management using risk assessment protocols
for diagnosis, treatment, and prevention,
including nonsurgical means for repairing or
remineralizing tooth structure.
Om
> 9
Le o) (o)
Si E 'andon B, Philip N; An Overview of Caries is! sessment: Rationale, Risk 25
si sment Meth and Risk» -based Carles Man nadien Prapcar Indian Journal
de) ony. na tpptcom
Sr Cm ST € Lei
« The science of CAMBRA deals with caries
management using risk assessment protocols
for diagnosis, treatment, and prevention,
including nonsurgical means for repairing or
remineralizing tooth structure.
Om
> 9
Le o) (o)
Si E 'andon B, Philip N; An Overview of Caries is! sessment: Rationale, Risk 25
si sment Meth and Risk» -based Carles Man nadien Prapcar Indian Journal
de) ony. na tpptcom
Sr Cm ST € Lei
ative Dentistry
and Endodontics
E-mail seetanbav@ gmail.com
Caries management by risk assessment:
A review on current strategies for caries
prevention and management
$. Uma Maheswari, Jacob Raja’, Arvind Kumar, R. Gnana Seelan
ABSTRACT
The curront trend in treating dental caries is using nondestructive risk-based caries management strategies
rather than focusing on the restorative treatment alone. Currently, there have been many changes in
eextanding of the mulidacated nature of caries process and its management, Caras Management by Risk
mont (CAMBRA) which is an evidence-baced approach focuses on dotormining many factors causing
the expression of disease and take corrective action. The cinicians can ascortnin what behaviors are incraasing
‘a ici for d sgn pe bie ha commen ne ot a. With this
AMEL protocol, a novel treatment plan can be designed to arrest dental canos tharstıy dacraasing
the chance of cavitation. After the recognition of the multi factonal nat aries irealvang the Bof, the
contemporary approaches focused mainly on the various options to cope with the locally out-ol-balance
oral bioflm and stop the progression of the disease. The initial carios lesions can be diagnosed with modern
diagnostic aids and with the help of CAMERA, reestablishment of tha intagrity of the tooth surface auch on
in the caries process wil bring great rowords for patients, T
tissuos using noninvasive strategies,
26
{ppt.com
and Endodontics
E-mail seetanbav@ gmail.com
Caries management by risk assessment:
A review on current strategies for caries
prevention and management
$. Uma Maheswari, Jacob Raja’, Arvind Kumar, R. Gnana Seelan
ABSTRACT
The curront trend in treating dental caries is using nondestructive risk-based caries management strategies
rather than focusing on the restorative treatment alone. Currently, there have been many changes in
eextanding of the mulidacated nature of caries process and its management, Caras Management by Risk
mont (CAMBRA) which is an evidence-baced approach focuses on dotormining many factors causing
the expression of disease and take corrective action. The cinicians can ascortnin what behaviors are incraasing
‘a ici for d sgn pe bie ha commen ne ot a. With this
AMEL protocol, a novel treatment plan can be designed to arrest dental canos tharstıy dacraasing
the chance of cavitation. After the recognition of the multi factonal nat aries irealvang the Bof, the
contemporary approaches focused mainly on the various options to cope with the locally out-ol-balance
oral bioflm and stop the progression of the disease. The initial carios lesions can be diagnosed with modern
diagnostic aids and with the help of CAMERA, reestablishment of tha intagrity of the tooth surface auch on
in the caries process wil bring great rowords for patients, T
tissuos using noninvasive strategies,
26
{ppt.com
6. Traffic Light Matrix
« Commonly used CRA tool in Australia
« Color codes such as red, green, and orange
+ to alert the clinician regarding the current risk status
« based on 19 criteria in 5 different categories including
saliva (6 criteria), plaque(3 criteria), diet (2 criteria),
fluoride exposure (3 criteria), and modifying factors (5
criteria).
OÍ
3
o © [© )
ndon B, Philip. N, Ar Overview of Caries essment Rationale, Risk 27
sment Methoÿs, and Risk-based! anal ment Piptocals. Indian Journal
Se
Fe dk Ona fpptcom
« Commonly used CRA tool in Australia
« Color codes such as red, green, and orange
+ to alert the clinician regarding the current risk status
« based on 19 criteria in 5 different categories including
saliva (6 criteria), plaque(3 criteria), diet (2 criteria),
fluoride exposure (3 criteria), and modifying factors (5
criteria).
OÍ
3
o © [© )
ndon B, Philip. N, Ar Overview of Caries essment Rationale, Risk 27
sment Methoÿs, and Risk-based! anal ment Piptocals. Indian Journal
Se
Fe dk Ona fpptcom
Saliva: (a) Resting: Hydration, viscosity, and pH (b) stimulated:
Quantity/rate, pH, and buffering capacity
Plaque: PH, maturity, and bacteria — mutans count
Diet: Number of sugar and acid exposures in-between meals/day
Fluoride: Exposure to fluoride through water/toothpaste/ professional
treatment
Modifying factors: Drugs that reduce salivary flow, diseases
resulting in dry mouth, fixed/removable appliances, recent active
caries, and poor compliance.
7) ~ o. je | ra gen a O fpptcom
Quantity/rate, pH, and buffering capacity
Plaque: PH, maturity, and bacteria — mutans count
Diet: Number of sugar and acid exposures in-between meals/day
Fluoride: Exposure to fluoride through water/toothpaste/ professional
treatment
Modifying factors: Drugs that reduce salivary flow, diseases
resulting in dry mouth, fixed/removable appliances, recent active
caries, and poor compliance.
7) ~ o. je | ra gen a O fpptcom
Poor oral hygiene WM Feeding Poor
Parental Neglect J Oral
Acidic Beverage mE Health
Sticky & sugary Food
Fair oral hygiene
Parental Awareness
Less Sticky & sugary
Food
Dental visits
Good oral hygiene
+ + Parental Awareness
Sticky 8 sugary Food
Follow Up Visits
Maintenance
6 monthly
Dental
Visits
+ No dental caries
+ Brushing Twice
+ Flossing
| Reference: AAPD Guidelines: Cares risk assessment management for boats, children, B adolescents 2014
29
y + # O a.
{ppt.com
Parental Neglect J Oral
Acidic Beverage mE Health
Sticky & sugary Food
Fair oral hygiene
Parental Awareness
Less Sticky & sugary
Food
Dental visits
Good oral hygiene
+ + Parental Awareness
Sticky 8 sugary Food
Follow Up Visits
Maintenance
6 monthly
Dental
Visits
+ No dental caries
+ Brushing Twice
+ Flossing
| Reference: AAPD Guidelines: Cares risk assessment management for boats, children, B adolescents 2014
29
y + # O a.
{ppt.com
“* CARIES ACTIVITY TEST
* Caries activity tests have been well known in dentistry for the past
few years.
* in routine clinical practice these caries activity tests require specially
prepared culture media and laboratory facilities for incubation and
expensive kits to perform.
* principle causative organism being Streptococci mutans.
oe
2 0 N
o © ( O!
ula N, Arun A, Mythri H. Caties Activity ests Research and Reviews: 30
Journal of Dental pa O
~ = 2
CA fppt.com
* Caries activity tests have been well known in dentistry for the past
few years.
* in routine clinical practice these caries activity tests require specially
prepared culture media and laboratory facilities for incubation and
expensive kits to perform.
* principle causative organism being Streptococci mutans.
oe
2 0 N
o © ( O!
ula N, Arun A, Mythri H. Caties Activity ests Research and Reviews: 30
Journal of Dental pa O
~ = 2
CA fppt.com
( imal of Dental
a, Aime JOumal of De
WHY CARIES ACTIVITY TESTS ???
+ To determine the need and extent of personalized =
preventive measures.
+ To serve as a index of the success of therapeutic
measures.
« To motivate and monitor the effectiveness of education
process.
* To identify high risk groups and individuals.
of
2 9
Le > ©
Ne ula N, Arun A, Mythri H. Caries Activity Test search and Reviews:
a pont
Le fppt.com
a, Aime JOumal of De
WHY CARIES ACTIVITY TESTS ???
+ To determine the need and extent of personalized =
preventive measures.
+ To serve as a index of the success of therapeutic
measures.
« To motivate and monitor the effectiveness of education
process.
* To identify high risk groups and individuals.
of
2 9
Le > ©
Ne ula N, Arun A, Mythri H. Caries Activity Test search and Reviews:
a pont
Le fppt.com
Various Caries activity tests
A. Tests which measure caries activity
-Lactobacillus colony count test
-Streptococcus mutans level in saliva
-S. Mutans screening tests
Plaque-tooth pick method
Saliva/tongue blade method
S. Mutans adherence method
-Alban test
-Dewar test
-Swab test
-Salivary buffer capacity test
+ B. Tests which measure caries susceptibili
-Snyder’s colorimetric test
-Enamel solubility test
-Dewar test
k calcium? y © ( e)
ry Reductase Test
; 5 ©
e. NÉ manlcommula N, AruñíA, Mythri H: Carisó AGIMiNPTEsts: Resedicifand Reviews: pucom
A. Tests which measure caries activity
-Lactobacillus colony count test
-Streptococcus mutans level in saliva
-S. Mutans screening tests
Plaque-tooth pick method
Saliva/tongue blade method
S. Mutans adherence method
-Alban test
-Dewar test
-Swab test
-Salivary buffer capacity test
+ B. Tests which measure caries susceptibili
-Snyder’s colorimetric test
-Enamel solubility test
-Dewar test
k calcium? y © ( e)
ry Reductase Test
; 5 ©
e. NÉ manlcommula N, AruñíA, Mythri H: Carisó AGIMiNPTEsts: Resedicifand Reviews: pucom
Lactobacillus Colony Count test
(Hadley 1933)
ACTION :- To estimate the number of acidogenic and acid
uric bacteria in the patients saliva by counting the
number of colonies appearing on tomato peptone agar
plates (PH-5.0) after inoculation with a sample of saliva.
EQUIPMENT : Saliva collecting bottles, Paraffin, two 9-ml
tubes of saliva, two agar plates, two bent glass rods,
Quebec counter and pipettes.
Oo.
= vo ( 2)
Ne ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
( Joymal of Dental Sclenges2013 =
Le fppt com
(Hadley 1933)
ACTION :- To estimate the number of acidogenic and acid
uric bacteria in the patients saliva by counting the
number of colonies appearing on tomato peptone agar
plates (PH-5.0) after inoculation with a sample of saliva.
EQUIPMENT : Saliva collecting bottles, Paraffin, two 9-ml
tubes of saliva, two agar plates, two bent glass rods,
Quebec counter and pipettes.
Oo.
= vo ( 2)
Ne ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
( Joymal of Dental Sclenges2013 =
Le fppt com
Interpretation:-
No. of lactobacilli per Caries activity
ml saliva
0-1000 Little or No
1000-5000 Slight
5000-10,000 Moderate
>10,000 Marked
120.
©
ae and Reviews:
13.
Ne ula N, Arun A, Mythri H. Caries Activity 5,
mal of Dental Scienges2a;
>. ff ~ 5: Ka q
“m tppt.com
No. of lactobacilli per Caries activity
ml saliva
0-1000 Little or No
1000-5000 Slight
5000-10,000 Moderate
>10,000 Marked
120.
©
ae and Reviews:
13.
Ne ula N, Arun A, Mythri H. Caries Activity 5,
mal of Dental Scienges2a;
>. ff ~ 5: Ka q
“m tppt.com
Snyder’s Test
* Introduced by Snyder in 1951.
Measures the rapidity of acid formation by salivary
microorganisms, when a sample of stimulated saliva is
inoculated into glucose agar medium with bromocresol
green as color indicator.
Equipment: Saliva collecting bottles, Paraffin a tube of
Snyder glucose agar containing bromocresol green and
adjusted to PH 4.7 to 5 pipettes and incubating facilities.
o
= vo ( O)
Ne ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
Joymal of Dental Sclenges2013
y + Far‘ ga fppt.com
* Introduced by Snyder in 1951.
Measures the rapidity of acid formation by salivary
microorganisms, when a sample of stimulated saliva is
inoculated into glucose agar medium with bromocresol
green as color indicator.
Equipment: Saliva collecting bottles, Paraffin a tube of
Snyder glucose agar containing bromocresol green and
adjusted to PH 4.7 to 5 pipettes and incubating facilities.
o
= vo ( O)
Ne ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
Joymal of Dental Sclenges2013
y + Far‘ ga fppt.com
02m
I =~
SALIVA
a YELLOW
SALIVA AND MEDIUM REA
Procedure ¿E u Br
HE
LIQUIFIED SNYDER
TEST AGAR—30 E
Interpretation ZS SE Ta
If yellow If yellow If yellow
Marked caries Definite caries Limited caries
susceptibility susceptibility susceptibility
Ifgreen lf green If green
| Continue to Continue to Caries inactive
| incubate & incubate &
observe at 48. observe at 72
3 ? Grs hrs
ula N, Arun À. Mythri H. Caries Activity is fjesearch and Reviews: 36
Journal of Dental 13, ( )
‘a ©, {ppt.com
I =~
SALIVA
a YELLOW
SALIVA AND MEDIUM REA
Procedure ¿E u Br
HE
LIQUIFIED SNYDER
TEST AGAR—30 E
Interpretation ZS SE Ta
If yellow If yellow If yellow
Marked caries Definite caries Limited caries
susceptibility susceptibility susceptibility
Ifgreen lf green If green
| Continue to Continue to Caries inactive
| incubate & incubate &
observe at 48. observe at 72
3 ? Grs hrs
ula N, Arun À. Mythri H. Caries Activity is fjesearch and Reviews: 36
Journal of Dental 13, ( )
‘a ©, {ppt.com
a ( y Jounal of of Dental Scienges2013
Alban’s Test
« Itis a simplified substitute for the Snyder test.
+ Recommended, for all patients prone to caries,
especially children undergoing orthodontic treatment.
Oo.
= o © ( ©)
Ni ula N, Arun A, Mythri H. Caties Activity s. Research and Reviews:
= ippt.com
Alban’s Test
« Itis a simplified substitute for the Snyder test.
+ Recommended, for all patients prone to caries,
especially children undergoing orthodontic treatment.
Oo.
= o © ( ©)
Ni ula N, Arun A, Mythri H. Caties Activity s. Research and Reviews:
= ippt.com
Procedure:-
60 gms of
Snyder test agar Agar is
placed in 1 liter Distribute 5 ml
of water and solution per
suspension is dest tube
bring to boil
\ 2 tubes are
[ taken & patient Tubes are
/ is asked to Labeled and
E expectorate Incubate at
€ directly in test 98.6°F for upto 4
Gz tube days
©
©
. Caries Activity is. Research and Reviews:
cages a ron
— E AA tppt.com
60 gms of
Snyder test agar Agar is
placed in 1 liter Distribute 5 ml
of water and solution per
suspension is dest tube
bring to boil
\ 2 tubes are
[ taken & patient Tubes are
/ is asked to Labeled and
E expectorate Incubate at
€ directly in test 98.6°F for upto 4
Gz tube days
©
©
. Caries Activity is. Research and Reviews:
cages a ron
— E AA tppt.com
Interpretation:
fppt.com
fppt.com
Fosdick calcium dissolution test
Action: The test measures the milligrams of powdered
enamel dissolved in 4 hours by acid, formed when the
patients saliva is mixed with glucose and powdered
enamel.
Equipment: Powdered human enamel, saliva collection
bottles, sterile test tubes, test tube agitation equipment
and equipment for determining the calcium content of
saliva.
OÍ
o © ( e)
Ni ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
la) Journal of Dental Sci enges2013 CRM ) {fppt.com
Action: The test measures the milligrams of powdered
enamel dissolved in 4 hours by acid, formed when the
patients saliva is mixed with glucose and powdered
enamel.
Equipment: Powdered human enamel, saliva collection
bottles, sterile test tubes, test tube agitation equipment
and equipment for determining the calcium content of
saliva.
OÍ
o © ( e)
Ni ula N, Arun A, Mythri H. Caries Activity s. Research and Reviews:
la) Journal of Dental Sci enges2013 CRM ) {fppt.com
Procedure
2.5ml of stimulated saliva are collected, one part of this is analyzed for
calcium content, the rest is placed in an 8 inch sterile test tube with
about 0.19 of powdered human enamel.
The tube is sealed and shaken for 4 hours at body temperature after
which it is again analyzed for calcium content.
The chewing of gum to stimulate saliva produces sugar. If paraffin is
used, aconcentration of about 5% glucose is added. The amount of
the enamel dissolution increases as the caries activity increases.
Interpretation
Amount of calcium increases, as the caries activity increases.
Amount of dissolution increases, as the caries increases.
©
2 9
o © ( )
ula N, Arun A. Mythri H. Caries Activity s. Research and Reviews:
3 01 Dental Slngasian'3. + O
mm e - ú
fppt.com
2.5ml of stimulated saliva are collected, one part of this is analyzed for
calcium content, the rest is placed in an 8 inch sterile test tube with
about 0.19 of powdered human enamel.
The tube is sealed and shaken for 4 hours at body temperature after
which it is again analyzed for calcium content.
The chewing of gum to stimulate saliva produces sugar. If paraffin is
used, aconcentration of about 5% glucose is added. The amount of
the enamel dissolution increases as the caries activity increases.
Interpretation
Amount of calcium increases, as the caries activity increases.
Amount of dissolution increases, as the caries increases.
©
2 9
o © ( )
ula N, Arun A. Mythri H. Caries Activity s. Research and Reviews:
3 01 Dental Slngasian'3. + O
mm e - ú
fppt.com
Dewar test
* Action: Similar to Fosdick calcium dissolution test
except that the final pH after four hrs is measures,
instead of the amount Of calcium dissolved.
= Not commonly used as it has not been adequately
tested for clinical correlation.
Oo.
3
= o © ( ©)
Ne ula N, Arun A, Mythri H. Caries clivily s(Sjesearch and Reviews:
( Journal of Dental 252013.
a —
= ippt.com
* Action: Similar to Fosdick calcium dissolution test
except that the final pH after four hrs is measures,
instead of the amount Of calcium dissolved.
= Not commonly used as it has not been adequately
tested for clinical correlation.
Oo.
3
= o © ( ©)
Ne ula N, Arun A, Mythri H. Caries clivily s(Sjesearch and Reviews:
( Journal of Dental 252013.
a —
= ippt.com
Swab test
developed by Grainger et al in 1965.
It has advantage compared to other tests, as no saliva
collection is necessary.
Valuable in evaluating caries activity in very young
patients.
Action: It is based on the same principle as the snyder's
test.
Oo.
3
= o © ( ©)
Ne ula N, Arun À, Mythri H. Caries Activity s(Sjesearch and Reviews:
( 2013.
= ippt.com
developed by Grainger et al in 1965.
It has advantage compared to other tests, as no saliva
collection is necessary.
Valuable in evaluating caries activity in very young
patients.
Action: It is based on the same principle as the snyder's
test.
Oo.
3
= o © ( ©)
Ne ula N, Arun À, Mythri H. Caries Activity s(Sjesearch and Reviews:
( 2013.
= ippt.com
Procedure
Oral flora is sampled by swabbing the buccal surfaces of the teeth
with the help of cotton applicator.
Sample is subsequently incubated in the medium.
The change in the Ph following a 48 hour incubation period is read on
a pH meter.
Marked Caries
Activity
Active
pH 4.2-4.4
Slightly Active
Caries inactive
search and Reviews:
Le fppt.com
Oral flora is sampled by swabbing the buccal surfaces of the teeth
with the help of cotton applicator.
Sample is subsequently incubated in the medium.
The change in the Ph following a 48 hour incubation period is read on
a pH meter.
Marked Caries
Activity
Active
pH 4.2-4.4
Slightly Active
Caries inactive
search and Reviews:
Le fppt.com
Salivary Reductase Test
(Susceptibility test)
Action: Measures the rate at which an indicator molecule,
diazo-resorcinol, changes from blue to red reduction by
the mixed salivary flora. The test “measures the activity of
a Single Enzyme reductase.”
Equipment: The Reductase test comes in a kit (Treatex) that
includes calibrated saliva collection tubes with the reagent
inside of the tubes, cap, plus flavored Paraffin.
il
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(Susceptibility test)
Action: Measures the rate at which an indicator molecule,
diazo-resorcinol, changes from blue to red reduction by
the mixed salivary flora. The test “measures the activity of
a Single Enzyme reductase.”
Equipment: The Reductase test comes in a kit (Treatex) that
includes calibrated saliva collection tubes with the reagent
inside of the tubes, cap, plus flavored Paraffin.
il
2 9
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Ne ula N, Arun A, Mythri H. Caries Activity Ss Jjesearch and Reviews:
13
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> Saliva is collected
Pro ced ure:- by chewing Sample is mixed with
paraffin & dye Diazo-resorcinol
expectorated
directly in the test
tube
Observe the color
change after 15 minutes
Blue 15 1 Non conducive
minutes
Orchid 15 2 Slightly .
minutes conducive Interpretation
Red 15 3 Moderately
minutes conducive
Red Immediat 4 Highly
ely conducive e
— Pink Immediat 5 Extremely &
Whiliemmargabimula N, Arun A, Mythri DRUM Ss fjesearch and Reviews:
~*~ Jopmnal of of Dental Scienges2013. a ) A.
Pro ced ure:- by chewing Sample is mixed with
paraffin & dye Diazo-resorcinol
expectorated
directly in the test
tube
Observe the color
change after 15 minutes
Blue 15 1 Non conducive
minutes
Orchid 15 2 Slightly .
minutes conducive Interpretation
Red 15 3 Moderately
minutes conducive
Red Immediat 4 Highly
ely conducive e
— Pink Immediat 5 Extremely &
Whiliemmargabimula N, Arun A, Mythri DRUM Ss fjesearch and Reviews:
~*~ Jopmnal of of Dental Scienges2013. a ) A.
Buffer Capacity Test
Action: Buffer capacity can be quantitated using either a pH
meter or color indicator.
The test measures the number of millilitres of acid
required to lower the pH of saliva through an arbitrary pH
interval, such as from pH 7.0 to 6.0 or the amount of acid or
base necessary to bring color indicators to their end point.
Equipment: Needed equipment includes a pH meter, titration
equipment, 0.05N lactic acid, 0.05N base, Paraffin, Sterile
glass jars containing a small amount of oil.
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2,
Ne ula N, Arun A, Mythri H. Caries Activity Ss Jjesearch and Reviews:
13
of Ex ces: 2013, ( )
) Jounal of rental Sciengesi20 2 {fppt.com
Action: Buffer capacity can be quantitated using either a pH
meter or color indicator.
The test measures the number of millilitres of acid
required to lower the pH of saliva through an arbitrary pH
interval, such as from pH 7.0 to 6.0 or the amount of acid or
base necessary to bring color indicators to their end point.
Equipment: Needed equipment includes a pH meter, titration
equipment, 0.05N lactic acid, 0.05N base, Paraffin, Sterile
glass jars containing a small amount of oil.
OÍ
2,
Ne ula N, Arun A, Mythri H. Caries Activity Ss Jjesearch and Reviews:
13
of Ex ces: 2013, ( )
) Jounal of rental Sciengesi20 2 {fppt.com
Procedure:-
+ 10ml of stimulated saliva is collected under oil at least Ihr
after eating: 5ml of this are measured into a beaker.
« The pH of the saliva is adjusted to 7.0 by addition of lactic
acid or base.
+ The level of lactic acid in the graduated cylinder is
recorded ,lactic acid is then added to the sample until a
PH of 6.0 is reached.
of
3
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Ne ula N, Arun A, Mythri H. Caries Activily s(Sjesearch and Reviews:
( mal of Dental nces 20 252013.
9: E. I
7 ippt.com
+ 10ml of stimulated saliva is collected under oil at least Ihr
after eating: 5ml of this are measured into a beaker.
« The pH of the saliva is adjusted to 7.0 by addition of lactic
acid or base.
+ The level of lactic acid in the graduated cylinder is
recorded ,lactic acid is then added to the sample until a
PH of 6.0 is reached.
of
3
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Ne ula N, Arun A, Mythri H. Caries Activily s(Sjesearch and Reviews:
( mal of Dental nces 20 252013.
9: E. I
7 ippt.com
Interpretation
+ There is an inverse relationship between buffering
capacity of saliva and caries activity
j Acid buffering 4 ]
: Caries
capacity
Activity
Oo.
3
s 9 © ( ©)
Ne ula N, Arun À, Mythri H. Caries Activity s(Sjesearch and Reviews:
13
PL E © () o
+ There is an inverse relationship between buffering
capacity of saliva and caries activity
j Acid buffering 4 ]
: Caries
capacity
Activity
Oo.
3
s 9 © ( ©)
Ne ula N, Arun À, Mythri H. Caries Activity s(Sjesearch and Reviews:
13
PL E © () o
Cariostat test
A sterile cotton swab - run across the buccal surfaces of all
maxillary teeth present.
The cotton swab is then placed into the ampule supplied by
the manufacturer (2 ml of the culture medium).
Incubated for 48 hr at 37°C.
PD
alla
Fits, ie Ba dec HE
es Par PH
A sterile cotton swab - run across the buccal surfaces of all
maxillary teeth present.
The cotton swab is then placed into the ampule supplied by
the manufacturer (2 ml of the culture medium).
Incubated for 48 hr at 37°C.
PD
alla
Fits, ie Ba dec HE
es Par PH
* The test medium's color change was compared with four
reference tubes provided.
* Scored :
Dark blue (pH 7) = 0;
Green (pH 5.5) = 1;
Yellow-green (pH 4.5) = 2;
Bright yellow (pH 4) = 3.
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reference tubes provided.
* Scored :
Dark blue (pH 7) = 0;
Green (pH 5.5) = 1;
Yellow-green (pH 4.5) = 2;
Bright yellow (pH 4) = 3.
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Dentocult SM Strip mutans
« Mutans streptococci play an important role in the initiation
and progression of dental caries and they are considered
the primary cause of bacteriological caries.
« This bacterium thrives in the plaque that forms on the
surface of teeth.
* The earlier the colonisation of teeth occurs, the higher
the prevalence of dental caries.
5 “e
\ © >
Ni mula N, Arun A; MythriH. Caries Activity Testsi«Beseareh and Reviews:
a A ia ot Dental se. [7 tollem
« Mutans streptococci play an important role in the initiation
and progression of dental caries and they are considered
the primary cause of bacteriological caries.
« This bacterium thrives in the plaque that forms on the
surface of teeth.
* The earlier the colonisation of teeth occurs, the higher
the prevalence of dental caries.
5 “e
\ © >
Ni mula N, Arun A; MythriH. Caries Activity Testsi«Beseareh and Reviews:
a A ia ot Dental se. [7 tollem
>. F. ~ a. ©
Interpretation:
* Mutans streptococci adhere to the rough area of the strip
in proportion to their density in saliva. After incubation they
are visible as light to dark blue, raised colonies on the
rough area of the test strip.
es
> Q q
‘ x = ©
Ne ula N, Arun À. Mythri H. Caries Activity Resch and Reviews:
Journal of Dental 13, ( )
An, fpptcom
Interpretation:
* Mutans streptococci adhere to the rough area of the strip
in proportion to their density in saliva. After incubation they
are visible as light to dark blue, raised colonies on the
rough area of the test strip.
es
> Q q
‘ x = ©
Ne ula N, Arun À. Mythri H. Caries Activity Resch and Reviews:
Journal of Dental 13, ( )
An, fpptcom
ORATEST
+ based on the rate of oxygen depletion by micro organisms.
+ Under aerobic conditions the bacterial enzyme, aerobic dehydrogenase
transfers electrons or protons to oxygen.
+ Once oxygen gets utilized by the aerobic organisms and an anaerobic
environment is attained, methylene blue [redox indicator] acts as an
electron acceptor and gets reduced to leucomethylene blue.
» The metabolic activity of the aerobic microorganism is reflected by the
reduction of methylene blue to leucomethylene blue.
+ The test is based on rinsing the mouth with sterile milk which dislodges
the micro-organisms and also produces a substrate for their further
metabolism. The formation of leucomthylene blue can be easily
cause of the white color of ie
© o
ula N, Arun A, Mythri H. Caties Activily s. Research and Reviews:
naar of Bepta]
ps] ippt.com
+ based on the rate of oxygen depletion by micro organisms.
+ Under aerobic conditions the bacterial enzyme, aerobic dehydrogenase
transfers electrons or protons to oxygen.
+ Once oxygen gets utilized by the aerobic organisms and an anaerobic
environment is attained, methylene blue [redox indicator] acts as an
electron acceptor and gets reduced to leucomethylene blue.
» The metabolic activity of the aerobic microorganism is reflected by the
reduction of methylene blue to leucomethylene blue.
+ The test is based on rinsing the mouth with sterile milk which dislodges
the micro-organisms and also produces a substrate for their further
metabolism. The formation of leucomthylene blue can be easily
cause of the white color of ie
© o
ula N, Arun A, Mythri H. Caties Activily s. Research and Reviews:
naar of Bepta]
ps] ippt.com
+ Conclusion
* Clinical variables especially past caries experience,
bacterial levels, sociodemographic variables are most
significant predictors of future dental caries
development.
* Caries risk assessment is goal of practitioners to
establish more efficient dental care delivery system.
55
fppt.com
* Clinical variables especially past caries experience,
bacterial levels, sociodemographic variables are most
significant predictors of future dental caries
development.
* Caries risk assessment is goal of practitioners to
establish more efficient dental care delivery system.
55
fppt.com
+ . .
“ Bibliography
Caries-risk Assessment and Management for Infants, Children, and Adolescents.
REFERENCE MANUAL V40/N O6 18/19.
Pediatric Dentistry Infacy through Adolescence by Casamasimo p, Field H. 5th edition.
Per Axelson. Diagnosis and risk predicion of dental caries.
Texbook of Pediatric Dentistry By Nikhil Marwah. Jaypee Brothers Publication. 3rd edition.
S. Uma Maheswari, Jacob Raja1, Arvind Kumar, R. Gnana Seelan. Caries management by
risk assessment: A review on current strategies for caries prevention and management.
Journal of Pharmacy and Bioallied Sciences August 2015 Vol 7 Supplement 2.
Nemmarugommula N, Arun A, Mythri H. Caries Activity Tests. Research and Reviews:
Journal of Dental Sciences 2013.
Soben Peter; Essential of Preventive And Community Dentistry;3rd & 4th ed.
D. Bratthall, G Hansel Petersson, JR Stjernswärd. Cariogram, Internet Version 2.01, April 2,
2004.
Nagaraj and Vishnani: Cariogram .A caries risk prediction software. International Journal of
Scientific Study .January 2014.Vol 1.Issue 4.
Bratthall D, Hansel Petersson G. Cariogram a multifactorial risk assessment model for a
multifactorial disease. Community Dent Oral Epidemiol. 2005 Aug;33(4):256-64.
ee © ©
y 2 9 i
— a + to fpptcom
“ Bibliography
Caries-risk Assessment and Management for Infants, Children, and Adolescents.
REFERENCE MANUAL V40/N O6 18/19.
Pediatric Dentistry Infacy through Adolescence by Casamasimo p, Field H. 5th edition.
Per Axelson. Diagnosis and risk predicion of dental caries.
Texbook of Pediatric Dentistry By Nikhil Marwah. Jaypee Brothers Publication. 3rd edition.
S. Uma Maheswari, Jacob Raja1, Arvind Kumar, R. Gnana Seelan. Caries management by
risk assessment: A review on current strategies for caries prevention and management.
Journal of Pharmacy and Bioallied Sciences August 2015 Vol 7 Supplement 2.
Nemmarugommula N, Arun A, Mythri H. Caries Activity Tests. Research and Reviews:
Journal of Dental Sciences 2013.
Soben Peter; Essential of Preventive And Community Dentistry;3rd & 4th ed.
D. Bratthall, G Hansel Petersson, JR Stjernswärd. Cariogram, Internet Version 2.01, April 2,
2004.
Nagaraj and Vishnani: Cariogram .A caries risk prediction software. International Journal of
Scientific Study .January 2014.Vol 1.Issue 4.
Bratthall D, Hansel Petersson G. Cariogram a multifactorial risk assessment model for a
multifactorial disease. Community Dent Oral Epidemiol. 2005 Aug;33(4):256-64.
ee © ©
y 2 9 i
— a + to fpptcom
“Part Il
+ Introduction
“ Importance of diagnosis
«+ Criteria for diagnosis
+ Traditional Methods
Recent Advances
“ Conclusion
+ Bibliography
Fr
WS!
57
fppt.com
+ Introduction
“ Importance of diagnosis
«+ Criteria for diagnosis
+ Traditional Methods
Recent Advances
“ Conclusion
+ Bibliography
Fr
WS!
57
fppt.com
* INTRODUCTION
* Diagnosis is derived from Greek word ‘dia’ means- by
and ‘gnosis’ means knowledge.
« Dental caries is the most common disease in the world.
+ Diagnosis is the process of identifying a disease by its
signs and symptoms and results of various diagnostic
procedure.
* The conclusion reached by this process is also called as
diagnosis.
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nas de Almeida Rodrigues and Ad: jan En: 1 AS 12). Traditional and Novel Caries58
¿Conte oral roach to Dental -YuLi PEd.), ISBN: 978-953-51-
porary Approach to Dental Garies,Dr. Miñg-YuLiEd.) >
* Diagnosis is derived from Greek word ‘dia’ means- by
and ‘gnosis’ means knowledge.
« Dental caries is the most common disease in the world.
+ Diagnosis is the process of identifying a disease by its
signs and symptoms and results of various diagnostic
procedure.
* The conclusion reached by this process is also called as
diagnosis.
Oo.
o © ( O!
nas de Almeida Rodrigues and Ad: jan En: 1 AS 12). Traditional and Novel Caries58
¿Conte oral roach to Dental -YuLi PEd.), ISBN: 978-953-51-
porary Approach to Dental Garies,Dr. Miñg-YuLiEd.) >
* Objectives of caries diagnosis are to identify those
lesions that require surgical treatment, those that require
nonsurgical (restorative) treatment, and those persons
who are at high risk for developing carious lesions.
68
ne
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi (2012). Traditional and Novel
‘Caries Detectj lethods, Contemporary Approach to Dental Garies, Dr. Ming-Yu Li (Ed.), ISBN: 978-
> 959-51,0305-9, Ce)
© 59
gen a, O fpptcom
lesions that require surgical treatment, those that require
nonsurgical (restorative) treatment, and those persons
who are at high risk for developing carious lesions.
68
ne
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi (2012). Traditional and Novel
‘Caries Detectj lethods, Contemporary Approach to Dental Garies, Dr. Ming-Yu Li (Ed.), ISBN: 978-
> 959-51,0305-9, Ce)
© 59
gen a, O fpptcom
“ IMPORTANCE OF DIAGNOSIS
* Itis self evident that before preventive means can be intelligently
instituted or before curative or restorative procedures can be
restored to, it is first necessary to make a thorough diagnosis of a
case.
+ The examination of the patient is, then, an important procedure and
should be considered carefully and thoroughly.
+ It should include not only a close inspection of the teeth and
supporting structures, but also general inspection of patient.
=, or
affi Bini Jonas de Almeida Rodíígues and Adri i (2012). Traditional and Novel
ods, Contemporary Approach to Dental Sp" Ming-Yu Li (Ed.), ISBN: 978- 60
ps] {ppt.com
* Itis self evident that before preventive means can be intelligently
instituted or before curative or restorative procedures can be
restored to, it is first necessary to make a thorough diagnosis of a
case.
+ The examination of the patient is, then, an important procedure and
should be considered carefully and thoroughly.
+ It should include not only a close inspection of the teeth and
supporting structures, but also general inspection of patient.
=, or
affi Bini Jonas de Almeida Rodíígues and Adri i (2012). Traditional and Novel
ods, Contemporary Approach to Dental Sp" Ming-Yu Li (Ed.), ISBN: 978- 60
ps] {ppt.com
1.
2.
3.
% CRITERIA FOR DIAGNOSIS
For a robust gold standard 3 criteria should be fulfilled
Reproducible
Reflect the patho-anatomical appearance
Be independent of the diagnostic tests under assessment
According to PITTS(1997)the ideal method for diagnosis of carious
lesions would be non-invasive and provide simple, reliable, valid,
sensitive, specific, and be based on biologic processes directly
related to the carious process
°
3 ( )
0 © Ce)
, Jonas de Almeida Rodrigues and Adria! si (2012). Traditional and Novel
61
thods, conte parar Approach: toi le Cari fr. Yu Li (Ed.), ISBN: 978-
= u 963-514-0306 Sch. LE" {ppt.com
2.
3.
% CRITERIA FOR DIAGNOSIS
For a robust gold standard 3 criteria should be fulfilled
Reproducible
Reflect the patho-anatomical appearance
Be independent of the diagnostic tests under assessment
According to PITTS(1997)the ideal method for diagnosis of carious
lesions would be non-invasive and provide simple, reliable, valid,
sensitive, specific, and be based on biologic processes directly
related to the carious process
°
3 ( )
0 © Ce)
, Jonas de Almeida Rodrigues and Adria! si (2012). Traditional and Novel
61
thods, conte parar Approach: toi le Cari fr. Yu Li (Ed.), ISBN: 978-
= u 963-514-0306 Sch. LE" {ppt.com
+ It should also be affordable, acceptable, and allow early
implementation in both clinical practice and research
settings.
* Its use should promote informed and appropriate
preventive treatment decisions, enhancing long term oral
health.
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implementation in both clinical practice and research
settings.
* Its use should promote informed and appropriate
preventive treatment decisions, enhancing long term oral
health.
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“ TRADITIONAL METHODS
* Meticulous clinical examination
* Tactile examination
+ Radiographic examination
« Tooth separation
« Dental floss
or
3
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, Contemporarf Approach to Del Dr. g-YuLi jEc.), ISBN: 978-953-51-
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* Meticulous clinical examination
* Tactile examination
+ Radiographic examination
« Tooth separation
« Dental floss
or
3
o © o
nas de Almeida Rodrigues and Adrian Lussi (2012). Traditional and Novel Caries53
, Contemporarf Approach to Del Dr. g-YuLi jEc.), ISBN: 978-953-51-
te Enr Pe a fpptcom
Meticulous clinical examination
+ Careful examination of the teeth under clean and dry
conditions using good illumination may reveal visual
signs of caries like
1. Brownish discoloration of pit and fissure
2. Opacity beneath pit and fissures or marginal ridges
3. Frank cavitation of the tooth surface —
or
- £ 5 10 ve © i
deff À view of Dental Caries Detection Technologies. PennWell
ate as OL TO
+ Careful examination of the teeth under clean and dry
conditions using good illumination may reveal visual
signs of caries like
1. Brownish discoloration of pit and fissure
2. Opacity beneath pit and fissures or marginal ridges
3. Frank cavitation of the tooth surface —
or
- £ 5 10 ve © i
deff À view of Dental Caries Detection Technologies. PennWell
ate as OL TO
+ This method is based on a combination of light, mirror, and
gentle probing and is used in most epidemiologic surveys .
« Caries is diagnosed if the tooth meets the American dental
association criteria of softened enamel that catches the
explorer and resists its removal.
« Or allow the explorer to penetrate proximal surfaces under
moderate to firm probing pressure.
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3
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r. -YWLi YEd.), ISBN: 978-953-51-
Yu LME ;
ppt.com
gentle probing and is used in most epidemiologic surveys .
« Caries is diagnosed if the tooth meets the American dental
association criteria of softened enamel that catches the
explorer and resists its removal.
« Or allow the explorer to penetrate proximal surfaces under
moderate to firm probing pressure.
os
3
o © ( O!
LUSS: (2012). Traditional and Novel Cariesó5
r. -YWLi YEd.), ISBN: 978-953-51-
Yu LME ;
ppt.com
RADIOGRAPHIC EXAMINATION
+ Conventional, intraoral periapical and bitewing
radiographs are employed for diagnosis of dental
caries.
Bitewing radiographs have more diagnostic value because
* — Interproximal caries
* Recurrent caries below proximal restoration
* Both maxilla and mandible in one film
OÍ
2,
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s F Lussi A, Traditional and Novel Caries Dei eçion Methods. Chapter - March 66
9 A | 2012 PE ao fpptcom
+ Conventional, intraoral periapical and bitewing
radiographs are employed for diagnosis of dental
caries.
Bitewing radiographs have more diagnostic value because
* — Interproximal caries
* Recurrent caries below proximal restoration
* Both maxilla and mandible in one film
OÍ
2,
oO © ( 5)
s F Lussi A, Traditional and Novel Caries Dei eçion Methods. Chapter - March 66
9 A | 2012 PE ao fpptcom
Advantages |
» Discloses « Accuracy-
inaccessible sites Angulation, exposure
* Depth of lesion timing, processing.
« Noninvasive « 2 Dimensional
« Record purpose « Does not reveal
earliest stage of
caries
+ Differentiate- caries,
fracture/ cervical
burnout
« Observer bias
yo" we ey L
Lussi A. Traditional and Novel ae Methods. Chapter - March 67
0 ~~ W204 O
L La tpptcom
» Discloses « Accuracy-
inaccessible sites Angulation, exposure
* Depth of lesion timing, processing.
« Noninvasive « 2 Dimensional
« Record purpose « Does not reveal
earliest stage of
caries
+ Differentiate- caries,
fracture/ cervical
burnout
« Observer bias
yo" we ey L
Lussi A. Traditional and Novel ae Methods. Chapter - March 67
0 ~~ W204 O
L La tpptcom
TOOTH SEPARATION
+ Temporary elective tooth separation to detect the
approximal smooth surface caries.
* orthodontic elastic separator can be applied for 2-3 days
around the contact areas of approximal surfaces.
200 o
Dine. ( Lussi A, Traditional and Novel Caries Detecidn Methods. Chapter - March 68
y + E] ~ O. Y „2012 = LA. fppt.com
+ Temporary elective tooth separation to detect the
approximal smooth surface caries.
* orthodontic elastic separator can be applied for 2-3 days
around the contact areas of approximal surfaces.
200 o
Dine. ( Lussi A, Traditional and Novel Caries Detecidn Methods. Chapter - March 68
y + E] ~ O. Y „2012 = LA. fppt.com
TITLE AUTHOR LO AIM MATERIAL AND CONCLUS
Ss E METHODODOLGY ION
JOURNA
E
The NovaesT lla toinvestigate The proximal spaces biological
influence of F, the influence between the posterior interdental
interdental Matos,Ce of interdental primary teeth (n = 344) of spacing
spacing on libertp, spacing on 76 children (4-12 years old) does not
the Braga M, the were evaluated before and influence
detection of Mendes performance after temporary separation. the
proximal E of proximal Stainless steel strips with performance
caries Brazilian caries different standardized eof
lesions in Oral detection thicknesses were used to proximal
primary Research methods in measure the presence of caries
teeth. . Aug primary biological spacing and the detection
2012 molars. spacing obtained after methods in
temporary separation with primary
orthodontic rubber rings. molars,
First, the presence of and
proximal caries lesions was temporary
assessed by visual tooth
inspection, bitewing separation
radiographs and a pen-type provides
lacar fhinracranra rlawiroa enarinn
Ss E METHODODOLGY ION
JOURNA
E
The NovaesT lla toinvestigate The proximal spaces biological
influence of F, the influence between the posterior interdental
interdental Matos,Ce of interdental primary teeth (n = 344) of spacing
spacing on libertp, spacing on 76 children (4-12 years old) does not
the Braga M, the were evaluated before and influence
detection of Mendes performance after temporary separation. the
proximal E of proximal Stainless steel strips with performance
caries Brazilian caries different standardized eof
lesions in Oral detection thicknesses were used to proximal
primary Research methods in measure the presence of caries
teeth. . Aug primary biological spacing and the detection
2012 molars. spacing obtained after methods in
temporary separation with primary
orthodontic rubber rings. molars,
First, the presence of and
proximal caries lesions was temporary
assessed by visual tooth
inspection, bitewing separation
radiographs and a pen-type provides
lacar fhinracranra rlawiroa enarinn
DENTAL FLOSS
« Dental floss is sawed through the contact areas between
the teeth.
« Ifit frays or shreds then it is a sign of proximal caries.
ma OR de Almeida Rodrigues and an Lussi (2012). Traditional and Novel Caries/0
, Contemporal roachito Del ir. "YufLi (Ed.), ISBN: 978-953-51-
y ~ di nap a ar > —-— À g-YuLi JE ) fpptcom
« Dental floss is sawed through the contact areas between
the teeth.
« Ifit frays or shreds then it is a sign of proximal caries.
ma OR de Almeida Rodrigues and an Lussi (2012). Traditional and Novel Caries/0
, Contemporal roachito Del ir. "YufLi (Ed.), ISBN: 978-953-51-
y ~ di nap a ar > —-— À g-YuLi JE ) fpptcom
“ RECENT ADVANCES
9.
oO A Se
Xeroradiography
Digital Subtraction radiography
Fiber optic transillumination
Digital fiberoptic transillumination
Diagnodent
Electrical caries monitor (ECM)
Quantitative laser fluorescence
Ultrasonic imaging
Cone beam computated tomography (CBCT)
10. Radiovisuography (RVG)
11. Optical coherence tomography
12. Caries detector dyes
71
fppt.com
9.
oO A Se
Xeroradiography
Digital Subtraction radiography
Fiber optic transillumination
Digital fiberoptic transillumination
Diagnodent
Electrical caries monitor (ECM)
Quantitative laser fluorescence
Ultrasonic imaging
Cone beam computated tomography (CBCT)
10. Radiovisuography (RVG)
11. Optical coherence tomography
12. Caries detector dyes
71
fppt.com
1. XERORADIOGRAPHY
* Invented & first used by engineer Dr. Robert
C. McMaster in 1950.
« Highly electrostatic imaging technique
+ Aphoto conductive plate is electrically
charged and this plate is coated with a layer of
selenium and is placed in a light proof
cassette and this is placed in patients mouth
and x-ray exposed.
EN
ı 0
te SADA O
Dini. 6 Lussi A. Traditional and Novel Caries Deteción Methods. Chapter - March 72
\ » 2012: Pe
y + F. ~ BA Fr u LEE Q fppt.com
* Invented & first used by engineer Dr. Robert
C. McMaster in 1950.
« Highly electrostatic imaging technique
+ Aphoto conductive plate is electrically
charged and this plate is coated with a layer of
selenium and is placed in a light proof
cassette and this is placed in patients mouth
and x-ray exposed.
EN
ı 0
te SADA O
Dini. 6 Lussi A. Traditional and Novel Caries Deteción Methods. Chapter - March 72
\ » 2012: Pe
y + F. ~ BA Fr u LEE Q fppt.com
The latent image that is formed on photoconductive plate
is converted in to a positive image by a process known
as development in a processor unit.
Here the image is developed using a liquid toner.
The toner image on the plate surface is then dried and
lifted off the plate by means of transparent adhesive
tape.
Lamination of the tape to a translucent backing material
fixes the image which is now ready to view.
Oo.
3
o © ( O!
i Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 73
o, mh 20126 GE. ao fpptcom
is converted in to a positive image by a process known
as development in a processor unit.
Here the image is developed using a liquid toner.
The toner image on the plate surface is then dried and
lifted off the plate by means of transparent adhesive
tape.
Lamination of the tape to a translucent backing material
fixes the image which is now ready to view.
Oo.
3
o © ( O!
i Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 73
o, mh 20126 GE. ao fpptcom
|« Advantages
— Edge enhancement
— Less radiation exp.
— No wet processing
— No accidental film
exposure
— No special room
required
« Disadvantages
— Expensive
— Discomfort
because of electric
charge
7
4
ippt.com
— Edge enhancement
— Less radiation exp.
— No wet processing
— No accidental film
exposure
— No special room
required
« Disadvantages
— Expensive
— Discomfort
because of electric
charge
7
4
ippt.com
2. DIGITAL SUBTRACTION RADIOGRAPHY
* Introduced by Richard Webber
« Digitization- taking a picture of the radiograph using
high quality camera.
« This is fed to a computer imaging device called digitizer
75
{ppt.com
* Introduced by Richard Webber
« Digitization- taking a picture of the radiograph using
high quality camera.
« This is fed to a computer imaging device called digitizer
75
{ppt.com
« Two standardized radiographs produced with identical
exposure geometry are used.
« The first one is called the “reference image” and the
subsequent images are taken for comparison.
+ The reference image is displayed on the screen over
which the subsequent images are superimposed
+ The difference between the original and subsequent
images can be seen as dark areas.
Oo.
3
o © ( O!
Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 76
O. zn n_ O PA
exposure geometry are used.
« The first one is called the “reference image” and the
subsequent images are taken for comparison.
+ The reference image is displayed on the screen over
which the subsequent images are superimposed
+ The difference between the original and subsequent
images can be seen as dark areas.
Oo.
3
o © ( O!
Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 76
O. zn n_ O PA
« Advantage * Disadvantages
— Superior to — Expensive
conventional
radiography
— Approximal caries
visualized better
| on
> 3 q
Dini E i Lussi A. Traditional and Novel = cion Methods. Chapter - March 77
> 201
PR Ba On
LA. {ppt.com
— Superior to — Expensive
conventional
radiography
— Approximal caries
visualized better
| on
> 3 q
Dini E i Lussi A. Traditional and Novel = cion Methods. Chapter - March 77
> 201
PR Ba On
LA. {ppt.com
TITLE
To assess
the one-
year
outcome of
glass-
ionomer
cement
(GIC)
restorations
with partial
carious
dentin
removal in
primary
molars
using digital
subtraction
radiographs
AUTHOR LO AIM
E
JOURNA
L
Phongha
nyudha A,
Ruangdit
bc,
Pornpras
ertsuk-S,
Oral
Health &
Preventiv
e
Dentistry.
2017
E
MATERIAL AND
METHODODOLGY
To assess the Children ages 6-8 years
one-year were recruited. Forty-
outcome of nine primary molars with
glass- deep carious lesions
ionomer were studied. The
cement (GIC) carious dentin was
restorations removed at the
with partial dentoenamel junction
carious (DEJ) and restored with
dentin GIC. Digital radiographs
removal in were taken immediately
primary after restoration, and at 6
molars using and 12 months after
digital restoration.
subtraction
radiographs.
CONCLUSIO
N
Using digital
subtraction
radiographs,
GIC
restorations
with partial
carious dentin
removal in
primary
molars
showed a high
potential for
dentin
remineralisatio
n after 1 year.
To assess
the one-
year
outcome of
glass-
ionomer
cement
(GIC)
restorations
with partial
carious
dentin
removal in
primary
molars
using digital
subtraction
radiographs
AUTHOR LO AIM
E
JOURNA
L
Phongha
nyudha A,
Ruangdit
bc,
Pornpras
ertsuk-S,
Oral
Health &
Preventiv
e
Dentistry.
2017
E
MATERIAL AND
METHODODOLGY
To assess the Children ages 6-8 years
one-year were recruited. Forty-
outcome of nine primary molars with
glass- deep carious lesions
ionomer were studied. The
cement (GIC) carious dentin was
restorations removed at the
with partial dentoenamel junction
carious (DEJ) and restored with
dentin GIC. Digital radiographs
removal in were taken immediately
primary after restoration, and at 6
molars using and 12 months after
digital restoration.
subtraction
radiographs.
CONCLUSIO
N
Using digital
subtraction
radiographs,
GIC
restorations
with partial
carious dentin
removal in
primary
molars
showed a high
potential for
dentin
remineralisatio
n after 1 year.
3. FIBEROPTIC TRANSILLUMINATION
+ Fiber optic transillumination has been designed for
caries detection by FRIEDMAN and MARCUS in 1970.
« When teeth are examined with a fiberoptic light source ,
caries appears as a dark shadow.
ürü YO i. Recen thods far Diagnosis of Dental 79
spy Meandros Medp ty 2018; 193 . ÖL ( ) pen
+ Fiber optic transillumination has been designed for
caries detection by FRIEDMAN and MARCUS in 1970.
« When teeth are examined with a fiberoptic light source ,
caries appears as a dark shadow.
ürü YO i. Recen thods far Diagnosis of Dental 79
spy Meandros Medp ty 2018; 193 . ÖL ( ) pen
Dini
« Advantage .
— Noninvasive
— No radiation
hazards
— Acceptance of
patient
— Useful in patients
with crowding
5 20 \e
> Disadvantages _
— Observer bias
— No permanent
record of findings
— Accessibility to
place probe
(e)
©
, Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 80
( > 20127
#. - 2) as ¿3
fppt.com
« Advantage .
— Noninvasive
— No radiation
hazards
— Acceptance of
patient
— Useful in patients
with crowding
5 20 \e
> Disadvantages _
— Observer bias
— No permanent
record of findings
— Accessibility to
place probe
(e)
©
, Lussi A. Traditional and Novel Caries ecion Methods. Chapter - March 80
( > 20127
#. - 2) as ¿3
fppt.com
4. DIGITAL FIBEROPTIC TRANSILLUMINATION
* This is a digitized and computed version of the FOTI.
+ DIFOTI can also be used to detect fractures, cracks, and
secondary caries around restorations.
+ DIFOTI uses white light to trans illuminate each tooth
and to instantly create high-resolution digital images of
the tooth.
„= En
erging technolagieblor didgnosis ot ella ies: The road so far. J. Appl. Phys. Jun 2009
81
~ 0. Zr Zn © 4 ao fpptcom
* This is a digitized and computed version of the FOTI.
+ DIFOTI can also be used to detect fractures, cracks, and
secondary caries around restorations.
+ DIFOTI uses white light to trans illuminate each tooth
and to instantly create high-resolution digital images of
the tooth.
„= En
erging technolagieblor didgnosis ot ella ies: The road so far. J. Appl. Phys. Jun 2009
81
~ 0. Zr Zn © 4 ao fpptcom
Itis based on the principle that carious tooth tissue scatters and
absorbs more light than surrounding healthy tissue.
The light is then directed through the mouthpiece to a miniature
electronic charge coupled device CCD camera in the handpiece.
The camera digitally images the light emerging from either the
smooth surface opposite the illuminated surface or the occlusal
surface.
These images are displayed on a computer monitor in real time and
stored on the hard drive for easy retrieval for comparative review of
images over time.
a
2 3
o © ©
* Lussi A. Traditional and Novel = leçion Methods. Chapter - March 82
de 201
~ 2) E a
= fppt.com
absorbs more light than surrounding healthy tissue.
The light is then directed through the mouthpiece to a miniature
electronic charge coupled device CCD camera in the handpiece.
The camera digitally images the light emerging from either the
smooth surface opposite the illuminated surface or the occlusal
surface.
These images are displayed on a computer monitor in real time and
stored on the hard drive for easy retrieval for comparative review of
images over time.
a
2 3
o © ©
* Lussi A. Traditional and Novel = leçion Methods. Chapter - March 82
de 201
~ 2) E a
= fppt.com
5. Diagnodent
laser auto fluorescence technology
instead of using blue light it uses red light of wavelength 655nm.
This red light identifies caries as having an increased fluorescence
over sound tooth, whereas blue light highlights caries as a reduced
fluorescence compared to sound tooth.
Areading is provided on a digital display accompanied by an audible
tone
Higher the digital reading and pitch of the audible tone, greater the
potential for caries involvement of the dentinoenamel junction and
underlying dentine
©
à Oo € )
o © fe}
Çürük Tarn Yóntemieri, Recent Methods far Diagnosis of Dental 83
Meandros Med'Dent J 2018;19:1:8 5 ( )
~ PAE = fpptcom
laser auto fluorescence technology
instead of using blue light it uses red light of wavelength 655nm.
This red light identifies caries as having an increased fluorescence
over sound tooth, whereas blue light highlights caries as a reduced
fluorescence compared to sound tooth.
Areading is provided on a digital display accompanied by an audible
tone
Higher the digital reading and pitch of the audible tone, greater the
potential for caries involvement of the dentinoenamel junction and
underlying dentine
©
à Oo € )
o © fe}
Çürük Tarn Yóntemieri, Recent Methods far Diagnosis of Dental 83
Meandros Med'Dent J 2018;19:1:8 5 ( )
~ PAE = fpptcom
+ Diagnodent unit comprises a pen like device with a
detachable tips of different diameter
+ The central core fiber running trough the pen grip and
the tip is the red laser, with surrounding fiber being
detectors to measure the returned fluorescence light
from the tooth surface
as, í Lussi A. Traditional and Novel Caries Defecian Methods. Chapter - March
D. Pizzen 2
detachable tips of different diameter
+ The central core fiber running trough the pen grip and
the tip is the red laser, with surrounding fiber being
detectors to measure the returned fluorescence light
from the tooth surface
as, í Lussi A. Traditional and Novel Caries Defecian Methods. Chapter - March
D. Pizzen 2
TABLE 2 - Ranked scale used in the DIAGNOdent ex-
amination.
Score Range | Interpretation
No demineralization
or demineralization
limited to the outer
half of enamel
HI <15
Demineralization
extending into the
H2 15-19 | inner half of enamel
up to the upper third
| of dentin
Demineralization
H3 >19 extending into deeper
dentin
= above 25 are considered to suggest a high probability
or
erging technologies for diagnosis 5 in ARBs: No so far. J. Appl. Phys. @n
N {i es © KA PE, tpptcom
amination.
Score Range | Interpretation
No demineralization
or demineralization
limited to the outer
half of enamel
HI <15
Demineralization
extending into the
H2 15-19 | inner half of enamel
up to the upper third
| of dentin
Demineralization
H3 >19 extending into deeper
dentin
= above 25 are considered to suggest a high probability
or
erging technologies for diagnosis 5 in ARBs: No so far. J. Appl. Phys. @n
N {i es © KA PE, tpptcom
TITLE
Evaluation
of Accuracy
of
DIAGNOde
ntin
Diagnosis
of Primary
and
Secondary
Caries in
Compariso
nto
Convention
al Methods
AUTHOR LO AIM
Ss
JOURNA
L
Nokhbatol
foghahaie
H et.al.
Journal of
Lasers in
Medical
Sciences
Volume 4
Number 4
Autumn
2013
E
la
comparative
review of the
efficiency of
DIAGNOdent
in
comparison
to visual
methods and
radiographic
methods in
the
diagnostic of
teeth occlusal
surfaces
MATERIAL AND
METHODODOLGY
Search of PubMed,
Google Scholar
electronic resources
was performed in
order
to find clinical trials in
English in the period
between 1998 and
2013. Full texts of
only
35 articles were
available.
Conclusion:
Considering the
CONCLUSION
Considering the
sensitivity and
specificity
reported in the
different studies,
it
seems that
DIAGNOdent is
an appropriate
modality for
caries detection
asa
complementary
method beside
other methods
and its use alone
to obtain
treatment plan is
not enough.
Evaluation
of Accuracy
of
DIAGNOde
ntin
Diagnosis
of Primary
and
Secondary
Caries in
Compariso
nto
Convention
al Methods
AUTHOR LO AIM
Ss
JOURNA
L
Nokhbatol
foghahaie
H et.al.
Journal of
Lasers in
Medical
Sciences
Volume 4
Number 4
Autumn
2013
E
la
comparative
review of the
efficiency of
DIAGNOdent
in
comparison
to visual
methods and
radiographic
methods in
the
diagnostic of
teeth occlusal
surfaces
MATERIAL AND
METHODODOLGY
Search of PubMed,
Google Scholar
electronic resources
was performed in
order
to find clinical trials in
English in the period
between 1998 and
2013. Full texts of
only
35 articles were
available.
Conclusion:
Considering the
CONCLUSION
Considering the
sensitivity and
specificity
reported in the
different studies,
it
seems that
DIAGNOdent is
an appropriate
modality for
caries detection
asa
complementary
method beside
other methods
and its use alone
to obtain
treatment plan is
not enough.
6. ELECTRICAL CARIES MONITOR
+ The Conductance measurement were made between a
specially designed probe tip and a hand held connector
« The frequency of the device was of 25 Hz which was
able to produce a low current of 3 micro amperes
* The machine displayed a frowning face that indicated
extensive demineralization or smiling face indicated a
sound site
a
3
fe AO (a)
Di Ki el Çürük Tanı Yöntemleri. Rec: etho laggiagnosis of Dental 87
PR. j nis)
En
Le fppt.com
+ The Conductance measurement were made between a
specially designed probe tip and a hand held connector
« The frequency of the device was of 25 Hz which was
able to produce a low current of 3 micro amperes
* The machine displayed a frowning face that indicated
extensive demineralization or smiling face indicated a
sound site
a
3
fe AO (a)
Di Ki el Çürük Tanı Yöntemleri. Rec: etho laggiagnosis of Dental 87
PR. j nis)
En
Le fppt.com
« The main disadvantage of this ECM is difficult
measuring procedure.
« Enamel cracks and hypo mineralized areas can give
false positive readings
88
fppt.com
measuring procedure.
« Enamel cracks and hypo mineralized areas can give
false positive readings
88
fppt.com
7. QUANTITATIVE LASER FLOURESENCE
+ BENNEDICT-first person to observe the fluorescence in human
teeth
« He noted a differential fluorescence between sound and carious
enamel,
* The visible light with in the blue green region has been used for the
development of a sensitive method for the detection of caries at an
early stage
* The tooth is illuminated with a broad beam of a blue green light of
488nm wave length from an argon ion laser.
OS
9 à
o © ( 5)
A, Raisingahi D,/Sharma M.RECE! NT A ES IN DETECTION AND 89
AL CARIES7yournal of Evolution ofiMedical arid DegtalSciences/Valume
+ a ¿0 Le LR
FA OE IATA fpptcom
+ BENNEDICT-first person to observe the fluorescence in human
teeth
« He noted a differential fluorescence between sound and carious
enamel,
* The visible light with in the blue green region has been used for the
development of a sensitive method for the detection of caries at an
early stage
* The tooth is illuminated with a broad beam of a blue green light of
488nm wave length from an argon ion laser.
OS
9 à
o © ( 5)
A, Raisingahi D,/Sharma M.RECE! NT A ES IN DETECTION AND 89
AL CARIES7yournal of Evolution ofiMedical arid DegtalSciences/Valume
+ a ¿0 Le LR
FA OE IATA fpptcom
» When the teeth are illuminated with high intensity blue
light, the resultant auto-fluorescence of enamel is
detected by an intraoral camera which produces a
fluorescent image.
* The emitted fluorescence has a direct relationship with
the mineral content of the enamel.
« Thus, the intensity of the tooth image at a demineralised
area is darker than the sound area. Fluorescence Example
©
9
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iA, Raisingani Dy Sharma M. RECENT AL ES IN DETECTION AND 90
cal arid DeptalSciences/Volume
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fppt.com
light, the resultant auto-fluorescence of enamel is
detected by an intraoral camera which produces a
fluorescent image.
* The emitted fluorescence has a direct relationship with
the mineral content of the enamel.
« Thus, the intensity of the tooth image at a demineralised
area is darker than the sound area. Fluorescence Example
©
9
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iA, Raisingani Dy Sharma M. RECENT AL ES IN DETECTION AND 90
cal arid DeptalSciences/Volume
pay
fppt.com
* Incipient as well developed caries in enamel were
clearly visible as dark areas which contrasted with the
fluorescent surrounding
* Microradiographic analysis of the longitudinally ground
section of the tooth confirmed that the dark area in the
laser fluorescence corresponded to a demineralization of
the enamel
* This can also be used to image plaque and calculus, and
therefore be useful in identifying active caries.
or
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iA, Raisingani D, Sharma M. RECENT Al ES IN DETECTION AND 9
AL CARIESEournal bl Evolul ical arid 3 Dental Sciences/Volume
annad: OR A1 A
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clearly visible as dark areas which contrasted with the
fluorescent surrounding
* Microradiographic analysis of the longitudinally ground
section of the tooth confirmed that the dark area in the
laser fluorescence corresponded to a demineralization of
the enamel
* This can also be used to image plaque and calculus, and
therefore be useful in identifying active caries.
or
2 (
o © Ce)
iA, Raisingani D, Sharma M. RECENT Al ES IN DETECTION AND 9
AL CARIESEournal bl Evolul ical arid 3 Dental Sciences/Volume
annad: OR A1 A
ippt.com
Technique
o The QLF device consists of the light source and the intraoral camera
o The QLF technique is a 2-stage process. First, an image of the
toothmust be acquired with the intraoral camera (ccd) held in the hand.
o Then, both qualitative and quantitative assessments of mineral loss are
obtained.
o The enhanced contrast between sound and demineralized enamel
enables the clinician to identify areas of concern.
o
jechia. Emerging technologies for disgnosts af d guvieg: The road so far. J. Appl. Phys. Jun 2009
o © o
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RECEI
AL CARIES Journal of voto eM id Degtall§ciences/Volume
un AA A ee By ipptcom
o The QLF device consists of the light source and the intraoral camera
o The QLF technique is a 2-stage process. First, an image of the
toothmust be acquired with the intraoral camera (ccd) held in the hand.
o Then, both qualitative and quantitative assessments of mineral loss are
obtained.
o The enhanced contrast between sound and demineralized enamel
enables the clinician to identify areas of concern.
o
jechia. Emerging technologies for disgnosts af d guvieg: The road so far. J. Appl. Phys. Jun 2009
o © o
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« Advantage
— Early detection of
caries possible- 7
contrast
— Depth of lesion can
be estimated
— No harm to
patient/operator-
visible light
o ©
AL CARIESEounal E Evol
A RN
+ Disadva ntages
(e)
©
iA, Raisingani D, Sharma M. RENTA NGES IN DETECTION AND
— Does not differentiate
between caries &
developmental defects
— Expensive
— Secondary caries with
metal filings can not
be detected
94
ical id Degtal\Sciences/Volume
i Dental
ippt.com
— Early detection of
caries possible- 7
contrast
— Depth of lesion can
be estimated
— No harm to
patient/operator-
visible light
o ©
AL CARIESEounal E Evol
A RN
+ Disadva ntages
(e)
©
iA, Raisingani D, Sharma M. RENTA NGES IN DETECTION AND
— Does not differentiate
between caries &
developmental defects
— Expensive
— Secondary caries with
metal filings can not
be detected
94
ical id Degtal\Sciences/Volume
i Dental
ippt.com
8. ULTRASONIC IMAGING
* Ultrasonic imaging can be used to detect early caries on the smooth
surfaces.
* Here an ultrasonic probe is used to send and receive sound waves from the
surfaces of the tooth.
+ Normal enamel produces -no echoes
Initial white spot lesions - weak surface echoes
cavitated areas -echoes of high amplitude.
* This method may be more sensitive than visual, tactile or radiographic
… method for detecting early lesions.
o
> à
D x = ©
A, Raisingani D, Sharma M. REGENT Al NS IN DETECTION AND 95
u ical Degtaljßciences/valume
rac dara A = ff _ LA
ppt com
* Ultrasonic imaging can be used to detect early caries on the smooth
surfaces.
* Here an ultrasonic probe is used to send and receive sound waves from the
surfaces of the tooth.
+ Normal enamel produces -no echoes
Initial white spot lesions - weak surface echoes
cavitated areas -echoes of high amplitude.
* This method may be more sensitive than visual, tactile or radiographic
… method for detecting early lesions.
o
> à
D x = ©
A, Raisingani D, Sharma M. REGENT Al NS IN DETECTION AND 95
u ical Degtaljßciences/valume
rac dara A = ff _ LA
ppt com
> Ultrasonic system is composed of a transducer (probe) & an ultrasonic
precision thickness gauge.
> The contact transducer is of the right angle type with a 1.5mm tip
contact diameter, 11MHz nominal center frequency with a removable
plexiglass delay tip.
> The delay line tip of the contact transducer is at a right angle so that it
could be inserted or used in restricted height areas.
> These high frequency focused delay line transducers are compatible
with any ultrasonic instrument capable of displaying a return echo at
depths as minute as 0.01 0inches.
+ The useful range is from 0.010 to 0.25 inches approximately.
©
5 Oo
A, Raisingan'D, Sharma M. RECENT ICES IN DETECTION AND
AL CARIES, Journal of Evoluti ical anti Dental Sciences/Volume 96
> > (
06, 2014 mm = fpptcom
precision thickness gauge.
> The contact transducer is of the right angle type with a 1.5mm tip
contact diameter, 11MHz nominal center frequency with a removable
plexiglass delay tip.
> The delay line tip of the contact transducer is at a right angle so that it
could be inserted or used in restricted height areas.
> These high frequency focused delay line transducers are compatible
with any ultrasonic instrument capable of displaying a return echo at
depths as minute as 0.01 0inches.
+ The useful range is from 0.010 to 0.25 inches approximately.
©
5 Oo
A, Raisingan'D, Sharma M. RECENT ICES IN DETECTION AND
AL CARIES, Journal of Evoluti ical anti Dental Sciences/Volume 96
> > (
06, 2014 mm = fpptcom
9. CONE BEAM COMPUTATED
TOMOGRAPHY (CBCT)
+ CBCT also called as dental volumetric tomography, cone-
beam volumetric tomography, dental CT, and cone beam
imaging.
+ Initially developed for angiography in 1982 and subsequently
applied to maxillofacial imaging.
+ The principal feature of CBCT is that multiple planar
projections are acquired by rational scan to produce a
volumetric dataset from which inter-relational images can be
a
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AGI AL CARIES? cuna Evol (cal afid DentalSciences/Volume
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TOMOGRAPHY (CBCT)
+ CBCT also called as dental volumetric tomography, cone-
beam volumetric tomography, dental CT, and cone beam
imaging.
+ Initially developed for angiography in 1982 and subsequently
applied to maxillofacial imaging.
+ The principal feature of CBCT is that multiple planar
projections are acquired by rational scan to produce a
volumetric dataset from which inter-relational images can be
a
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AGI AL CARIES? cuna Evol (cal afid DentalSciences/Volume
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Cone-beam scanners use a 2D digital array providing an area detector
rather than a linear detector as CT does. This is combined with a 3D X-
ray beam with circular collimation so that the resultant beam is in the
shape of a cone, hence the name “cone beam.”
As CBCT requires only a single scan for capturing the necessary data
the time required for CBCT scanning is substantially less (< 30 sec).
This technology has limitations related to the cone beam projection
geometry, detector sensitivity, and contrast resolution that produce
images that lack the clarity and utility of conventional CT images.
98
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rather than a linear detector as CT does. This is combined with a 3D X-
ray beam with circular collimation so that the resultant beam is in the
shape of a cone, hence the name “cone beam.”
As CBCT requires only a single scan for capturing the necessary data
the time required for CBCT scanning is substantially less (< 30 sec).
This technology has limitations related to the cone beam projection
geometry, detector sensitivity, and contrast resolution that produce
images that lack the clarity and utility of conventional CT images.
98
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10. RADIOVISUOGRAPHY (RVG)
* The very first system that was introduced in digital radiography in
dentistry was radiovisiography by Trophy in France in 1987.
* Digital radiography is a method of reproducing a radiographic image
using a technology sensor of solid-state, which are broken into
electronic pieces, and presented and stored as an image using a
computer.
DVANGES be AND ke
al and Deftal£ciences/Volume
= Pr
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* The very first system that was introduced in digital radiography in
dentistry was radiovisiography by Trophy in France in 1987.
* Digital radiography is a method of reproducing a radiographic image
using a technology sensor of solid-state, which are broken into
electronic pieces, and presented and stored as an image using a
computer.
DVANGES be AND ke
al and Deftal£ciences/Volume
= Pr
fppt com
» There are two advanced technologies that create digital images
without an analog precursor;
1. Direct digital images.
2. Semi direct digital images.
+ Direct digital images are acquired using a solid-state sensor.
+ The solid-state sensors are based on charge coupled device (CCD)
and complementary metal oxide semiconductor (CMOS) and
CMOS-active pixel sensor (CMOS-APS) based chips.
« Semidirect digital images are obtained using a phosphor plate
system.
(e)
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IA, ar D,Sharma M. ion cé ES IN DETECTION AND 100
ical 9 Ds als: ciences/Volume
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without an analog precursor;
1. Direct digital images.
2. Semi direct digital images.
+ Direct digital images are acquired using a solid-state sensor.
+ The solid-state sensors are based on charge coupled device (CCD)
and complementary metal oxide semiconductor (CMOS) and
CMOS-active pixel sensor (CMOS-APS) based chips.
« Semidirect digital images are obtained using a phosphor plate
system.
(e)
> 9
o © (o )
IA, ar D,Sharma M. ion cé ES IN DETECTION AND 100
ical 9 Ds als: ciences/Volume
{ppt.com
11. OPTICAL COHERENCE
TOMOGRAPHY
« OCT, creates cross sectional images of biological structures
using differences in the reflection of light
« It was first proposed by Huang et al for imaging the
biological tissue
« OCT uses reflections of near infra-red light to determine not
only the presence of decay but also the depth of caries
progression.
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TOMOGRAPHY
« OCT, creates cross sectional images of biological structures
using differences in the reflection of light
« It was first proposed by Huang et al for imaging the
biological tissue
« OCT uses reflections of near infra-red light to determine not
only the presence of decay but also the depth of caries
progression.
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iA, Raisingahi D, Sharma M. ES IN DETECTION AND 101
AL GARIESOHoumal of Evol edical arid Degtaljßciences/volume
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* OCT uses light wavelength of which dictates the
scattering and therefore the depth of penetration of the
imaging technique
* Most of the OCT techniques described for imaging the
dental tissue have used wavelength 842-1310 nm. this
gives the imaging depth of 0.6 -2mm
i A, Raisingahi D, Sharma M. RECENT ADV ES IN DETECTION AND 102
AL CARIES Journal of Evol Gf Medical and Degtaljßciences/valume
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scattering and therefore the depth of penetration of the
imaging technique
* Most of the OCT techniques described for imaging the
dental tissue have used wavelength 842-1310 nm. this
gives the imaging depth of 0.6 -2mm
i A, Raisingahi D, Sharma M. RECENT ADV ES IN DETECTION AND 102
AL CARIES Journal of Evol Gf Medical and Degtaljßciences/valume
rac data dl => E 2 fpptcom
* OCT is based on the interference of light
« When a light beam is spilt into two and recombined , interference
produces a pattern , the intensity of which is determined by the level
of light in each beam
* OCT systems use super luminescent diodes as a light source , this
type of source produces light with a broad range of wavelength ,each
of which produce it's inference pattern
- The intensity of the interference is a function of scattering caused by
the changes in tissue structures of the tooth
« Variation in scattering measured in relation to the depth from a single
point on the tooth surface is called an A- scan
(5)
2 3
o © ( 5)
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ALCARIESE soulna ef Evoly ledical aña Degtal\Sciences/Valume
PL,
ant, hé dt À tpptcom
« When a light beam is spilt into two and recombined , interference
produces a pattern , the intensity of which is determined by the level
of light in each beam
* OCT systems use super luminescent diodes as a light source , this
type of source produces light with a broad range of wavelength ,each
of which produce it's inference pattern
- The intensity of the interference is a function of scattering caused by
the changes in tissue structures of the tooth
« Variation in scattering measured in relation to the depth from a single
point on the tooth surface is called an A- scan
(5)
2 3
o © ( 5)
iA, Raisingani Dy Sharma M. RECEI TAI ES IN DETECTION AND 103
ALCARIESE soulna ef Evoly ledical aña Degtal\Sciences/Valume
PL,
ant, hé dt À tpptcom
As two beams are produced from a light source
. 1. sample beam
. 2. reference beam
« Sample beam goes into the tooth and scattered according to the nature
of tissue so caries teeth scatters light to a greater extent than sound tooth
structure
+ Reference beam travels to the moveable mirror and reflected back and
recombined with a sample beam
- The recombined reference and sample beam are focused on a photo
detector where any degree of interference between the beams can be
observed
> 3 Q
iA, Raisingahi Dy Sharma M. RECENT A ES IN DETECTION AND 104
AL CARIES) cum? of Evoli ical DE De als: ciences/Volume
an él Ae dt 4 tpptcom
. 1. sample beam
. 2. reference beam
« Sample beam goes into the tooth and scattered according to the nature
of tissue so caries teeth scatters light to a greater extent than sound tooth
structure
+ Reference beam travels to the moveable mirror and reflected back and
recombined with a sample beam
- The recombined reference and sample beam are focused on a photo
detector where any degree of interference between the beams can be
observed
> 3 Q
iA, Raisingahi Dy Sharma M. RECENT A ES IN DETECTION AND 104
AL CARIES) cum? of Evoli ical DE De als: ciences/Volume
an él Ae dt 4 tpptcom
12. CARIES DETECTOR DYES
+ Useful to aid the dentist in differentiation of infected dentin.
* They are non-specific protein dyes that stain the organic
matrix of less mineralized dentin, including normal circum
pulpal dentin and sound dentin in the area of the dentino-
enamel junction.
* Observation of colored dye signifies presence of caries.
+ Various dyes like Procion, calcein, brilliant blue, propylene
e been uséd io detect cn) caries.
iA, Raisingani Dy Sharma M. RECENT A ES IN DETECTION AND 105
AL CARIES oumal of Evoli ical atid Dental5ciences/Volume
rr + ea > E PE, fpptcom
+ Useful to aid the dentist in differentiation of infected dentin.
* They are non-specific protein dyes that stain the organic
matrix of less mineralized dentin, including normal circum
pulpal dentin and sound dentin in the area of the dentino-
enamel junction.
* Observation of colored dye signifies presence of caries.
+ Various dyes like Procion, calcein, brilliant blue, propylene
e been uséd io detect cn) caries.
iA, Raisingani Dy Sharma M. RECENT A ES IN DETECTION AND 105
AL CARIES oumal of Evoli ical atid Dental5ciences/Volume
rr + ea > E PE, fpptcom
Commercial products:
1. SNOOP (Pulpdent) (propylene glycol)(Rs.2100)
2. Seek/Sable Seek(Ultradent)(Rs.653)
3 Caries Detector(Kuraray)(Rs.2149)
4. Caries Finder/Caries Finder G(Danville Materials)
5. Cari-D-Tect (Gresco)
e N ej
iA, Raisingani Dy Sharma M RECENT A NS IN DETECTION AND
4 u ical Degtaljßciences/volume
“ A = ¢ {ppt.com
1. SNOOP (Pulpdent) (propylene glycol)(Rs.2100)
2. Seek/Sable Seek(Ultradent)(Rs.653)
3 Caries Detector(Kuraray)(Rs.2149)
4. Caries Finder/Caries Finder G(Danville Materials)
5. Cari-D-Tect (Gresco)
e N ej
iA, Raisingani Dy Sharma M RECENT A NS IN DETECTION AND
4 u ical Degtaljßciences/volume
“ A = ¢ {ppt.com
13. TERAHERTZ PULSATING IMAGNING
> Uses waves with Terahertz frequency(1012 Hz ) for an
image to be obtained by terahertz irradiation.
+ Object is placed in the path of the beam.
> Itis possible to record terahertz images using CCD
detector.
> De
ag or: - aid |
a
iA, Raisingani DySharma M.RECE! al ¡SES IN DETECTION AND 107
AL GARIESOoumal E Evoll arid Dental Soiences/Volume
FA Ona e > fpptcom
> Uses waves with Terahertz frequency(1012 Hz ) for an
image to be obtained by terahertz irradiation.
+ Object is placed in the path of the beam.
> Itis possible to record terahertz images using CCD
detector.
> De
ag or: - aid |
a
iA, Raisingani DySharma M.RECE! al ¡SES IN DETECTION AND 107
AL GARIESOoumal E Evoll arid Dental Soiences/Volume
FA Ona e > fpptcom
ren enna me iaa poi iria:
‘he TRE ly caren tran FB. NE RIT A Da Tan ern Th AO ÇA m mas NE
A mag a mean Par er ag me ton nee da are Pea Ere un
rm fe nga ant no, gene Ta arg mates poet tangy art bee bee aarp immo Du mate rc
Baan yo. tm rar nr dete
©
2 9 ©
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1A, Raisingani Dy Sharma Mi oe Auges INDETECTIONAND 108
ical
AL CARIES Moumal of Evol DentalSciences/Volume
LAR data ™ ur Lim fpptcom
‘he TRE ly caren tran FB. NE RIT A Da Tan ern Th AO ÇA m mas NE
A mag a mean Par er ag me ton nee da are Pea Ere un
rm fe nga ant no, gene Ta arg mates poet tangy art bee bee aarp immo Du mate rc
Baan yo. tm rar nr dete
©
2 9 ©
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1A, Raisingani Dy Sharma Mi oe Auges INDETECTIONAND 108
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AL CARIES Moumal of Evol DentalSciences/Volume
LAR data ™ ur Lim fpptcom
all
CO, LASER -
Radiation of wavelength - 10.6 um is used.
Philosophy underlying application of carbon dioxide lasers is based on
assumption that subsurface layer of early carious lesions has more organic
content when compared with adjacent sound enamel.
Photo-vaporization by a CO2 laser of this organic material in the incipient
carious lesions will leave a carbonized residue, which appears dark black.
At low power levels & short duration times, inorganic substance of sound
enamel with minimum water content will be much less affected by laser
beam.
29 @
IA, lee DySharma M. oe ES IN DETECTION AND 109
ical á De tal Sciences/Valume
{ppt.com
CO, LASER -
Radiation of wavelength - 10.6 um is used.
Philosophy underlying application of carbon dioxide lasers is based on
assumption that subsurface layer of early carious lesions has more organic
content when compared with adjacent sound enamel.
Photo-vaporization by a CO2 laser of this organic material in the incipient
carious lesions will leave a carbonized residue, which appears dark black.
At low power levels & short duration times, inorganic substance of sound
enamel with minimum water content will be much less affected by laser
beam.
29 @
IA, lee DySharma M. oe ES IN DETECTION AND 109
ical á De tal Sciences/Valume
{ppt.com
< Conclusion
* Itis clear from the above discussion that the differences
in caries presentations and behavior in different
anatomical sites make it unlikely that any one diagnostic
modality will have adequate sensitivity and specificity of
detection of carious lesions for all sites.
« Acombination of diagnostic tools will help us diagnose
lesions earlier and detect failing restorations sooner, all
to avoid more costly, destructive dental procedures and
truly take dentistry into the preventive rather than the
reactive mode.
Oo.
re) ure) © (o)
110
>. A $ o, ur ¿A en ajo tppt.com
* Itis clear from the above discussion that the differences
in caries presentations and behavior in different
anatomical sites make it unlikely that any one diagnostic
modality will have adequate sensitivity and specificity of
detection of carious lesions for all sites.
« Acombination of diagnostic tools will help us diagnose
lesions earlier and detect failing restorations sooner, all
to avoid more costly, destructive dental procedures and
truly take dentistry into the preventive rather than the
reactive mode.
Oo.
re) ure) © (o)
110
>. A $ o, ur ¿A en ajo tppt.com
* Bibliography
Raper HR. Practical clinical preventive dentistry based upon periodic
roentgen ray examinations, J Am Dent Assoc 1925; 112(9):1084-100.
Theodore M.R., Harald O.H, Edward J. S Sturdevant's Art and Science of
operative dentistry 5th Edition Elsevier publication, Chapter
Cariology: The lesions, etiology, prevention and control; pg 65 - 134 3, Holt
RD. Advances in dental public health. Primary Dental Care 2001; 8(3):99-
102.
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi
Traditional and Novel Caries Detection Methods: uploaded 3rd April 2012 by
Jonas Almeida Rodrigues
Ekstrand, K.R.; Ricketts, D.N. & Kidd, E.A. Reproducibility and accuracy of
three methods for assessment of demineralization depth on the occlusal
surface: an in vitro examination. Caries Research. 1997; Vol.31, No.3, pp.
224-231, ISSN 0008-6568
Nyvad, B.; Machiulskiene, V. & Baelum, V. Reliability of a new caries
em differentiating between active and inactive caries lesions.
h. 1999; Vol 133, No.4, à, e) ), PP. 252-260, ISSN a
o. ac US = O {ppt.com
Raper HR. Practical clinical preventive dentistry based upon periodic
roentgen ray examinations, J Am Dent Assoc 1925; 112(9):1084-100.
Theodore M.R., Harald O.H, Edward J. S Sturdevant's Art and Science of
operative dentistry 5th Edition Elsevier publication, Chapter
Cariology: The lesions, etiology, prevention and control; pg 65 - 134 3, Holt
RD. Advances in dental public health. Primary Dental Care 2001; 8(3):99-
102.
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi
Traditional and Novel Caries Detection Methods: uploaded 3rd April 2012 by
Jonas Almeida Rodrigues
Ekstrand, K.R.; Ricketts, D.N. & Kidd, E.A. Reproducibility and accuracy of
three methods for assessment of demineralization depth on the occlusal
surface: an in vitro examination. Caries Research. 1997; Vol.31, No.3, pp.
224-231, ISSN 0008-6568
Nyvad, B.; Machiulskiene, V. & Baelum, V. Reliability of a new caries
em differentiating between active and inactive caries lesions.
h. 1999; Vol 133, No.4, à, e) ), PP. 252-260, ISSN a
o. ac US = O {ppt.com
Bader, J.D.; Shugars, D.A. 4 Bonito, A.J. Systematic reviews of selected dental caries
diagnosis and management methods. Journal of Dental Education. 2001;Vol.65,
No.10, (October), pp. 960-968, ISSN 0022-0337
Pitts, N. "ICDAS” -- an international system for caries detection and assessment being
developed to facilitate caries epidemiology, research and appropriated clinical
management. Community Dental Health. 2004;Vol.21, No.3, (September), pp. 193-
198, ISSN 0256-539X
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi (2012). Traditional
and Novel Caries Detection Methods, Contemporary Approach to Dental Caries, Dr,
Ming-Yu Li (Ed.), ISBN: 978-953-51-0305-9, InTech.
Dis Hekimlidinde Güncel Çürük Tani Yôntemleri. Recent Methods for Diagnosis of
Dental Caries in Dentistry. Meandros Med Dent J 2018;19:1-8
Mital P, Mehta N, Saini A, Raisingani D, Sharma M. RECENT ADVANCES IN
DETECTION AND DIAGNOSIS OF DENTAL CARIES. Journal of Evalution of Medical
and Dental Sciences/Volume 3/Issue 01/ January 06, 2014
12
{ppt.com
diagnosis and management methods. Journal of Dental Education. 2001;Vol.65,
No.10, (October), pp. 960-968, ISSN 0022-0337
Pitts, N. "ICDAS” -- an international system for caries detection and assessment being
developed to facilitate caries epidemiology, research and appropriated clinical
management. Community Dental Health. 2004;Vol.21, No.3, (September), pp. 193-
198, ISSN 0256-539X
Michele Baffi Diniz, Jonas de Almeida Rodrigues and Adrian Lussi (2012). Traditional
and Novel Caries Detection Methods, Contemporary Approach to Dental Caries, Dr,
Ming-Yu Li (Ed.), ISBN: 978-953-51-0305-9, InTech.
Dis Hekimlidinde Güncel Çürük Tani Yôntemleri. Recent Methods for Diagnosis of
Dental Caries in Dentistry. Meandros Med Dent J 2018;19:1-8
Mital P, Mehta N, Saini A, Raisingani D, Sharma M. RECENT ADVANCES IN
DETECTION AND DIAGNOSIS OF DENTAL CARIES. Journal of Evalution of Medical
and Dental Sciences/Volume 3/Issue 01/ January 06, 2014
12
{ppt.com
13
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