cons sheet # 8 - Noran Mostafa

Caries detection
85% of dentist’s work is conservative (crown & bridges).
- Caries decreased ( 50-60%) due to:
1- Fluoridation in water.
2- Using of fissure sealer.
3- Decrease of Mesh treatment.

- Pit and fissure caries has increased up to 84% because bacteria adhere to them causing caries.
- We can classify caries to:
1- Pit &fissure caries.
2- Smooth surface caries.
Or class I,II,III,IV,…
(actually,classII,III,IV,V,VI are smooth surface caries.)

Diagnosis
1- Visual >>cavitations must exist to be detected visually.
2- Blunt explorer with a mirror>>it is important to know if there is stain or no stain, cavity or no cavity. (Not used if there is no cavity).
3- Sharp explorer with a mirror>>if little enamel demineralization was examined using a sharp explorer, it would perforate the surface to the subsurface.
*the most commonly used>>95% of dentists use it, but it is not a very good way.
* is Important if there is a cavity.
*The catch doesn’t always mean caries; maybe there is little demineralization or a big pit, it depends on the type of the fissure
(v-shaped, u-shaped or pulpal).
4- Transillumination>>bioptic light (blue light), when we put it on the tooth it gives a shadow if there is caries.

*it is good for class II&III examination.
*impossible to give detection for pit & fissure caries especially in the enamel (no diagnosis).


5-the radiograph.
a) Peri-apical x-ray.
 Shows the entire tooth including the root
 So clinical crown+root.
 Used if the caries extends to dentine >>radiolucency appears under dentine.
 Gives one third of the total examination >>so we don’t depend on radiographs alone for caries detection.
b) Bitewing x-ray.
 One of the best methods for proximal caries.
 Used for class II and class III.
 Shows the crown only.
**So Peri-apical & Bitewing used for proximal caries and if caries extends to dentine.
** 15-20% of cases: when you open the tooth there is no caries.
** So the most important step is detection of caries.
6-Electronic detector of caries (new).
 It is a small machine, not available in Jordan.
 If the tooth has no cavity, but in the x-ray there is caries reaching dentine>>called occult caries.
Enamel has nothing, no cavity>>but the tooth is bluish in color occlusally (can be seen when you dry the tooth).
 When one volt is applied on one area, if the resistance is:
- >600,000: free area, no caries.
- <250,000: there is caries.
 The general idea about electronic caries detector:
Electrical conductivity composed of microscopic cavity which is composed of demineralized enamel containing saline.


Preventive resin restoration & sealant restoration

1- Preventive resin restoration.
- If caries in enamel only.
( I can make a small cavity in enamel and make any type of filling).
- So if you have a small cavity (pit & fissure related to enamel), clean it and make filling (amalgum, composite or GI),then put fissure sealants for other tissues.
- Used for pediatrics (children) and adults.
2- Sealant restoration.
If we have occult caries, we remove all the caries (as in class I amalgum, composite or GI restoration)>>so make the cavity , put the restoration then for the other fissures : put fissure sealants.

((If a cavity in the mesial part while the distal part is intact, put fissure sealant on the distal part)).

*so there is a big difference between Preventive resin restoration and Sealant restoration:
**Preventive resin restoration: caries in enamel only.
**Sealants restoration: caries in dentine.

[If we make a cavity removing all the caries, sealing the cavity and changing the diet ( acidic food and drinks), after a while the bacterial growth decreases about 18.64].


***So:
- The best way is Electronic detector of caries.
- The best way after Electronic detector of caries:
If we have intact occlusal surface but there is discoloration, we try to clean the discoloration with brush-pumice .
 If there is no bluish discoloration (the same color of the tooth)>> no caries.
 If there is white spot lesion>>the beginning of enamel surface caris.
 If there is bluish discoloration >> subsurface caries.
we use x-ray along with them (radiograph best for class II& III and for proximal surfaces more than occlusal surfaces).
((the massaran>>uses: 1-removes the broken parts of a file or a reamer from the pulp without affecting the tooth. 2- used for taking a core sample from caries to test it)).

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Done by: Nouran Mustafa.
Cons sheet # 8
Dr. Maher
Lect. Date: 28-3-2011.

#8