Cbabdental Caries 4-Caries Diagnosis and Risk Assessment
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Transcript of Cbabdental Caries 4-Caries Diagnosis and Risk Assessment
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DIAGNOSIS OF DENTALCARIES & CARIES RISK
ASSESSMENT
Dr.M.Ganesh,MDS(Pediatric Dentistry)
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DIAGNOSIS
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Why is diagnosis important?
Caries diagnosis and treatment has traditionally beenlimited to the detection and restoration of cavitatedlesions.
Undoubtedly, unaffected teeth are superior to
restored teeth. Therefore early detection of incipientcaries and limitation of caries activity prior tosignificant tooth destruction are primary goals of aneffective diagnosis and treatment programme
Cavitation is preceded by a lengthy period ofsubsurface demineralization that presents the dentistan opportunity to detect the disease and startpreventive measures prior to the advent of significanttooth damage.
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VISUAL INSPECTION
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REQUISITES
Plaque should be removed to obtain reliablediagnosis of caries visually
Tooth must be properly dried Strict isolation
Sequential examination
Adequate lighting
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VISUAL INSPECTION
Can be direct or indirect
Magnification loupes, Slides, Temporary
separation as adjuncts for better visionCrude tool for diagnosis
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TACTILE EXAMINATION
Explorer and Floss
Right angle probe
Back action probe Shepherds crook
Cow horn with curved ends
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Procedure used
In the examination of the patient, the occlusalsurfaces of the teeth are examined first. A smallsharp explorer is placed in the main areas of pits and
fissures or in areas of discoloration if present, thepoint is then placed in the grooves that radiate fromthe fossae to see if any of the areas are soft andcannot support the weight of the explorer.
Care should be taken to withdraw the explorer alongthe same path as it was inserted. This is essential toprevent false catch felt by the explorer due to lateralshift of the same.
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Use is condemned at times
Physical damage to intact surfaces
Fracture and cavitation of incipient lesions
False catch due to mechanical binding
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RADIOGRAPHS
Conventional Film Radiography
Bite wing Radiography
Intra Oral Periapical Radiographs
DIGITAL RADIOGRAPHY
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Increasing knowledge about the limitations ofconventional caries diagnostic methods
and changes in lesion morphology act as aspur to the development of new diagnostic aids.
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INTRA ORAL DENTAL XERORADIOGRAPHY
Xerographic copying Record images
No wet processing
Uses photoconductors or semiconductors
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DYES IN CARIES DETECTION
Widespread use in medicine,
biology & dentistry
Discrimination & easyidentification of objects
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CARIOUS ENAMEL DETECTION
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DETECTION OF CARIOUS DENTIN
Infected Vs Affected Dentin
http://images.google.co.in/imgres?imgurl=http://www.cda-adc.ca/jcda/vol-65/issue-10/graphics/Bryant9.jpg&imgrefurl=http://www.cda-adc.ca/jcda/vol-65/issue-10/566.html&h=116&w=170&sz=35&tbnid=5t7K-yjH_T763M:&tbnh=64&tbnw=94&hl=en&start=6&prev=/images%3Fq%3Dcaries%2Bdetection%2Bdyes%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.fu-berlin.de/zahnerhaltung/bilder/ip001.jpg&imgrefurl=http://www.fu-berlin.de/zahnerhaltung/b_2.html&h=325&w=538&sz=52&tbnid=ab8w0WeyI7geZM:&tbnh=78&tbnw=130&hl=en&start=2&prev=/images%3Fq%3Dcaries%2Bexcavation%26svnum%3D10%26hl%3Den%26lr%3Dhttp://images.google.co.in/imgres?imgurl=http://www.scielo.br/img/revistas/jaos/v12n3/21673f2.gif&imgrefurl=http://www.scielo.br/scielo.php%3Fpid%3DS1678-77572004000300002%26script%3Dsci_arttext%26tlng%3Den&h=428&w=664&sz=59&tbnid=A0TMgYJWhovIGM:&tbnh=87&tbnw=136&hl=en&start=2&prev=/images%3Fq%3Dinfected%2Bdentin%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.scielo.br/img/revistas/jaos/v12n3/21673f8.jpg&imgrefurl=http://www.scielo.br/scielo.php%3Fpid%3DS1678-77572004000300002%26script%3Dsci_arttext%26tlng%3Den&h=479&w=664&sz=65&tbnid=wSuAC06H1r_aGM:&tbnh=98&tbnw=136&hl=en&start=1&prev=/images%3Fq%3Dinfected%2Bdentin%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
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FIBER OPTIC TRANSILLUMINATION
Alternative for bite wing
In medicine since 1960s
Used for surgical retraction indentistry,caries detection,calculus, soft tissue lesions
Especially proximal lesions
Ease & flexibility
http://images.google.co.in/imgres?imgurl=http://www.inspektor.nl/dental/Images/premolf_aangepaste_kleur.jpg&imgrefurl=http://www.inspektor.nl/dental/qlfmain.htm&h=232&w=200&sz=9&tbnid=ntG8-CL_N2g0vM:&tbnh=103&tbnw=88&hl=en&start=8&prev=/images%3Fq%3DFLUORESCENCE%2Bof%2Bteeth%26svnum%3D10%26hl%3Den%26lr%3D -
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FIBER-OPTICS
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THE UNIT
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DIAGNOSTIC PROCEDURE
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ADVANTAGES
Several angles- 3 D picture
Cracks & Fissures
Vitality testing
Subgingival calculusFood pockets
Root canals
Sinus involvement
Fast; no processingCost effective
Field use or screening
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DIFOTI
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USE OF LASER FLUORESCENCE
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PRINCIPLE
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DIAGNODENT
Chairside, battery-powered quantitative diode laserfluorescence device655nm light beamChanges assigned a numeric value, which is displayed
on the monitor
http://images.google.co.in/imgres?imgurl=http://www.centrelavallee.com/IMAGE/Diagnodent%2520copy.jpg&imgrefurl=http://www.centrelavallee.com/technologie.php&h=228&w=288&sz=27&tbnid=aFBxgeOTi0pyCM:&tbnh=87&tbnw=110&hl=en&start=6&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.bittnerjrdds.com/assets/photos/diagnodent.jpg&imgrefurl=http://www.bittnerjrdds.com/pages/library/diagnodent.htm&h=230&w=350&sz=42&tbnid=7AQ-jkQEqDo9tM:&tbnh=76&tbnw=116&hl=en&start=1&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
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OPERATION
http://images.google.co.in/imgres?imgurl=http://www.moresmiles.com/images/Diag003.jpg&imgrefurl=http://www.moresmiles.com/technology.html&h=155&w=189&sz=12&tbnid=NspJzmgU9rPioM:&tbnh=79&tbnw=97&hl=en&start=16&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.cranews.com/additional_study/2000/00-12/diagnodent/images/2_3ini.jpg&imgrefurl=http://www.cranews.com/additional_study/2000/00-12/diagnodent/example_cases.htm&h=217&w=238&sz=11&tbnid=h4t-Ey-fpo1ziM:&tbnh=94&tbnw=104&hl=en&start=14&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.dent.med.uni-muenchen.de/~kkunzelm/infokollegen/interview-kariesdiagnose-bilder-Dateien/image007.jpg&imgrefurl=http://www.dent.med.uni-muenchen.de/~kkunzelm/infokollegen/interview-kariesdiagnose.html&h=300&w=300&sz=36&tbnid=ZmnZ-OwYV3gH8M:&tbnh=111&tbnw=111&hl=en&start=4&prev=/images%3Fq%3DDIAGNODENT%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
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DIAGNODENT VALUES
Between 5 and 25 - initial lesions in theenamelGreater than this range indicate early
dentinal cariesAdvanced dentin caries is said to yield valuesgreater than 35
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ELECTRONIC RESISTANCE
MEASUREMENTS
Depth dependent gradient of enamel solubility orpermeability- unique pattern of demineralization
http://images.google.co.in/imgres?imgurl=http://www.uic.edu/classes/peri/peri343/carilec4/enamcar2.gif&imgrefurl=http://www.uic.edu/classes/peri/peri343/carilec4/enamhel4.htm&h=317&w=298&sz=5&tbnid=78kepUclj5U63M:&tbnh=113&tbnw=106&hl=en&start=1&prev=/images%3Fq%3Dwhite%2Bspot%2Blesion%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG -
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PRINCIPLE & OPERATION
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CARIES METER
Electronic caries detector
Solid Probe on dried occlusal surface
Green- sound surface
Yellow- enamel caries Orange- Dentinal caries
Red- Pulpal involvement
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ULTRASONIC CARIES DETECTOR
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The first component in risk assessment involvesidentifying the childs risk and protective factors.
use information obtained in theinterview,observation of parent-child interaction, oral
exam, and diagnostic procedures to identify thepotential risks to full attainment of good oral healthoutcomes.
identifies the protective factors that can reduce thenegative impact of risk factors and contribute to
attaining those outcomes.
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The second part of risk assessment involvesweighing the risk and protective factors todetermine an oral health supervision plan.
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L Ri k
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Low Risk Optimal fluoride exposures both systemic and topical Consumption of simple sugars or limiting to mealtime High caregiver socioeconomic status (financially stable)
Regular dental visits
Moderate Risk Suboptimal systemic fluoride exposure with optimal topical
exposure Between meal snacking (1-2)
Midlevel caregiver socioeconomic status (eligible schoollunch/SCHIP)
Irregular use of dental services
High Risk
Suboptimal topical fluoride exposure Frequent between meal snacking (3 or more) Low level caregiver socioeconomic status No usual source of dental care Active caries present in the mother Children with special health care needs
Conditions decreasing saliva flow (medications)
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Interactive Cariogram program for
estimation of individual caries risk
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