Diagnosis and prediction of root caries

Diagnosis is the process of recognizing diseases by their characteristic clinical signs and symptoms. Diagnostic ability varies considerably between and among examiners, and, consequently, the accuracy of the diagnosis can be questioned. Root caries is a disease for which there are several clinical signs (location, color, surface texture, and surface cavitation). Unfortunately, these signs are open to broad clinical interpretation. As a result, estimates of disease occurrence (incidence rate) have ranged from 0.87 to 8.20/100 surfaces at risk/year or 0.15 to 0.43 lesions/person/year for adults living independently in the community. When multiple examiners are utilized, interexaminer agreement has been reported to be relatively good but could be further improved by minimizing the effects of several sources of examiner disagreement, including the absence of a global consensus on the signs which indicate the presence of root caries. The use of a diagnostic test can enhance the diagnosis and prediction of root caries, but the development of useful tests is hindered by the lack of an accurate clinical standard of diagnosis. At this time, diagnostic tests for root caries are quite limited and of questionable value. A powerful predictive tool for root caries would result from the combination of risk assessment measures and a valid diagnostic test developed with use of standardized and accurate methods of clinical diagnosis.

How dentists classified and treated non-carious cervical lesions

All North Carolina general dentists were shown color photographs of three non-carious cervical lesions. A fourth picture showed cervical caries. Respondents were asked how they defined each lesion, its cause, treatment and frequency of appearance in practice. Cervical caries was identified and treated by almost all responding dentists, but they applied more varied terms, causes and treatments to non-carious defects.

Problems in caries diagnosis

This paper reviews some of the problems in the diagnosis of primary and secondary caries, particularly with respect to the questionable lesion that has neither penetrated to dentine nor cavitated. Because tactile diagnosis of caries with sharp probes can be unreliable as well as damaging, diagnosis should include careful visual inspection (preferably with magnification), radiographic examination, fibre optic transillumination (FOTI), and/or measurement of electrical resistance depending on the anatomical location. Probably the most important and difficult diagnostic decision for the clinician is whether the patient is at high, moderate or low risk of caries. Consideration of various factors in the patient's history, and clinical and laboratory examinations will assist in this classification of risk.

An in vitro evaluation of fluorescein penetration into natural root surface carious lesions

In order to develop a method for detection and quantification of initial root surface carious lesions, the use of fluorescein sodium as a fluorescent dye is evaluated. The penetration depth of fluorescein sodium into human roots containing natural carious lesions was measured on approximately 130-microns-thick slices, cut in a direction perpendicular to the pulp. This depth was compared to the lesion depth that was measured on the same slice with transversal microradiography. The results indicate that fluorescein sodium in water penetrates into demineralized layers of root dentine even if a surface layer with a high mineral content is present. The penetration depth is about 1.1 times the microradiographically determined lesion depth.

The diagnosis of dental caries: 2. The detection of approximal, root surface and recurrent lesions

The range of diagnostic techniques used to detect and monitor dental caries which are available to practitioners has broadened in recent years. Following the consideration of the assessment of caries in buccal, lingual and occlusal surfaces in the first article in this series, this second article gives a description of the diagnostic methods currently employed in the detection of primary caries in approximal and root surfaces as well as those used for recurrent lesions. The third paper will discuss the rationale for the use of these techniques and provide an overview of present and potential future diagnostic techniques.

Comparison of two scoring methods for root surface caries in hamsters

The aim of this investigation was to compare two methods of scoring root surface caries in hamster teeth. The experimental material was mandibles from hamsters which had been infected with Actinomyces viscosus, fed a caries-promoting diet, and received either 0, 1, 10, or 25 ppm fluoride in the drinking water during an 18-week experimental period (Stookey, 1986). Root surface caries on the lingual surfaces of mandibular first molars was scored according to the grid method of Doff et al. (1977) and by the quantitative planimetric method of Firestone et al. (1986). Data from both methods confirmed that 25 and 10 ppm fluoride were significantly more caries-inhibitory than 1 ppm fluoride, which, in turn, significantly reduced root surface caries compared with the 0 ppm control group. Correlation coefficients for caries scores (0.92) and ranking of the scores (0.88) for each animal between the two methods were highly significant (p < 0.0001). The planimetric measurement of root surface caries in hamsters was as sensitive as the grid-scoring method.