醫(yī)學(xué)院授課ppt講義模板：牙齒CARIESDIAGNOSI

1、DR. KAUSER SADIA FAKHRUDDINCARIES DIAGNOSIS1Why is diagnosis important?It forms the basis for a treatment decision. Active lesions require some form of active management, whereas arrested lesions do not.Informing the patientAdvising health service planners2DiagnosisDiagnostic tests needs to be both

2、valid and reliable. VALID: means that the test measures what it is intended to measure, e.g., white spot lesion with a matt surface indicates an active lesion which has not yet cavitated.RELIABLE: or reproducibility means the test can be repeated with the same result (intra-examiner reproducibility

3、and inter-examiner reproducibility) 345PREREQUISITES FOR DETECTION AND DIAGNOSIS678Diagnostic toolsVisualTactileVisual tactileRadiographs _ Conventional Intrao ral Periapical radiograph & bitewingDigital radiograph-enhancement, subtraction, tuned aperture computed tomography (TACT)91011121314Based o

4、n Visual LightOptical caries monitorFOTI & DIFOTIQLF & DiagnodentUltraviolet15Based on Electrical CurrentElectrical conductanceElectrical Impedence16UltrasoundDyes-Enamel & DentineNewer Technology:TerahertzMultiphoton imagingOptical coherence tomographyInfrared flourescenceInfrared thermography17Ear

5、ly Caries DetectionElectrical conductivity measurements (ECM)Laser fluorescence using the Diagnodent unit (KaVo-IR)Ultrasound measurements (UM)Quantitative light fluorescence (QLF)(watch this video carefully showing different techniques for caries detection)18Early Caries DetectionOptical Coherence

6、tomography (OCT)Fibreoptic transillumination (FOTI)Digital imaging fibreoptic transillumination (DIFOTI)Direct Digital radiography (DDR)19DETECTION AND DIAGNOSIS ON INDIVIDUAL SURFACES20FREE SMOOTH SURFACESENAMELCAN BE DIAGNOSED WITH SHARP EYE, SAT THE STAGE OF THE WHITE OR BROWN SPOT LESION BEFORE

7、CAVITATION HAS OCCURRED PROVIDED THE TEETH ARE CLEAN, DRY AND WELL LIT. Although the white spot lesion is the earliest visual sign of disease, it has been preceded by destructive processes which arent seen macroscopic.21Free smooth surface caries 22Smooth surface dental caries is recognized by white

8、 or brown lesions. In this photograph, the white areas are early evidence of disease. At this stage the lesions are not detectable by radiographs.Radiographic examination of the mandibular first molar and the maxillary second bicuspid reveals that considerable dentin destruction has taken place.23RO

9、OT SURFACEIn its early stages, appears as one or more small, well defined, discolored areas located in an area of plaque stagnation close to the gingival margin.Lesion may vary in color from yellowish, or light brown, through mid-brown to almost black. FREE SMOOTH SURFACES24Active lesions are plaque

10、 covered, soft or leathery in consistency and may be cavitated.Arrested lesions are hard and are often located in a plaque free area coronal to the gingival margin. Arrested lesions may be cavitated.25Although lesion consistency is important in diagnosing activity, but great care should be taken whe

11、n using a sharp instrument on these surfaces. IT MAY BE SAFER TO TEST CONSISTENCY OF THE LESION BY GENTLE USE OF A PERIODONTAL PROBE OR THE BACK OF AN EXCAVATOR. IT SHOULD BE NOTED THAT COLOR OF THE LESION IS NOT A GOOD INDICATOR OF LESION ACTIVITY. 26Root surface lesions tend to spread LATERALLY an

12、d coalesce with minor neighboring lesions and may thus eventually encircle the tooth. Commonly, the lesions extend only 0.25-1mm in depth. They do not always spread apically as the gingival margin recedes, but new lesions may develop later at the level of the new gingival margin. 27PITS AND FISSURES

13、28Clinical-Visual ExaminationClean, dry well lit the surfaceThe active, un-cavitated lesion is white, often with a matt surface. The corresponding inactive lesion may be brownThe enamel lesion are not visible on radiograph. 29The enamel lesion that is only visible on a dry tooth surface is in outer

14、enamel. The lesion visible on a wet surface is all the way through enamel and may be into dentine. 30Cavitated lesions may present as micro-cavities with or without a grayish discoloration of the enamel. The micro-cavity is easily missed on visual examinationCareful examination of bitewing radiograp

15、hs is important and serve as a useful safety net to avoid missing micro-cavities. 31Hidden cariesA lesion that has been missed on visual examination but found on radiograph has been called hidden caries. 32More advanced lesions may present as cavities exposing dentineCavitated lesions are usually vi

16、sible in dentine on bitewing radiographCavitated occlusal lesions, whether micro-cavities or cavities down to dentine, are usually active because the patient cannot clean plaque out of the cavity. 33Laser Fluorescence method (DIAGNOdent)34APPROXIMAL SURFACESClinical- Visual examination: It is diffic

17、ult to see the white spot lesion on an approximal surface because the lesion forms just cervical to the contact area and vision is obscured by the adjacent tooth. The lesion is usually only discovered at a relatively late stage when it has already progressed into the dentine and is seen as a pinkish

18、-grey area shining up through the marginal ridge. 35The teeth should be isolated, clean and dry. In contrast, an approximal lesion on the root surface may be diagnosed visually but gingival health is mandatory for such a diagnosis to be reliable.Thus, if the gingival are red, swollen and tending to

19、bleed, caries diagnosis in these areas should be deferred until improved oral hygiene has been instituted and the inflammation is resolved. 36Tactile examination: A sharp curved probe (Briault) can be used gently to try to determine whether an approximal lesion is cavitated. 37Bitewing radiographIt

20、is of paramount importance in the diagnosis of the approximal carious lesion. Caries on the approximal root surface is also visible on a bitewing radiograph, although this appearance is sometimes confused with the cervical radiolucency. 38Transmitted lightCan also be of considerable assistance in th

21、e diagnosis of approximal caries.This technique consists of shining light through the contact point. A carious lesion has a lowered index of light transmission and therefore appears as a dark shadow that follows the outline of the decay through the dentine. 39FOTI (fiber optic transillusion) In post

22、erior teeth a stronger light source is required and fibre-optic lights, with the beam reduced to 0.5mm in diameter, have been used. It is important that the diameter of the light source is small so that glare and loss of surface detail are eliminated. The technique FOTI. It is particularly advantage

23、s in patients with posterior crowding where bitewing radiographs will produce overlapping images and in pregnant women where unnecessary radiation should be avoided. 40Tooth separation41SECONDARY OR RECURRENT CARIES42Is primary caries at the margin of a restoration. The clinical diagnostic criteria

24、are thus identical to those for primary caries as described above. 43Clinical-visual examination A particular problem with amalgam restorations is marginal breakdown or fracture, often called ditching. Ditching occurs occlusally in an area that is easy to clean. Recurrent caries usually occurs appro

25、ximally and cervically in areas of plaque stagnation Ditching does not reliably predict infected dentine beneath the ditched area unless the ditch is an obvious cavity that would admit the tip of a periodontal probe (over 0.4mm)44Discoloration around restoration with clinically intact margins also d

26、oes not reliably predict new caries beneath the restorationStaining around an amalgam restoration should not trigger its replacement unless a carious cavity, or a very wide ditch that traps plaque, is also present. 45Stain around a tooth-colored filling can also present as grey or brown discolored dentine shining up through intact enamel. This appearance probably represents residual caries left when the cavity was originally repaired. Clinical studies indicates that this appearance does not reliably indicate infected dentine (and p