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Recent Methods for Diagnosis of Dental Caries in Dentistry Diş Hekimliğinde Güncel Çürük Tanı Yöntemleri Hülya Yılmaz, Sultan Keleş

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Recent Methods for Diagnosis of Dental Caries in Dentistry Diş Hekimliğinde Güncel Çürük Tanı Yöntemleri Hülya Yılmaz, Sultan Keleş Meandros Med Dent J Review / Derleme Recent Methods for Diagnosis of Dental Caries in Dentistry Diş Hekimliğinde Güncel Çürük Tanı Yöntemleri Hülya Yılmaz, Sultan Keleş Adnan Menderes University Faculty of Dentistry, Department of Pediatric Dentistry, Aydın, Turkey Abstract In recent years, the early diagnosis of dental caries has gained importance as conservative dentistry is kept in the forefront. Especially in pediatric patients, the dentist should focus on the early detection of dental caries and minimally invasive treatment options. The conventional caries detection methods often fail to detect initial enamel lesions that have not progressed to cavitation. For this reason, various new techniques have been developed aiding early detection of caries. The aim of this review is to give general information about recent caries detection methods and to mention their benefits when used in conjunction with conventional methods. Öz Koruyucu diş hekimliğinin ön planda tutulduğu günümüzde, diş çürüklerinin erken tanısı oldukça önem kazanmıştır. Özellikle çocuk hastalarda diş çürüklerinin erken dönemde saptanıp minimal invaziv tekniklerle tedavi edilmeleri amaçlanmaktadır. Keywords Diş çürüklerinin tanısında sıklıkla kullanılan geleneksel yöntemler, henüz kavitasyona Dental caries, caries detection, early diagnosis neden olmamış çürüklerin tanısında yetersiz kalmaktadır. Bu nedenle diş çürüklerinin tanısında geleneksel yöntemlere ilaveten yeni yöntemler geliştirilmiştir. Bu derlemenin amacı, çürük tanısında kullanılan güncel yöntemler hakkında genel bir Anah­tar­Ke­li­me­ler bilgi vermek ve bu yöntemlerin geleneksel yöntemlerle birlikte kullanıldığındaki Diş çürüğü, çürük teşhisi, erken teşhis yararlarından söz etmektir. Received/Geliş­Ta­rihi : 01.11.2016 Introduction Accepted/Ka­bul­Ta­ri­hi : 02.03.2017 Early detection and diagnosis of dental caries reduces irreversible doi:10.4274/meandros.21931 loss of tooth structure, the treatment costs and the time needed for restoration of the teeth. Dental caries often initiates at the fissures in Ad­dress­for­Cor­res­pon­den­ce/Ya­zış­ma­Ad­re­si: the occlusal surface of the tooth. Conventional examination for caries Hülya Yılmaz MD, detection is primarily done using visual inspection, tactile sensation and Adnan Menderes University Faculty of radiographs. While these methods give satisfactory results in detection Dentistry, Department of Pediatric Dentistry, Aydın, Turkey of cavitated lesions, they are usually inadequate for the detection of Phone : +90 506 318 03 93 initial lesions. Because of these deficiencies, new detection methods E-mail : [email protected] have been developed to aid better diagnosis. General criteria for an ORCID ID: orcid.org/0000-0003-0963-1944 ideal caries detection method include following (1,2); • Ideal caries detection method should capture the whole caries © Meandros Medical and Dental Journal, Published by progress, from the earliest stage to the cavitation stage, Galenos Publishing House. This is article distributed under the terms of the • It should be accurate, Creative Commons Attribution NonCommercial 4.0 International Licence (CC BY-NC 4.0). • It should be precise, Meandros Med Dent J 2018;19:1-8 1 2 Yılmaz and Keleş. Diagnosis of Dental Caries • It should be easy to apply, 1. Sharp tip of the explorer can produce traumatic • It should be useful for all surfaces of the tooth defects on the enamel surface, including caries adjacent to restorations, 2. The cariogenic bacteria may be transferred from • It should assess the activity of the lesion, one tooth surface to another, • It should be sensitive, allowing lesions to be 3. Probing may cause cavitation and fracture in the detected at early stages. incipient lesions, 4. Explorers have low sensitivity resulting in Conventional Methods Used in Diagnosis of undetected lesions. Dental Caries If the explorer catches or resists removal when moderate pressure is applied, and when this is Visual Inspection accompanied by one of the following; It is one of the most common diagnosis methods • Softness at the base of the lesion, implemented by dentists. In order to make an • Opacity adjacent to the pit or fissure, accurate assessment, the teeth should be clean, • The enamel is softened adjacent to the pit and dry and examined under a light source. In visual fissure, we can conclude that the area is carious. examination, changes in tooth structure such as; Pickard, proposed the use of dental floss for the enamel dissolution, white spot lesions, discoloration, detection of caries. When there is food packing surface roughness and presence of cavitation are between the teeth and the floss is frayed when passed assessed. When illuminated, the carious tissues through the contact area, this might be the indication scatter the light and make enamel look whiter and of caries (6). opaque. This is due to increased porosity caused by Radiography demineralization. Similarly, when dentin undergoes Radiographic examination has great value in demineralization, a shadow is observed under the detecting caries lesions especially when they are not intact enamel. When caries progress, the surface clinically visible. In low caries population, as a result breaks down and a cavitation is formed (2). of fluoride use, the surface of enamel does not break In the International Consensus Workshop on Caries down, making the caries detection harder. In recent Clinical Trials, held in Scotland in 2002, the importance years, the incidence of such lesions has increased of the early detection of caries was emphasized dramatically (7). According to studies, bitewing and the idea of development of International Caries radiography has been proven to be an effective Detection and Assessment System (ICDAS) was method in the detection of proximal caries and hidden proposed. In 2005, the ICDAS criteria was revised and caries (8). published as ICDAS II (3). Besides its advantages, radiographs also have some According to studies, ICDAS gives reliable and limitations too. For this reason, it is advisable to use accurate results in identification of early caries lesions clinical evaluation along with radiographic imaging. and changes taking place in the long term (4). The disadvantages of radiography are as follows (2,9); The basic codes are given as follows; • Proximal contacts are overlapped, 0. Sound tooth surface, • The lesion depth may appear to be increased due 1. First visual change in enamel, to angulation and this may lead to false diagnosis, 2. Distinct visual change in enamel, • Occlusal lesions may not be detected because of 3. Localized enamel breakdown due to caries with the superposition of the buccal and lingual cusps, no visible dentin, • The real cause of the radiolucency can’t be 4. Underlying dark shadow from dentin (with or determined whether it is due to caries, resorption or without enamel breakdown), wear, 5. Distinct cavity with visible dentin, • The superficial demineralization of the buccal 6. Extensive distinct cavity with visible dentin. and lingual surfaces may seem like proximal caries, Tactile Sensation • Active and arrested caries can’t be distinguished The explorer and the dental floss are used for in the radiographs, tactile examination but the use of an explorer is not • Radiographs may give false positive results due preferred because (1,5); to a phenomenon called “Mach band effect”. In this Meandros Med Dent J 2018;19:1-8 Yılmaz and Keleş. Diagnosis of Dental Caries 3 perceptual phenomenon, the contrast between the In order to be seen in the radiographs, there must dark and lighter areas has increased, resulting in a be 40% of demineralization in the lesions. This means dark demarcation band. This effect causes formation that detection of deeper lesions is significantly harder of a radiolucent area in dentin enamel junction, compared with superficial lesions (12). • Cervical burn out is another optical phenomenon In an in vitro study comparing the capacity of where a wedge shaped radiolucent area is seen conventional radiographic imaging with digital between the bone and the cemento-enamel junction. imaging systems in detection of proximal caries, it was This effect is due to tissue density and the low concluded that these two systems provided similar penetration of X-rays at the cervical region. results, showing no significant difference over another. Despite the disadvantages, radiographs are It is highly recommended to use digital imaging as the the most commonly used diagnosis tool and with radiation dose is significantly lower (13). the development of new techniques many of the Fiber Optic Transillumination problems are solved (10). The light transmission index of decayed and Caries Detecting Dyes sound tooth are different (6). Sound enamel is There are two layers of decalcification in carious formed of densely packed hydroxyapatite crystals. dentin. The first one is the soft and infected layer When this structure is disrupted, in the presence of which doesn’t have the capacity of remineralization. demineralization, the photons of light are scattered The second one is hard, intermediately decalcified and resulting in an optical disruption (14). When we has the ability of remineralization. Many studies were examine the carious tissues with fiber optic device, carried out to differentiate these layers. Although we observe dark shadows along the dentinal tubules there are opinions stating the benefit of caries as it has lower light transmission index compared with detection dyes, there are also opinions that
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