医学院授课ppt讲义模板：牙齿CARIESDIAGNOSI

DR.KAUSERSADIAFAKHRUDDINCARIESDIAGNOSISWhyisdiagnosisimportant???Itformsthebasisforatreatmentdecision.Activelesionsrequiresomeformofactivemanagement,whereasarrestedlesionsdonot.InformingthepatientAdvisinghealthserviceplannersDiagnosisDiagnostictestsneedstobebothvalidandreliable.VALID:meansthatthetestmeasureswhatitisintendedtomeasure,e.g.,whitespotlesionwithamattsurfaceindicatesanactivelesionwhichhasnotyetcavitated.RELIABLE:orreproducibilitymeansthetestcanberepeatedwiththesameresult(intra-examinerreproducibilityandinter-examinerreproducibility)LesionsintopulpD4+clinicallydetectablelesionindentineD3+clinicallydetectable“cavities”limitedtoenamelD2+clinicallydetectableenamellesionswith“intact”surfaceD1•NAC(Noactivecareadvised)+lesionsdetectableonlywithtraditionaldiagnosticaids•NAC(Noactivecareadvised)+sub-clinicalinitiallesionsinadynamicstateofprogression/regressionPREREQUISITESFORDETECTIONANDDIAGNOSISREQUIRESGOODLIGHTINGCLEANANDDRYTEETHcleandepositsofcalculusorplaque.Remember,tobrushplaqueoutofthefissurecozitseasytomissawhitespotlesionattheentrancetoafissureEachquadrantofthemouthisisolatedwithcottonrollstopreventsalivawettingthetoothandthoroughdryingwithgentleblastofairfromthreeinonesyringeSharpeyesordentalloupesLightprobing.Sharpprobesshouldneverbeusedtodetectthe“tacky”feelofearlycavitationGoodbitewingradiographsDiagnostictoolsVisualTactileVisualtactileRadiographs_ConventionalIntraoralPeriapicalradiograph&bitewingDigitalradiograph-enhancement,subtraction,tunedaperturecomputedtomography(TACT)BasedonVisualLightOpticalcariesmonitorFOTI&DIFOTIQLF&DiagnodentUltravioletBasedonElectricalCurrentElectricalconductanceElectricalImpedenceUltrasoundDyes-Enamel&DentineNewerTechnology:TerahertzMultiphotonimagingOpticalcoherencetomographyInfraredflourescenceInfraredthermographyEarlyCariesDetectionElectricalconductivitymeasurements(ECM)LaserfluorescenceusingtheDiagnodentunit(KaVo-IR)Ultrasoundmeasurements(UM)Quantitativelightfluorescence(QLF)(watchthisvideocarefullyshowingdifferenttechniquesforcariesdetection)EarlyCariesDetectionOpticalCoherencetomography(OCT)Fibreoptictransillumination(FOTI)Digitalimagingfibreoptictransillumination(DIFOTI)DirectDigitalradiography(DDR)DETECTIONANDDIAGNOSISONINDIVIDUALSURFACESFREESMOOTHSURFACESENAMELCANBEDIAGNOSEDWITHSHARPEYE,SATTHESTAGEOFTHEWHITEORBROWNSPOTLESIONBEFORECAVITATIONHASOCCURREDPROVIDEDTHETEETHARECLEAN,DRYANDWELLLIT.Althoughthewhitespotlesionistheearliestvisualsignofdisease,ithasbeenprecededbydestructiveprocesseswhicharen'tseenmacroscopic.FreesmoothsurfacecariesSmoothsurfacedentalcariesisrecognizedbywhiteorbrownlesions.Inthisphotograph,thewhiteareasareearlyevidenceofdisease.Atthisstagethelesionsarenotdetectablebyradiographs.Radiographicexaminationofthemandibularfirstmolarandthemaxillarysecondbicuspidrevealsthatconsiderabledentindestructionhastakenplace.ROOTSURFACEInitsearlystages,appearsasoneormoresmall,welldefined,discoloredareaslocatedinanareaofplaquestagnationclosetothegingivalmargin.Lesionmayvaryincolorfromyellowish,orlightbrown,throughmid-browntoalmostblack.FREESMOOTHSURFACESActivelesionsareplaquecovered,softorleatheryinconsistencyandmaybecavitated.Arrestedlesionsarehardandareoftenlocatedinaplaquefreeareacoronaltothegingivalmargin.Arrestedlesionsmaybecavitated.Althoughlesionconsistencyisimportantindiagnosingactivity,butgreatcareshouldbetakenwhenusingasharpinstrumentonthesesurfaces.ITMAYBESAFERTOTESTCONSISTENCYOFTHELESIONBYGENTLEUSEOFAPERIODONTALPROBEORTHEBACKOFANEXCAVATOR.ITSHOULDBENOTEDTHATCOLOROFTHELESIONISNOTAGOODINDICATOROFLESIONACTIVITY.RootsurfacelesionstendtospreadLATERALLYandcoalescewithminorneighboringlesionsandmaythuseventuallyencirclethetooth.Commonly,thelesionsextendonly0.25-1mmindepth.Theydonotalwaysspreadapicallyasthegingivalmarginrecedes,butnewlesionsmaydeveloplateratthelevelofthenewgingivalmargin.PITSANDFISSURESClinical-VisualExaminationClean,drywelllitthesurfaceTheactive,un-cavitatedlesioniswhite,oftenwithamattsurface.ThecorrespondinginactivelesionmaybebrownTheenamellesionarenotvisibleonradiograph.Theenamellesionthatisonlyvisibleonadrytoothsurfaceisinouterenamel.Thelesionvisibleonawetsurfaceisallthewaythroughenamelandmaybeintodentine.Cavitatedlesionsmaypresentasmicro-cavitieswithorwithoutagrayishdiscolorationoftheenamel.Themicro-cavityiseasilymissedonvisualexaminationCarefulexaminationofbitewingradiographsisimportantandserveasausefulsafetynettoavoidmissingmicro-cavities.HiddencariesAlesionthathasbeenmissedonvisualexaminationbutfoundonradiographhasbeencalledhiddencaries.MoreadvancedlesionsmaypresentascavitiesexposingdentineCavitatedlesionsareusuallyvisibleindentineonbitewingradiographCavitatedocclusallesions,whethermicro-cavitiesorcavitiesdowntodentine,areusuallyactivebecausethepatientcannotcleanplaqueoutofthecavity.LaserFluorescencemethod(DIAGNOdent)APPROXIMALSURFACESClinical-Visualexamination:Itisdifficulttoseethewhitespotlesiononanapproximalsurfacebecausethelesionformsjustcervicaltothecontactareaandv