Although the evidence shows that many diagnostic methods are less than desirably accurate, current diagnostic interpretations still must be used until new, more sensitive, techniques are available and validated. The evidence-based reports supported previous caries experience and pathologically low salivary flow rate as indicators of significant risk. Most studies from the systematic reviews involved children and excluded root caries, adults, and anterior teeth. Therefore, the clinician must extrapolate reportedly successful preventive and arresting/remineralization techniques from children to adults, root caries, and anterior teeth. In the absence of clear evidence on adequately sensitive diagnostic methods for detecting early noncavitated lesions and risk assessment indicators, clinicians need guidelines for treatment. Continue reading
Numerous risk indicators, that is, characteristics or measurements that assist in the prediction of caries, whether or not they are involved in caries causation, have been suggested for children. Unfortunately, more of the supportive data come from cross-sectional correlations with accumulated caries experience than from prospective, protocol-based incidence studies. The prospective studies employed different combinations of potential predictors in a variety of populations, varied considerably in sample size and quality, and have not produced a broadly applicable index or set of criteria for risk assessment. More and higher-quality comprehensive, longitudinal, multifactor studies of implicated risk indicators are needed to obtain firm support for their associations with caries incidence, to clarify the strengths of these associations in differing populations, and to reveal the extent to which the risk indicators provide independent as opposed to redundant information. In addition, although the nature of the disease process suggests that many of the proposed indicators may well be appropriate throughout life, validation studies in adult populations are largely absent or incomplete. Continue reading
1. What are the best methods for detecting early and advanced dental caries (validity and feasibility of traditional methods; validity and feasibility of emerging methods)?
Observations and studies during the past two decades have indicated that diagnostic and treatment paradigms may differ significantly for large, cavitated lesions versus early, small lesions and demineralized areas on tooth surfaces. The essential anatomic-pathophysiologic problem is that the carious lesion occurs within a small, highly mineralized structure following penetration through the structure’s surface in a manner which may be difficult to detect using current methods. Additionally, carious lesions occur in a variety of anatomic locations, often adjacent to existing restorations, and have unique aspects of configuration and rate of spread. These differences make it unlikely that any one diagnostic modality will have adequate sensitivity and specificity of detection for all sites. The application of multiple diagnostic tests to the individual patient increases the overall efficacy of caries diagnosis. Existing diagnostic modalities require stronger validation, and new modalities with appropriate sensitivities and specificities for different caries sites, caries severities, and degrees of caries activity are needed. Continue reading