ECC II Caries Disease Status Drs Francisco Ramos-Gomez, Man Wai Ng and Jessica Lee
Strategies for the detection and monitoring of early carious lesions.
Detection and Staging Traditional Non- Surgical Model focus Medical Model Caries focussed on detecting disease at the operative intervention level interest in staging interest in early lesions
The Iceberg of caries Lesions into pulp & clinically detectable lesions into dentine Traditional Practice after Pitts Surface intact clinically visible lesions in dentine and enamel - Where we are now? Caries detectable by new methods only very early enamel lesions
Why is staging important
Enhanced Visual Method of Ekstrand, Ricketts and Kidd Formalised in ICDAS International Caries Detection & Assessment System Includes Coronal Root caries Enables detection at and early threshold Staging of lesions
Principles of staging using ICDAS Score 1 Score 0 no lesion 1 Lesion seen only see when dry 2 Lesion seen wet 3 Localised enamel breakdown 4 Localised enamel + dentine shadow 5 Distinct cavity + dentine shadow + cavitation 6 Extensive distinct cavity Score 2 Score 3 Score 4
Modified Principles of staging using ICDAS for Primary Dentition Score 0 no lesion 1 Lesion seen only see when dry 2 Lesion seen wet 2 COMBINED 1 & 2 3 Localized enamel breakdown 4 Localized enamel + dentine shadow 5 Distinct cavity + dentine shadow + cavitation 6 Extensive distinct cavity Score 1 Score 2 Score 3 Score 4
How is this applied Teeth are cleaned thoroughly - ideally by brushing or professionally cleaning prior to examination Each tooth is assessed If no lesion present Tooth dried for 5 secs with air Tooth is re-examined
ICDAS Caries Lesion Activity ICDAS Code 1,2 or 3 Characteristics of Lesion Active Lesion Surface of enamel is whitish/yellowish opaque with loss of luster; feels rough when tip of probe is moved gently across the surface. Lesion is in a plaque stagnation area, i.e.: pits and fissures, near gingival and approximal surface below contact point Inactive Lesion Surface of enamel is whitish, brownish or black. Enamel may be shiny and feels hard and smooth when tip of probe is moved gently across surface. For smooth surfaces, caries lesion is typically located at some distance from gingival margin 4 5 or 6 Probably active Cavity feels soft or leathery on gently probing the dentin Cavity may be shiny and feels hard on gently probing the dentin
Could be code 0 or 1 Any carious discoloration seen when wet? Could be codes 1-6 No Code = 0 NO Any carious lesions when dried? YES Is there cavitation? Yes Code = 1 Could be codes 1, 2, 4 Could be codes 3.5.6 Could be codes 1 or 2 NO Is there shadowing? YES Is dentin exposed? NO Extends beyond pit/fissure? Yes Code = 4 No Code = 3 YES More than ½ total surface involved? No Code = 1 Yes Code = 2 No Code = 5 Yes Code = 6
Principles of staging using ICDAS Score 1 Score 0 no lesion 1 Lesion seen only see when dry 2 Lesion seen wet 3 Localised enamel breakdown 4 Localised enamel + dentine shadow 5 Distinct cavity + dentine shadow + cavitation 6 Extensive distinct cavity Score 2 Score 3 Score 4
Parameters for Assessing and Documenting Caries Status and Activity Accurate assessments may be hampered by Presence of heavy plaque Lack of patient cooperation A one month disease management visit after an initial visit may allow for a more accurate assessment of Demineralized enamel surfaces Remineralized surfaces Pit and fissure caries Caries activity is determined by using a ball ended explorer or gently sliding a sharp ended explorer over the exposed dentin Never poke a sharp explorer into the exposed dentin
Old CHB system D2A D2B D2C D2A D2B D2C D2 -- -- D2A D2B D2C D1 -- -- D1 -- -- -- -- -- D1= Demineralized enamel D2=Cavitation into dentin, cannot be palpated with explorer D2A=Inactive lesion, feels hard, may appear brownish or black or shiny D2B=Somewhat active, feels leathery D2C=Active, feels soft
CHB D2A D2B D2C D2A D2B D2C D2 -- -- D2A D2B D2C D1 -- -- D1 -- -- -- -- -- Proposal 6 A, B, C 5 A, B, C 4 -- 3 -- 2 -- 2 -- 0 -- 1,2,3 = Enamel lesions 4,5,6 = Dentin lesions A=Inactive lesion, feels hard, may appear brownish or black or shiny B=Somewhat active, feels leathery C=Active, feels soft
1,2,3 = Enamel lesions 4,5,6 = Dentin lesions A=Inactive lesion, feels hard, may appear brownish or black or shiny B=Somewhat active, feels leathery C=Active, feels soft Proposal 6 A, B, C 5 A, B, C 4 -- 3 -- 2 -- 2 -- 0 -- New CHB system D2A D2B D2C D2A D2B D2C D2 -- -- D1.5 D1 -- -- D1 -- -- -- -- --
2 or D1 Case 1 3 or D1.5
CASE 2 2 or D1
Case 3 4 or D2 (A/B/C or just D2) 3 or D1.5
Case 4 2 or D1 3 or D1.5
Case 5 (5A, 5B or 5C) or (D2A, D2B or D2C)
Case 6 (6B or 6C) or (D2B or D2C) (5B or 5C) or D2 or D2B or D2C (3 or 5A or 5B or 5C) or (D1.5 or D2A,B or C)
Case 7 (5A, 5B or 5C) or D2A, D2B or D2C)
Case 8 (6A, 6B or 6C) or D2C, D2B or D2A)
6C or D2C Case 9
(6A, 6B or 6C) or (D2A, D2B or D2C) Case 10 (6A,6B or 6C) or (D2A, D2B, or D2C)
Case 11 (6A, 6B or 6C) or (D2A,D2B or D2C) 5A or 5B or (D2B or D2A)
Case 12 (6A, 6B or 6C) or (D2A, D2B, or D2C)
6A or D2A Case 13
4 or D2 or D2B or D2C Case 14 6A or D2A
4 or D2 or D2C Case 15 6A, 6B or 6C or D2A or D2B
4 or D2 Case 16 6B or 6C or D2A or B
6A, 6B or 6C or D2A, D2B or D2C Case 17
6C or D2C Case 18
6C or D2C Case 19
6A or 6B or D2A or D2B Case 20 5- or D2B or D2A
6A or D2A with abscess Case 21
2 or D1: also remineralization
6A or D2A
6B or D2B: feels slightly soft to explorer 6A or D2A
6A or D2A: feels hard to explorer
12 months prior 12 months later post FUJI IX placement and loss