Table Of ContentDetection and
Assessment
of Dental Caries
A Clinical Guide
Andrea Ferreira Zandona
Christopher Longbottom
Editors
123
Detection and Assessment of Dental Caries
Andrea Ferreira Zandona
Christopher Longbottom
Editors
Detection and Assessment
of Dental Caries
A Clinical Guide
Editors
Andrea Ferreira Zandona Christopher Longbottom
Department of Comprehensive Care King’s College London Dental Institute
Tufts University School of Dental Medicine London, UK
Boston, MA
USA
ISBN 978-3-030-16965-7 ISBN 978-3-030-16967-1 (eBook)
https://doi.org/10.1007/978-3-030-16967-1
© Springer Nature Switzerland AG 2019
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Foreword I
A Clinical Guide to Dental Caries Detection and Assessment has been constructed
carefully by two authors who are deeply skilled in the art and science of caries
detection and assessment and who have worked for years to build the often-fragile
link bridging best evidence to best clinical practice. Together, they have assembled
a formidable array of international talent to provide a much needed, comprehensive,
accessible, well-illustrated, and authoritative guide for clinicians.
The Guide’s structure provides a logical flow from the essential background
required to understand the preparation for, conduct of, and limitations associated
with clinical visual assessment of caries. This is followed by descriptions of a range
of available visual detection criteria which are distinguished by some important dif-
ferences. Intriguingly, many criteria systems also share very substantial commonali-
ties. Detection during caries excavation is also addressed.
There follows a comprehensive series of chapters addressing additional detection
methods as aid to caries lesion diagnosis. These range through radiographic film
based and digital methods in both 2D and 3D, the use of white and near-infrared
light, followed by fluorescence, bioluminescence, and photothermal radiometry.
After considerations of what’s in the pipeline (which often remains a frustratingly
long one), important chapters cover making treatment decisions after caries detec-
tion and an essential appendix on the thorny but important topic of definitions.
The authors and contributors are to be congratulated on producing a focused and
very useful Clinical Guide. I share the hope of the Editors that “this book will give
the reader additional confidence to manage dental caries in the early stages with
non-surgical approaches by using more precise and objective methods of assess-
ment” and trust that this will help clinicians provide better care for their patients.
London, UK Nigel Pitts
v
Foreword II
Following the characterization of the initial phases of the dental caries process and
the repeated demonstration that subsurface demineralization could be reversed by
remineralization, many dental scientists focused their research on the identification
and development of strategies and technologies for the very early detection of the
caries process. For the past 40 years, numerous international dental scientists have
meticulously and successfully investigated a wide variety of clinical methodologies
and instrumental technologies for early caries detection resulting in a remarkable
number of scientific publications in the dental literature.
A Clinical Guide to Dental Caries Detection and Assessment has been developed
by two of these scientists who have been intimately involved in this research for
more than 20 years and they have enlisted additional renowned scientists with simi-
lar experiences. The knowledge and experiences of this team of investigators has
resulted in the compilation of this unique state-of-the-art review of research in this
area. In developing this Guide, the authors have carefully included both clinical and
instrumental technologies noting both the technical abilities of the strategies and
their limitations. This material will be quite useful for the clinical control and man-
agement of dental caries by dental practitioners using non-surgical procedures.
In addition, the information presented in the Guide will be useful for the future
development of even more effective procedures for the prevention of dental caries.
Due to time and cost considerations, the development and clinical validation of
more effective caries-preventive methods has become virtually impossible using
historical procedures for clinical caries trials accepted by governmental agencies.
However, these newer technologies will permit the assessment of significant caries-
preventive benefits in much shorter time periods in much smaller cohorts of panel-
ists. Without doubt this material will serve as a reference text for current as well as
future cariologists and the authors are collectively acknowledged for their efforts.
Indianapolis, IN, USA George K. Stookey
vii
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Andrea Ferreira Zandona and Christopher Longbottom
Part I Background
2 Preparing Teeth for a Clinical Examination . . . . . . . . . . . . . . . . . . . . . . 7
Christopher Longbottom and Andrea Ferreira Zandona
3 The Visual Presentation of Dental Caries . . . . . . . . . . . . . . . . . . . . . . . . 17
Andrea Cortes, Stefania Martignon, and Gail Douglas
4 The Concept of Hidden Caries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Christopher Deery
Part II Visual Detection Criteria
5 Nyvad Criteria for Assessment of Caries Lesion Activity
and Severity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Vita Machiulskiene
6 Visual Detection Criteria Using the International Caries
Detection and Assessment System (ICDAS) . . . . . . . . . . . . . . . . . . . . . . 45
Kim R. Ekstrand and Mariana M. M. B. Braga
7 The American Dental Association Caries Classification
System (ADA CCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Gregory Zeller, Douglas A. Young, and Brian Novy
8 The Caries Assessment Spectrum and Treatment (CAST)
Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Soraya Leal, Ana Paula Dias Ribeiro, and Ana Luiza de Souza Hilgert
9 Caries Detection Dyes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Marisa Maltz, Rodrigo Alex Arthur, and Clarissa Fatturi-Parolo
10 Fluorescence-Aided Caries Excavation: FACE . . . . . . . . . . . . . . . . . . . 99
Áine M. Lennon and Wolfgang Buchalla
ix
x Contents
Part III A dditional Detection Methods as Aid to
Caries Lesion Diagnosis
11 Conventional Bitewing Radiographs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Falk Schwendicke and Gerd Göstemeyer
12 Digital Bitewing Radiographs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Gerd Göstemeyer and Falk Schwendicke
13 Caries Detection with Dental Cone Beam
Computed Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Jeffery B. Price
14 Fibre-Optic Transillumination: FOTI . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Richard Hogan, Iain A. Pretty, and Roger P. Ellwood
15 Near-Infrared Light Transillumination . . . . . . . . . . . . . . . . . . . . . . . . . 151
Jan Kühnisch
16 Quantitative Light-Induced Fluorescence . . . . . . . . . . . . . . . . . . . . . . . 159
Baek-II Kim
17 DIAGNOdent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Klaus W. Neuhaus and Adrian Lussi
18 Photothermal Radiometry and Modulated Luminescence:
The Canary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Bennett T. Amaechi
Part IV C aries Diagnostic Methods in the Making
19 Near-Infrared Reflectance Imaging of Caries Lesions . . . . . . . . . . . . . 189
Daniel Fried
20 Optical Coherence Tomography for Imaging Dental Caries . . . . . . . . 199
Daniel Fried
21 Use of Ultrasound for Caries Detection . . . . . . . . . . . . . . . . . . . . . . . . . 209
Funda Çalışkan Yanıkoğlu and Dilek Tağtekin
22 Bioluminescence Technology to Aid Lesion Activity Assessment . . . . . 217
Christopher Longbottom and Bruce Vernon
Part V Treatment Decision After Detection
23 Clinical Decision-Making in Caries Management:
Role of Caries Detection and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 227
Margherita Fontana and Marie-Charlotte D. N. J. M. Huysmans
24 Integrating Caries Detection Devices into Clinical Practice . . . . . . . . . 235
Stephen Abrahams
Contents xi
Part VI Conclusion
25 Concluding Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Christopher Longbottom and Andrea Ferreira Zandona
Part VII Appendices
26 Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Marie-Charlotte D. N. J. M. Huysmans
Introduction 1
Andrea Ferreira Zandona and Christopher Longbottom
Dental caries detection is the cornerstone of every general dental practice. However,
limited time is spent in the dental schools’ curriculum; teaching dental caries
detection and calibration of faculty is regarded as a great challenge [1–5]. Extensive
lesions are usually easy to detect due to obvious clinical or radiological signs.
Lesions in the early stages, however, are challenging. The visual signs can be sub-
tle, and there can be many confounding effects. These lesions in the early stages,
with no cavitation and no radiographic sign of demineralization, are considered
questionable caries. A recent study with 82 practitioners and 6910 patients indi-
cated that up to 34% of patients had questionable occlusal caries [6]. Clinical expe-
rience does not seem to reduce the number of surfaces deemed with questionable
caries [6–8].
Dental caries remains a prevalent disease affecting millions of people worldwide
[9]. Given the widespread use of fluoride, the burden of disease has decreased [10]
but more than 90% of all United States dentate adults and more than two thirds of
all children still experience dental caries [11]. With more adults retaining teeth later
in life, we can expect an increase in surfaces with questionable caries. Many of
these questionable caries surfaces will not progress toward cavitation [12]; there-
fore, it is paramount to both determine if there is a lesion and to assess caries activ-
ity. A paradigm shift pushing the management of dental caries from an operative/
surgical approach to a nonsurgical approach in the last decades has led to a rise in
interest on more detailed and objective caries detection methods [13].
A. Ferreira Zandona (*)
Department of Comprehensive Care, Tufts University School of Dental Medicine,
Boston, MA, USA
e-mail: [email protected]
C. Longbottom
King’s College London Dental Institute, London, UK
e-mail: [email protected]
© Springer Nature Switzerland AG 2019 1
A. Ferreira Zandona, C. Longbottom (eds.), Detection and Assessment of Dental
Caries, https://doi.org/10.1007/978-3-030-16967-1_1
