EARLY CHILDHOOD CARIES

Clinical Features & Diagnosis

INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 AAPD, May 2003
INTRODUCTION

•Definition Presence of 1 or more decayed (cavitated or non-

•Terminologies
cavitated lesions), missing (due to caries), or
CLIN. FEATURES filled tooth surfaces in any primary tooth in a
•Pattern child 71 months of age or younger.
•Stages

CONSEQUENCES
Developed by a workshop organized in 1999 by
NIDCR, following the conference that was held
DIAGNOSIS in 1997.
•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION
Age in Months EC C S-ECC
•Definition
•Terminologies

CLIN. FEATURES <35 months ≥ 1 dmf surfaces ≥ 1 smooth dmf

•Pattern surfaces
•Stages

•≥ 1 smooth dmf
CONSEQUENCES
36 – 47 ≥ 1 dmf surfaces surfaces in max
months antr teeth
DIAGNOSIS
•≥ 4 dmf surfaces
•Case History
•Clin. exam
•Detect Caries •≥ 1 smooth dmf
•Risk Assessment 48 – 59 ≥ 1 dmf surfaces surfaces in max
months antr teeth
DIFFERENCE •≥ 5 dmf surfaces

CONCLUSION 60 – 71 ≥ 1 dmf surfaces ≥ 5 dmf surfaces

months
 Jacobi, 1862
American pediatrician, who is first
INTRODUCTION credited with describing nursing caries
•Definition
•Terminologies
Beltrami, 1930
Recognized the pattern of early caries
as “les dents noire de tout-petit” /
CLIN. FEATURES
“black teeth of the very young”
•Pattern
•Stages Elias Fass, 1962
Published the 1st comprehensive
CONSEQUENCES description of caries in infants (nursing
bottle mouth)
DIAGNOSIS
Winter et al, 1966
•Case History
•Clin. exam
•Detect Caries NURSING CARIES
•Risk Assessment

A unique pattern of dental decay in

DIFFERENCE
young children due to prolonged
nursing habit.
CONCLUSION

Winter GB, Hamilton MC, James PM. Role of the comforter as an

etiological factor in rampant caries of the deciduous dentition. Arch Dis
 Moss, 1966
INTRODUCTION
TOOTH CLEANING NEGLECT
•Definition
•Terminologies
To shift the emphasis away from the
bottle to the need for cleaning
CLIN. FEATURES

•Pattern Moss. Description and Epidemiology of Nursing Caries Journal of Public

•Stages
Health Dentistry, Volume 56 Issue 1: Pages 38 – 50.

CONSEQUENCES

Kroll et al, 1967

DIAGNOSIS

•Case History NURSING BOTTLE MOUTH

•Clin. exam
•Detect Caries
•Risk Assessment A syndrome characterized by a severe
caries pattern beginning with the
DIFFERENCE maxillary anterior teeth in a healthy
bottle fed infant or toddler
CONCLUSION

Kroll RG, Stone JH. Nocturnal bottle feeding as a contributory cause of

rampant dental caries in the infant and young child. J Dent Child 1967,
 Shelton et al, 1977

INTRODUCTION •NURSING BOTTLE SYNDROME

•Definition
•BOTTLE PROPPING CARIES
•Terminologies •LABIAL CARIES
•COMFORTER CARIES
CLIN. FEATURES

•Pattern
A devastating condition that may render
•Stages children dentally crippled
Shelton PG, Berkowitz RJ, Forrester DJ. Nursing bottle caries.
CONSEQUENCES
Pediatrics 59:777-78,1977.
DIAGNOSIS Dilley et al, 1980
•Case History
•Clin. exam
•Detect Caries •NIGHT BOTTLE SYNDROME
•Risk Assessment •BABY BOTTLE CARIES
•NURSING MOUTH
DIFFERENCE
A unique pattern of dental caries
CONCLUSION in young children.
Dilley GJ, Dilley DH, and Machen JB. Prolonged nursing habit: a profile of
patients and their families. ASDC journal of dentistry for children 1980,
 Croll, 1984

INTRODUCTION •BABY BOTTLE MOUTH

•Definition
•NURSING MOUTH DECAY
•Terminologies

A very destructive carious process which

CLIN. FEATURES can affect infants and toddlers.
•Pattern
•Stages Croll G, Turner J. Microbial characteristics of the human dental caries
associated with prolonged bottle feeding 1984. Arch Oral Biol 29:949-
CONSEQUENCES 951.

DIAGNOSIS Tsamtsouris, 1986

•Case History
•Clin. exam
•Detect Caries •NURSING BOTTLE CARIES
•Risk Assessment

Caries caused by prolonged use

DIFFERENCE of a bottle filled with any liquid
other than water.
CONCLUSION

Tsamsouris ,Tiraby G . A bacteriological study of nursing bottle caries in

children.
 Mim Kelly et al, 1987

INTRODUCTION •BABY BOTTLE TOOTH DECAY

•Definition
•Terminologies Caries caused by bottle feeding only and
not by breast feeding.
CLIN. FEATURES
Mim Kelly, Bruerd B. The prevalence of baby bottle tooth decay among
•Pattern
•Stages two native American populations. J Public Health Dent 1987;47:94-97

CONSEQUENCES
Rippa, 1988
DIAGNOSIS
•MILK BOTTLE SYNDROME
•Case History
•Clin. exam •INFANCY CARIES
•Detect Caries •SOOTHER CARIES
•Risk Assessment
•CIRCULAR CARIES

DIFFERENCE
A specific form of rampant decay of
the primary teeth of infants.
CONCLUSION

Louis W. Ripa. Nursing caries: a comprehensive Review.

Journal of pediatric dentistry 1988,10:268-282.
 Horowitz, 1998
INTRODUCTION •RAMPANT INFANT AND EARLY CHILDHOOD
•Definition DENTAL DECAY
•Terminologies

Define the age group of it affected by the

CLIN. FEATURES
disease and the usual rapidity of its
•Pattern development
•Stages
Horowitz HS. Rampant infant and early childhood caries. Washington:
Oral Health Module, National Health Service Corps Educational
CONSEQUENCES
Program for clinical and community issues in primary care. August 1,
1998; 36-50.
DIAGNOSIS Davies, 1998
•Case History
•Clin. exam
•Detect Caries •EARLY CHILDHOOD CARIES
•Risk Assessment

A complex disease involving maxillary

DIFFERENCE primary incisors within a month after
eruption and spread rapidly to involve other
CONCLUSION primary teeth
Davies GN. Early childhood caries: A synopsis.
Comm Dent Oral Epidemiol 1998;26:106-16.
 FACTORS SUPPORTING THE
INTRODUCTION
TERM ECC
•Definition
•Terminologies
•Sleeping with a bottle of milk or other
CLIN. FEATURES sweetened beverages does not always
cause caries
•Pattern
•Stages

•Only a small proportion of children who

CONSEQUENCES
take bottle of milk to bed is having caries

DIAGNOSIS

•Case History •In US, children who are 4 and 5 years old,
•Clin. exam an age by which bottle use ordinarily has
•Detect Caries
•Risk Assessment
been discontinued have been noted to
develop caries in the maxillary ant teeth
DIFFERENCE
•In countries such as China, Thailand and
Tanzania, where nursing bottles and
CONCLUSION feeding with a nursing bottle are rare,
infants may still experience ECC
 • MATERNALLY DERIVED STREPTOCOCCUS MUTANS DISEASE
(MDSMD)
INTRODUCTION
Mothers with high titers of the bacteria or who have
•Definition
•Terminologies
suffered from many dental caries themselves are likely
to pass the same virulence and associated problems on
CLIN. FEATURES
to their children.
•Pattern
•Stages
In fact, mothers whose salivary S. mutans levels
exceeded 105 colony forming units were about 9 times
CONSEQUENCES more likely to pass the bacteria on to their children.

DIAGNOSIS Berkowitz, R. J. Causes, Treatment and Prevention of Early

•Case History Childhood Caries: A Microbiologic Perspective. Journal of the
•Clin. exam Canadian Dental Association
•Detect Caries
•Risk Assessment 2003. 69(5): 304-307.

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages
A specific form of rampant caries
CONSEQUENCES
Involves the deciduous dentition
DIAGNOSIS

•Case History Occurs in Infants & Toddlers

•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Veerkamp & Weerheijm, 1995

INTRODUCTION
Stage Age Clinical appearance

•Definition Initial 10-20 Maxillary anterior teeth: Opaque white

•Terminologies
(Reversible) months demineralisation (Cervical / Interproximal)

CLIN. FEATURES Maxillary anterior teeth: Yellow brown

•Pattern Damaged 16-24 discolouration. (Cervical/Interproximal
•Stages
(Carious) months superficial defects).
#54 and # 64 in Initial stage
CONSEQUENCES
Maxillary anterior teeth: Marked enamel
DIAGNOSIS 20-36 defects & pulpal involvement.
Deep lesions
months #54 and # 64 in Damaged stage
•Case History
•Clin. exam #74 and # 84 in Initial stage
•Detect Caries
•Risk Assessment Maxillary anterior teeth: Loss of large parts of
30-48 enamel and dentin. Crown fracture.
DIFFERENCE Traumatic
months #54 and # 64 showing Deep lesions
#74 and # 84 in Damaged stage
CONCLUSION

Veerkamp JS, Weerheijm KL. Nursing-bottle caries: the importance of a

development perspective. ASDC J Dent Child. 1995 Nov-Dec;62(6):381-6.
 Reason For The Unique Distribution Of Caries
INTRODUCTION
Between maxillary and mandibular incisors and the
•Definition unequal severity of the lesion between incisors and the
•Terminologies other teeth is related to 3 factors:

CLIN. FEATURES
• Chronology of primary tooth eruption.
•Pattern • Duration of the potentially cariogenic oral habit .
•Stages • Muscular pattern of infant sucking.

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Harris and Garcia Godoy, 1999
INTRODUCTION
Stage Feature
•Definition
•Terminologies
Very mild Light demineralisation
CLIN. FEATURES usually at the gingival
crest & no cavitation.
•Pattern
•Stages

Mild Dimeralisation at the

CONSEQUENCES
gingival 3rd of the tooth &
moderate cavitation.
DIAGNOSIS

•Case History
•Clin. exam Moderate Frank cavitation on
•Detect Caries multiple tooth surfaces.
•Risk Assessment

DIFFERENCE Severe Widespread destruction

of tooth; partial to
CONCLUSION complete loss of clinical
crown.
 Wyne, 1999
INTRODUCTION Amjad Hussain Wyne. Early Childhood Caries: Nomenclature
and case definition. Community Dent Oral Epidemiol 1999;
•Definition
•Terminologies 27:313-315
Type 1 (Mild to moderate) Early Childhood Caries
CLIN. FEATURES

•Pattern •Isolated carious lesion(s) involving molars and/or incisors.

•Stages
•Cause : a com­bination of cariogenic semi-solid or solid
CONSEQUENCES food and lack of oral hygiene.

DIAGNOSIS •Mandibular incisors – unaffected

•Case History
•Clin. exam •Usually found in children who are 2 - 5 years old
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Wyne, 1999
INTRODUCTION Amjad Hussain Wyne. Early Childhood Caries: Nomenclature
and case definition. Community Dent Oral Epidemiol 1999;
•Definition
•Terminologies 27:313-315
Type II (Moderate to severe) Early Childhood Caries
CLIN. FEATURES
•Labiolingual carious lesions affecting maxillary in­cisors,
•Pattern with or without molar caries.
•Stages

•Cause : inappropriate use of feeding bottle or at-will

CONSEQUENCES breast-feeding or a combination of both, with or without
poor oral hygiene.
DIAGNOSIS

•Case History
•Mandibular incisors – unaffected
•Clin. exam
•Detect Caries •Usually found in children soon after the first teeth erupt.
•Risk Assessment

DIFFERENCE

CONCLUSION
 Wyne, 1999
INTRODUCTION Amjad Hussain Wyne. Early Childhood Caries: Nomenclature
and case definition. Community Dent Oral Epidemiol 1999;
•Definition
•Terminologies 27:313-315
Type III (Severe) Early Childhood Caries
CLIN. FEATURES
•Affects almost all the teeth
•Pattern
•Stages
•Cause : a combination of cariogenic food and poor oral
hygiene.
CONSEQUENCES
•Mandibular incisors – affected
DIAGNOSIS

•Case History
•Usually found in teenagers & adolescents.
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Dental Pain
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History • Levine, et al. Br Dent J 2002

•Clin. exam • Shepherd, et al. Br Dent J 2002
•Detect Caries • Milsom, et al. Br Dent J 2002
•Risk Assessment
• Slade, Community Dent Health 2001
DIFFERENCE

CONCLUSION Slade, 2001 : a 5 – 6% increase in probability of toothache for each

additional carious primary tooth.
 Disruption Of Growth & Development
INTRODUCTION (Failure To Thrive)
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE
•Elice and Fields. Pediatr Dent 1990
•Acs, et al. Pediatr Dent 1992
CONCLUSION
•Ayhan, et al. J Clin Pediatr Dent 1996
•Clarke, et al. Pediatr Dent 2006
 Disruption Of Intellectual Development
INTRODUCTION
(Low self esteem / Psychological Trauma)
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE
• Blumenshine, et al. J Publ Health Dent 2008
CONCLUSION • Jackson, et al. Am J Public Health. 2011
 Disruption To Quality Of Life
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment •Low, et al. Pediatr Dent 1999
•Acs, et al. Pediatr Dent 2001
DIFFERENCE •Cunnion, et al. J Dent Child 2010
•Filstrup, et al. Pediatr Dent 2003
CONCLUSION
•Sheiham. Br Dent J 2006
•Casamassimo, et al. J Am Dent Assoc 2009
 Greater Risk Of New Carious Lesions In
INTRODUCTION Both Primary & Permanent Dentitions
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
•Johnsen, et al. Pediatr Dent 1986
•Grindefjord, et al. Caries Res 1995
DIFFERENCE
•O’Sullivan and Tinanoff. J Public Health Dent 1996
•Al-Shalan, et al. Pediatr Dent 1997
CONCLUSION •Skeie, et al. Int J Paed Dent 2006
•Mejare, et al. Caries Res 2001
 Higher Incidence Of Hospitalization &
INTRODUCTION Emergency Visits
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
•Fleming, et al. Int J Paediatr Dent 1991
DIFFERENCE
•Wilson, et al. Clin Pediatr 1997
•Sheller, et al. Pediatr Dent 1997
•Oliva, et al. Pediatr Emerg Care 2008
CONCLUSION
 Increased Treatment Costs &
INTRODUCTION Treatment Time
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE
• Thikkurissy, et al. Am J Emerg Med 2010
CONCLUSION
 Sepsis
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
• Pine, et al. Br Dent J 2006
• Unkel, et al. Pediatr Dent 1997
DIFFERENCE
• Lin Clin Pediatr 2009
• Davies, et al. Clinical Intensive Care 2002
CONCLUSION
 Space Loss
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam • Northway. J Am Dent Assoc 2000
•Detect Caries
•Risk Assessment
• Laing, et al. Int J Paediatr Dent 2009
• Lin and Chang. J Clin Pediatr Dent 1998
• Rao and Sarkar. J Indian Soc Pedod PrevDent 1999
DIFFERENCE
• Padma Kumari, et al. J Indian Soc Pedod Prev Dent 2006
• Lin, et al. J Am Dent Assoc 2007
CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
Morbidity and mortality pyramid for Early Childhood
Caries
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES Utilization of scientific knowledge for identifying a diseased

process and to differentiate it from other diseased processes
DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION

Wulaerhan et al. BMC Oral Health 2014,

INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS When a patient has what is considered an excessive

•Case History amount of tooth decay, one must determine whether that
•Clin. exam person actually has a high susceptibility and truly
•Detect Caries
•Risk Assessment
rampant caries of sudden onset or whether the oral
condition represents years of neglect and inadequate
dental care.
DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History Mother's MS count could be an important risk

•Clin. exam indicator for ECC development.
•Detect Caries Priyadarshini et al. Dent Res J (Isfahan). 2013 Nov-Dec;
•Risk Assessment
10(6): 728–731.
DIFFERENCE

Maternal vitamin D levels & early childhood

CONCLUSION caries may be linked.
Snider J. J Am Dent Assoc. 2014 Jun;145(6):526.
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS
Babies born after maternal complications
•Case History during pregnancy or babies who experience a
•Clin. exam traumatic birth must be considered to be at
•Detect Caries
•Risk Assessment risk of developing ECC when exposed to
excessive bottle nursing.
Benjamin Peretz. Pediatr Dent 19:34-36, 1997
DIFFERENCE

CONCLUSION
The prevalence of ECC was related to low family
income, premature birth and infant obesity.
VE dos Santos Junior. et al. BMC Oral Health 2014, 14:47
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES
Lower level of maternal
•Pattern
•Stages
education is associated
with ECC
Qin M et al. Pediatr Dent.
CONSEQUENCES
2008 Mar-Apr;30(2):122-8
Tiberia MJ et al. Pediatr
DIAGNOSIS Dent. 2007 May-
•Case History Jun;29(3):201-8
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition Children who used systemic antibiotics during the first year
•Terminologies
of age had a significantly greater risk for ECC
Sumer M. Alaki. Pediatr Dent 2009;31:31-7)
CLIN. FEATURES

•Pattern Children with special needs

•Stages
Methamphetamine induced caries (MIC) / methmouth
CONSEQUENCES Howe. JCDA November 2005, Vol. 71, No. 10

DIAGNOSIS Syrups & ECC

Howe. JCDA November 2005, Vol. 71, No. 10
•Case History
•Clin. exam
•Detect Caries Vitamin D deficiency
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS Poor oral hygiene

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
Poor knowledge of oral hygiene
Qin M et al. Pediatr Dent. 2008 Mar-
Apr;30(2):122-8
DIFFERENCE

CONCLUSION Parents having problems brushing the

child’s teeth
Tiberia MJ et al. Pediatr Dent. 2007 May-
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages
Holding liquids in the mouth for prolonged times is
associted with ECC
CONSEQUENCES Tiberia MJ et al. Pediatr Dent. 2007 May-Jun;29(3):201-8

DIAGNOSIS Excessive sugar intake is an important contributors to the

•Case History
development of S-ECC.
•Clin. exam Qin M et al. Pediatr Dent. 2008 Mar-Apr;30(2):122-8
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS Iron deficiency is observed definitely in children having ECC

Pushpa Iranna Koppal. Int J Clin Pediatr Dent. 2013 Jan-Apr; 6(1): 1–6.
•Case History
•Clin. exam
•Detect Caries Early Childhood Caries may be a risk marker for iron
•Risk Assessment deficiency anemia
Clarke M et al. Pediatr Dent. 2006 May-Jun;28(3):254-9.
DIFFERENCE
Since iron deficiency has permanent effects on growth and development,
CONCLUSION pediatric dentists should recommend assessment of iron levels in S-ECC
patients regardless of their anthropometric appearance.
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies
Crowded and irregular teeth
CLIN. FEATURES
Salivary Deficiency
•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment Traditionally, dentists have relied upon
a visual, tactile& radiographic procedure
DIFFERENCE for the detection of dental caries.

CONCLUSION
 Visual Examination
INTRODUCTION To ensure that maximum information is obtained during
a visual examination, the teeth should be clean,
•Definition
•Terminologies completely dry and well illuminated.

CLIN. FEATURES
Most common method

•Pattern Looking for cavitations, discoloration, opacification or

•Stages
surface roughness

CONSEQUENCES Criteria for visual caries detection

DIAGNOSIS Aids for visual caries detection

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Visual Examination
INTRODUCTION EKSTRAND Criteria
•Definition
•Terminologies V0 •No/slight change in enamel translucency after prolonged air drying (5sec)

CLIN. FEATURES

•Pattern
•Stages
V1 •Opacity/discoloration hardly visible on wet surface, but distinctly visible after drying

CONSEQUENCES

DIAGNOSIS
V2 •Opacity/discoloration distinctly visible without air drying

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

V3 •Local enamel breakdown in opaque or discolored enamel and/ or grayish discoloration from underlying dentine

DIFFERENCE

CONCLUSION

V4 •Cavitation in opaque/discolored enamel exposing dentine

 Visual Examination
INTRODUCTION

•Definition
•Terminologies
ICDAS Criteria
CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Visual Examination
INTRODUCTION

•Definition
•Terminologies
ICDAS Criteria
CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Visual Examination
INTRODUCTION
Aids for Visual Caries Detection
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Tactile Examination
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam • Right angle probe (no.6)
•Detect Caries
•Risk Assessment
• Back action probe (no.17)

DIFFERENCE
• Sphered crook (no.23)
• Cow horn with curved ends (no.2)
CONCLUSION
 Black (1924)
Passing the explorer into the pits noting whether or there
INTRODUCTION is any softening and whether the instrument catches or
•Definition
enters at any point
•Terminologies
Marzouk (1985)
CLIN. FEATURES Sharp explorer pressing the tip into pit and fissure will
cause it to penetrate the enamel and or dentinal caries
•Pattern cone making a definitive diagnosis of caries
•Stages

Sturdevent (1985)
CONSEQUENCES
Defects are best detected when an explorer provides tug
back or resistance to removal
DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Hydrated Desiccated Surface Surface
texture hardness
INTRODUCTION
Normal translucent translucent smooth Hard
•Definition enamel
•Terminologies

CLIN. FEATURES Hypocalcified opaque opaque smooth Hard

enamel
•Pattern
•Stages
Incipient translucent opaque smooth Soft
CONSEQUENCES caries

DIAGNOSIS Active caries opaque opaque cavitated Very soft

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment Arrested opaque, opaque, dark roughened Hard
caries dark
DIFFERENCE

Accurate diagnosis of the presence or absence of occlusal caries remains challenging

CONCLUSION
for the clinician. Visual and tactile methods alone, in the absence of cavitation,
generally have relatively poor diagnostic capability for occlusal
surfaces under general practice conditions.
 X-ray Based Methods
INTRODUCTION
Conventional Radiography
•Definition
•Terminologies

•Based on the fact that as the caries progress proceeds,

CLIN. FEATURES
the mineral content of enamel and dentin decreases,
•Pattern resulting in A decrease in the attenuation of the x-ray
•Stages
beam as it passes through the teeth. This feature is
recorded on the image receptor as an increase in
CONSEQUENCES radiographic density.

DIAGNOSIS •Mainly used for the detection of carious lesions in

•Case History
approximal surfaces, but is also recommended as a
•Clin. exam supplement for occlusal caries detection.
•Detect Caries
•Risk Assessment
•Once an occlusal carious lesion is clearly visible on
radiographs, histological examination shows that
DIFFERENCE demineralization has extended to or beyond the middle
third of the dentin (ricketts et al., 1995). Therefore,
CONCLUSION radiographic examination may underestimate the extent of
caries lesions (dove, 2001).
 Radiographic Techniques
INTRODUCTION
Digital Radiography
•Definition
•Terminologies
•Requirements:

CLIN. FEATURES •RADIO component - a hypersensitive intra oral sensor and a

•Pattern conventional x-ray unit
•Stages •VISIO component - a video monitor and display processing system
•GRAPHY component - a high resolution video printer that provides a
CONSEQUENCES hard copy of screen image using the same video signal

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Radiographic Techniques
INTRODUCTION
Digital Radiography
•Definition
•Terminologies
•Advantages: •Limitations:
CLIN. FEATURES
Reductions in radiation dose Unknown sensor lifespan
•Pattern
•Stages
(between 5% to 50% of the dose
needed for conventional radiography) Rigidity and thickness of the
sensors,
CONSEQUENCES
Image is displayed immediately
after exposure and no processing had Presents lower spatial
DIAGNOSIS
to be performed. resolution when compared to
•Case History the image obtained by
•Clin. exam Digital manipulation of the image conventional radiography.
•Detect Caries
•Risk Assessment can be done to enhance viewing,
avoiding unnecessary or repeated High initial system cost
radiographs.
DIFFERENCE

Digital images facilitate

CONCLUSION
communication and case discussion
among dental professionals
 Radiographic Techniques
INTRODUCTION
Digital Subtraction Radiography
•Definition
•Terminologies •Allows professionals to distinguish small differences between
subsequent radiographs that otherwise would have remained
CLIN. FEATURES unobserved because of over-projection of anatomical structures or
differences in density that are too small to be recognized by the
•Pattern human eye.
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION

•Can be used to assess the progression, arrest, or regression of

caries lesions.
 Radiographic Techniques
INTRODUCTION
Digital Subtraction Radiography
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
Example of a subtraction of two digital bitewing radiographs.
(a) Radiograph showing proximal lesion on mesial surface of 1 st molar
DIFFERENCE
(b) (b) follow up radiograph taken 12 months later
(c) (c) the areas of difference between the two films are shown as
CONCLUSION black, i.e. in this case the proximal lesion has become more
radiolucent and hence has progressed.
 Radiographic Techniques
INTRODUCTION
Digital Subtraction Radiography
•Definition
•Terminologies
Two digital radiographic images obtained under different time
intervals, with the same projection geometry
CLIN. FEATURES

•Pattern
•Stages
Spatially and densitometrically aligned using specific software.
CONSEQUENCES

DIAGNOSIS
Intensities of corresponding pixels are subtracted of the gray scale
•Case History values
•Clin. exam
•Detect Caries
•Risk Assessment
A uniform difference image is produced, resulting in a new image
representing the differences between the two, called the subtraction
DIFFERENCE image.

If there is a change in the radiographic attenuation between the

CONCLUSION
baseline and follow-up examination, all the anatomical structures
that do no change between adiographs are shown as neutral gray
background, while regions that had mineral loss or gain are shown
 Fluorescent Techniques
INTRODUCTION
Quantitative Light-induced Fluorescence
•Definition
•Terminologies (QLF)

CLIN. FEATURES
•Uses a 50-watt xenon arc-lamp and an optical filter in
•Pattern
•Stages
order to produce a blue light with a 290- to 450-nm
wavelength, which is carried to the tooth through a light
guide fitted with a dental mirror.
CONSEQUENCES

•The fluorescence images are filtered by a yellow high-

DIAGNOSIS
pass filter (λ ≥ 540 nm) and then captured by a color
•Case History CCD camera
•Clin. exam
•Detect Caries
•Risk Assessment •When a lesion is present on the surface, an increase in
light scattering is observed relative to the surrounding
enamel.
DIFFERENCE

•The result of this is that the contrast between sound

CONCLUSION
enamel and a carious lesion is improved with the lesion
seen as being dark on a light green background
 Fluorescent Techniques
INTRODUCTION
Quantitative Light-induced Fluorescence
•Definition
•Terminologies (QLF)

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Fluorescent Techniques
INTRODUCTION
Laser fluorescence devices
•Definition
•Terminologies (DIAGNOdent & DIAGNOdent pen)

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
DIAGNOdent 2190 or
DIAGNOdent 2095
DIAGNOdent pen
DIFFERENCE

CONCLUSION
 Fluorescent Techniques
INTRODUCTION
Laser fluorescence devices
•Definition
•Terminologies (DIAGNOdent & DIAGNOdent pen)

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Fluorescent Techniques
INTRODUCTION
Laser fluorescence devices
•Definition
•Terminologies (DIAGNOdent & DIAGNOdent pen)

CLIN. FEATURES

•Pattern
•Stages
•Several factors might interfere the results, such as
staining, calculus or powder/paste remnants; calibration
procedures; and cut-off points variation for enamel and
CONSEQUENCES
dentin caries.

DIAGNOSIS •For this reason, DIAGNOdent or DIAGNOdent pen

•Case History should not be used as major method for caries detection,
•Clin. exam but as a supplementary tool for both visual and
•Detect Caries
•Risk Assessment radiographic examination.

DIFFERENCE

CONCLUSION
 Fluorescent Techniques
INTRODUCTION
Fluorescence Camera (VistaProof)
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment
(A)VistaProof fluorescence camera and DBSWIN software analysis.
(B) Six blue LEDsemitting a 405-nm light.
DIFFERENCE

CONCLUSION
 Fluorescent Techniques
INTRODUCTION
Fluorescence Camera (VistaProof)
•Definition
•Terminologies

CLIN. FEATURES •On the images, it is possible to see different areas of the
•Pattern
dental surface that fluoresce in green (sound dental tissue)
•Stages and in red (carious dental tissue).

CONSEQUENCES
•DBSWIN software is used to analyze the images and
translate into values the intensity ratio of the red and green
fluorescence.
DIAGNOSIS

•Case History •According to the manufacturer, those values are related to

•Clin. exam
•Detect Caries
the lesion extension. The higher is the bacterial colonization,
•Risk Assessment the higher is the red fluorescent signal.

DIFFERENCE
•The software highlights the lesions and classifies them in a
scale from 0 to 5, giving a treatment orientation in the first
evaluation: monitoring, remineralization or invasive
CONCLUSION
treatment.
 Enhanced Visual Techniques
INTRODUCTION
Fiber-optic Transillumination (FOTI) &
•Definition
•Terminologies Digital Fiber-optic Transillumination (DIFOTI)

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Enhanced Visual Techniques
INTRODUCTION
Fiber-optic Transillumination (FOTI) &
•Definition
•Terminologies Digital Fiber-optic Transillumination (DIFOTI)

CLIN. FEATURES •Basis: Carious lesion has a lowered index of light

•Pattern
transmission , an area of caries appears as a darkened
•Stages shadow that follows the spread of decay through the dentin

CONSEQUENCES
•To detect anterior caries, place the probe on the labio cervical region of
the tooth and examine from the lingual with a mouth mirror.
DIAGNOSIS
•To diagnose posterior proximal caries, place the probe on the bucco
•Case History cervical area of the tooth and examine from the occlusal surface.
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Electrical Techniques
INTRODUCTION
Electrical Caries Monitor (ECM)
•Definition
•Terminologies

•Uses alternating current and measures the bulk resistance

CLIN. FEATURES of tooth tissue.
•Pattern
•Stages •The porosity of caries lesions is filled with fluids with high
concentration of ions from the oral environment, and this
CONSEQUENCES more porous tissue decreases electrical resistance or
impedance more than the sound dental tissue.
DIAGNOSIS
•ECM is able to detect and quantify this difference.
•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Electrical Techniques
INTRODUCTION
Electrical Caries Monitor (ECM)
•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION (a) The ECM machine, (b) the ECM handpiece

(c) site specific measurement technique
(d) surface specific measurement technique.
 Dye Penetration Techniques
INTRODUCTION
Dyes For Detection Of Carious Enamel
•Definition
•Terminologies

CLIN. FEATURES
Procion dyes: stain enamel lesions but staining becomes
•Pattern irreversible because dye reacts with nitrogen and hydroxyl
•Stages
groups of enamel and acts as a fixative

CONSEQUENCES
Fluorescent dyes: like Calcein, Zyglo ZL-22 has been
used in vitro and not suitable for in vivo. Dye is made
DIAGNOSIS visible by ultraviolet illumination
•Case History
•Clin. exam Calcein dyes: makes a complex with calcium and remains
•Detect Caries bound to the lesion
•Risk Assessment

Brilliant blue: used to enhance diagnostic quality of

DIFFERENCE
fiberoptic transillumination.

CONCLUSION
 Dye Penetration Techniques
INTRODUCTION
Dyes For Detection Of Carious Dentin
•Definition
•Terminologies

CLIN. FEATURES 1% Acid red

•Pattern
•Stages
0.5% Basic fuchsin

Methylene blue
CONSEQUENCES

Ruthenium red
DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Axelsson Concept Of Risk
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Axelsson Concept Of Risk
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Axelsson Concept Of Risk
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Axelsson Concept Of Risk
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Cariogram
INTRODUCTION

•Definition A computer program showing a graphical picture that

•Terminologies
illustrate a possible overall caries risk scenario.

CLIN. FEATURES
It expresses as to what extent different etiological
•Pattern factors affect caries risk. (Bratthal , 1996)
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
 Cariogram
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages

CONSEQUENCES

DIAGNOSIS

•Case History
•Clin. exam
•Detect Caries
•Risk Assessment

DIFFERENCE

CONCLUSION
INTRODUCTION

•Definition
•Terminologies

CLIN. FEATURES

•Pattern
•Stages
DENTISTRY FOR THE CHILD & ADOLESCENT – 8th ED (Ralph.
CONSEQUENCES E. Mcdonald, David. R. Avery & Jeffrey. A. Dean)

DIAGNOSIS
HANDBOOK OF PEDIATRIC DENTISTRY - 3rd ED (Angus. C.
Cameron & Richard. P. Widmer)
•Case History
•Clin. exam
•Detect Caries PAEDIATRIC DENTISTRY - 3rd ED (Richard Welbury & Monty
•Risk Assessment Duggal)

DIFFERENCE PEDIATRIC DENTISTRY: INFANCY THROUGH ADOLESCENCE

(Paul S. Casamassimo, Henry W. Fields , Dennis J. McTigue, Arthur
CONCLUSION Nowak)

TEXT BOOK OF PEDIATRIC DENTISTRY – Shobha Tandon

thank you…