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Jo Frencken
Philips van Leijdenlaan 25
NL–6525 AX Nijmegen (The Netherlands)
E-Mail [email protected]
The Philosophical Evolution
Schwendicke F, Frencken J, Innes N (eds): Caries Excavation: Evolution of Treating Cavitated Carious Lesions.
Monogr Oral Sci. Basel, Karger, 2018, vol 27, pp 24–31 (DOI: 10.1159/000487828)
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Carious Lesion Diagnosis: Methods, Problems, Thresholds
Klaus W. Neuhaus · Adrian Lussi
Department of Preventive, Restorative and Pediatric Dentistry, Bern, Switzerland
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Abstract
The difference between carious lesion diagnosis and carious lesion detection is discussed here. Concerning carious lesions, 3 diagnostic requirements should be fulfilled: to detect lesions, to assess surface integrity, and to assess lesion activity to support clinical decision making. The first and most important diagnostic method is meticulous visual-tactile inspection. This is the only method that potentially contributes to all 3 diagnostic requirements. All other methods that are presented in this chapter, i.e., bitewing radiography, fluorescence-based technologies, and transillumination methods, are limited to assessing lesion depth in surfaces that are not visible to the eye and thus contribute to lesion detection only. At the end of the chapter, recent developments in objective lesion activity assessment are presented.
© 2018 S. Karger AG, Basel
Detection versus Diagnosis of Caries
In general, most dental practitioners’ use the term “caries diagnosis” synonymously with “caries detection” [1]. This might derive from the fact that the therapeutic step is indirectly linked to the diagnostic step [2, 3]. Because therapy is remunerated, and operative intervention more so than non-operative intervention, a dichotomous “caries yes/no thinking” is often employed in daily practice – although this is not sufficient. However, it is worthwhile considering the distinct differences between these two terms.
“Caries detection” means the discrimination between a healthy tooth surface and a tooth surface affected by a carious lesion to a certain degree. To a great extent the different methods of caries detection aim at staging the caries process in order to facilitate treatment decision making: initial stages of caries usually require different treatment options than further progressed stages. In this respect, caries detection also and most importantly involves the assessment of surface integrity of a tooth. Once a frank cavitation occurs
