Advertisement

European Archives of Paediatric Dentistry

, Volume 17, Issue 1, pp 13–25 | Cite as

Detection and monitoring of early caries lesions: a review

  • I. A. PrettyEmail author
  • K. R. Ekstrand
Original Scientific Article

Abstract

Aim

To review the current evidence base of detecting and monitoring early carious lesions in children and adolescents and a rationale proposed to ensure that such lesions are identified and appropriately managed.

Methods

The systematic literature search identified initially a review by Gomez and co-workers from 2013 and this still represents the current state of the science in relation to caries detection and monitoring. The review described among others, visible detection systems, image-based detection systems and point-measurement approaches.

Results

The current evidence base suggests that while there are numerous devices or technology-enabled detection systems, the use of a careful, methodical visual inspection of clean, dry teeth, supplemented where indicated by radiographic views, remains the standard of care in caries detection and diagnostics. Further, it is possible by means of existing visible and radiographical systems to monitor lesions over time. Using low-cost intra-oral cameras facilitates the recording of lesion appearance in the patient record and may be of significant benefit in monitoring early lesions over time following their detection. This benefit extends to the clinician and the patient for whom it may be a useful educational and motivational tool.

Conclusions

Recommendations are presented that can be adopted and adapted to local circumstances and that are both substantiated by evidence and promote a clear, simple and consistent approach to caries detection, diagnosis and monitoring in children and adolescents. The diagnoses (initial, active; moderate, active and extensive, active) are linked to appropriate management options within primary care.

Keywords

Caries Detection Diagnosis Early lesions Management 

Notes

Acknowledgments

The former Chief Dental Health Officer Christian Christiansen and former Dentist Jette Christiansen, Nexö Public Dental Health Service, are both thanked for letting us use the images in Figs. 3 and 4 in this paper.

References

  1. Agustsdottir H, Gudmundsdottir H, Eggertsson H, et al. Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS. Community Dent Oral Epidemiol. 2010;38:299–309.CrossRefPubMedGoogle Scholar
  2. Attrill DC, Ashley PF. Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods. Br Dent J. 2001;190:440–3.PubMedGoogle Scholar
  3. Bader JD, Shugars DA. A systematic review of the performance of a laser fluorescence device for detecting caries. J Am Dent Assoc. 2004;135:1413–26.CrossRefPubMedGoogle Scholar
  4. Bjørndal L, Kidd EA. The treatment of deep dentine caries lesions. Dent Update. 2005;32:402–4, 407–10, 413.Google Scholar
  5. Bloemendal E, de Vet HC, Bouter LM. The value of bitewing radiographs in epidemiological caries research: a systematic review of the literature. J Dent. 2004;32:255–64.CrossRefPubMedGoogle Scholar
  6. Boye U, Walsh T, Pretty IA, Tickle M. Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard. BMC Oral Health. 2012;27(12):10. doi: 10.1186/1472-6831-12-10.CrossRefGoogle Scholar
  7. Boye U, Willasey A, Walsh T, Tickle M, Pretty IA. Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children. Community Dent Oral Epidemiol. 2013;41(6):526–33. doi: 10.1111/cdoe.12049.CrossRefPubMedGoogle Scholar
  8. Braga MM, Ekstrand KR, Martignon S, et al. Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth. Caries Res. 2010a;44:300–8.CrossRefPubMedGoogle Scholar
  9. Braga MM, Mendes FM, Ekstrand KR. Detection activity assessment and diagnosis of dental caries lesions. Dent Clin North Am. 2010b;54:479–93.CrossRefPubMedGoogle Scholar
  10. Carvalho JC, Ekstrand KR, Thylstrup A. Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption. J Dent Res. 1989;68:773–9.CrossRefPubMedGoogle Scholar
  11. Carvalho JC, Ekstrand KR, Thylstrup A. Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol. 1991;9:23–8.CrossRefGoogle Scholar
  12. Carvalho JC, Thylstrup A, Ekstrand KR. Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol. 1992;20:187–92.CrossRefPubMedGoogle Scholar
  13. Côrtes DF, Ekstrand KR, Elias-Boneta AR, Ellwood RP. An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth. Caries Res. 2000;34:443–7.CrossRefPubMedGoogle Scholar
  14. Côrtes DF, Ellwood RP, Ekstrand KR. An in vitro comparison of a combined FOTI/visual examination of occlusal caries with other caries diagnostic methods and the effect of stain on their diagnostic performance. Caries Res. 2003;37:8–16.CrossRefPubMedGoogle Scholar
  15. Dirks B. Posteruptive changes in dental enamel. J Dent Res. 1966;45:503–11.CrossRefGoogle Scholar
  16. Ekstrand KR. How to maintain sound teeth: an individualized population strategy for children and adolescents. In: Meyer-Lückel H, Paris S, Ekstrand KR, editors. Caries Management—science and clinical practice. Stuttgart: Thieme; 2013. p. 306–10.Google Scholar
  17. Ekstrand KR, Qvist V. The impact of a national caries strategy in Greenland after 4 years. Int J Paediatr Dent 2014. doi: 10.1111/ipd.12138 [Epub ahead of print].
  18. Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res. 1997;31:224–31.CrossRefPubMedGoogle Scholar
  19. Ekstrand KR, Bruun G, Bruun M. Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res. 1998a;32:41–5.CrossRefPubMedGoogle Scholar
  20. Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, Schou S. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res. 1998b;32:247–54.CrossRefPubMedGoogle Scholar
  21. Ekstrand KR, Ricketts DN, Longbottom C, Pitts NB. Visual and tactile assessment of arrested initial enamel carious lesions: an in vivo pilot study. Caries Res. 2005;39:173–7.CrossRefPubMedGoogle Scholar
  22. Ekstrand KR, Martignon S, Ricketts DJ, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent. 2007;32:225–35.CrossRefPubMedGoogle Scholar
  23. Ekstrand KR, Luna LE, Promisiero L et al. The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study. Caries Res. 2011;45:93–9.CrossRefPubMedGoogle Scholar
  24. Ellwood RP, Gomez J, Pretty IA. Caries clinical trial methods for the assessment of oral care products in the 21st century. Adv Dent Res. 2012;24:32–5.CrossRefPubMedGoogle Scholar
  25. Espelid I, Mejàre I, Weerheijm K. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003;4:40–8.PubMedGoogle Scholar
  26. Ferreira Zandoná A, Santiago E, Eckert GJ, et al. The natural history of dental caries lesions: a 4-year observational study. J Dent Res. 2012;91:841–6.PubMedCentralCrossRefPubMedGoogle Scholar
  27. Fyffe HE, Deery C, Nugent ZJ, Nuttall NM, Pitts NB. Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM). Community Dent Oral Epidemiol. 2000;28:42–51.CrossRefPubMedGoogle Scholar
  28. Gomez J, Tellez M, Pretty IA, Ellwood RP, Ismail AI. Non-cavitated carious lesions detection methods: a systematic review. Community Dent Oral Epidemiol. 2013;41:54–66.PubMedGoogle Scholar
  29. Goodwin M, Sanders C, Davies G, Walsh T, Pretty IA. BMC Oral Health. 2015;15:3. doi: 10.1186/1472-6831-15-3.
  30. Guedes RS, Piovesan C, Ardenghi TM, et al. Validation of visual caries activity assessment: a 2-yr cohort study. J Dent Res. 2014;93(7 suppl):101S–7S.PubMedCentralCrossRefPubMedGoogle Scholar
  31. Guedes RS, Piovesan C, Floriano I, et al. Risk of initial and moderate caries lesions in primary teeth to progress to dentine cavitation: a 2-year cohort study. Int J Paediatr Dent. 2015. doi: 10.1111/ipd.12166.
  32. Ismail AI, Tellez M, Pitts NB, et al. Caries management pathways preserve dental tissues and promote oral health. Community Dent Oral Epidemiol. 2013;41:e12–40. doi: 10.1111/cdoe.12024.CrossRefPubMedGoogle Scholar
  33. Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015. doi: 10.1177/0022034515573272.
  34. Keyes PH. The infectious and transmissible nature of experimental dental caries: findings and implications. Arch Oral Biol. 1960;1:304.Google Scholar
  35. Kühnisch J, Bücher K, Henschel V, et al. Diagnostic performance of the universal scoring system (UniViSS) on occlusal surfaces. Clin Oral Investig. 2011;15:215–23.CrossRefPubMedGoogle Scholar
  36. Lillehagen M, Grindefjord M, Mejàre I. Detection of approximal caries by clinical and radiographic examination in 9-year-old Swedish children. Caries Res. 2007;41(3):177–85.CrossRefPubMedGoogle Scholar
  37. Longbottom CL, Huysmans MC, Pitts NB, Fontana M. Glossary of key terms. Monogr Oral Sci. 2009;21:209–16.CrossRefPubMedGoogle Scholar
  38. Maltz M, Alves LS. Incomplete caries removal significantly reduces the risk of pulp exposure and post-operative pulpal symptoms. J Evid Based Dent Pract. 2013;13:120–2.CrossRefPubMedGoogle Scholar
  39. Mejáre I. Bitewing examination to detect caries in children and adolescents—when and how often? Dent Update. 2005;32:588–90, 593–4, 596–7.Google Scholar
  40. Mejàre I, Stenlund H. Caries rates for the mesial surface of the first permanent molar and the distal surface of the second primary molar from 6 to 12 years of age in Sweden. Caries Res. 2000;34:454–61.CrossRefPubMedGoogle Scholar
  41. Mejàre I, Gröndahl HG, Carlstedt K, Grevér AC, Ottosson E. Accuracy at radiography and probing for diagnosis of peoximal caries. Scand J Dent Res. 1985;93:178–84.PubMedGoogle Scholar
  42. Mejàre I, Källestål C, Stenlund H, Johansson H. Caries development from 11 to 22 years of age: a prospective radiographic study. Prevalence and distribution. Caries Res. 1998;33:93–100.Google Scholar
  43. Mejàre I, Stenlund H, Zelezny-Holmlund C. Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden. Caries Res. 2004;38:130–41.CrossRefPubMedGoogle Scholar
  44. Meyer-Lückel H, Paris S, Ekstrand KR. Caries Management—science and clinical practice. Stuttgart: Thieme; 2013.CrossRefGoogle Scholar
  45. Miller WD. The microorganisms of the human mouth. Philadelphia, PA: S.S. White Dental Mfg. Co. 1890.Google Scholar
  46. Miller WD. The human mouth as a focus of infection. Dent Cosmos. 1891;33:689, 789, 913.Google Scholar
  47. Monaghan N, Davies GM, Jones CM, Neville JS, Pitts NB. The caries experience of 5-year-old children in Scotland, Wales and England in 2011–2012: reports of cross-sectional surveys using BASCD criteria. Community Dent Health. 2014a;2:105–10.Google Scholar
  48. Monaghan N, Davies GM, Jones CM, Neville JS, Pitts NB. The caries experience of 5-year-old children in Scotland, Wales and England in 2011–2012: reports of cross-sectional surveys using BASCD criteria. Community Dent Health. 2014b;31:105–10.PubMedGoogle Scholar
  49. Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res. 1999;33:252–60.CrossRefPubMedGoogle Scholar
  50. Nyvad B, Machiulskiene V, Baelum V. Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J Dent Res. 2003;82:117–22.CrossRefPubMedGoogle Scholar
  51. Peers A, Hill FJ, Mitropoulos CM, Holloway PJ. Validity and reproducibility of clinical examination, fibre-optic transillumination, and bite-wing radiology for the diagnosis of small approximal carious lesions: an in vitro study. Caries Res. 1993;27(4):307–11.CrossRefPubMedGoogle Scholar
  52. Pitts N. “ICDAS”—an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health. 2004;21:193–8.PubMedGoogle Scholar
  53. Pitts NB, Rimmer PA. An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. Caries Res. 1992;26:146–52.CrossRefPubMedGoogle Scholar
  54. Pitts NB, Stamm JW. International consensus workshop on Caries Clinical Trials (ICW-CCT)—final consensus statements: agreeing where the evidence leads. J Dent Res. 2004;83 Spec No C:C125–8.Google Scholar
  55. Pitts NB, Ismail AI, Martignon S, et al. ICCMS™ guide for practitioners and educators, 2014—see https://www.icdas.org/uploads/ICCMS-Guide_Full_Guide_UK.pdf.
  56. Pretty IA. Caries detection and diagnosis: novel technologies. J Dent. 2006;34:727–39.CrossRefPubMedGoogle Scholar
  57. Pretty IA, McGrady M, Zakian C, et al. Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting. BMC Public Health. 2012;20(12):366. doi: 10.1186/1471-2458-12-366.CrossRefGoogle Scholar
  58. Pretty IA, Ellwood RP. The caries continuum: opportunities to detect, treat and monitor the re-mineralization of early caries lesions. J Dent. 2013;41(Suppl 2):S12–21. doi: 10.1016/j.jdent.2010.04.003.CrossRefPubMedGoogle Scholar
  59. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;69:51–9.CrossRefGoogle Scholar
  60. Shwartz M, Gröndahl HG, Pliskin JS, Boffa J. A longitudinal analysis from bite-wing radiographs of the rate of progression of approximal carious lesions through human dental enamel. Arch Oral Biol. 1984;29:529–36.CrossRefPubMedGoogle Scholar
  61. Söchtig F, Reinhard H, Kühnisch J. Caries detection and diagnostics with near-infrared light transillumination: clinical experiences. Quintessence Int. 2014;45:531–8.PubMedGoogle Scholar
  62. Tellez M, Gomez J, Kaur S, et al. Non-surgical management methods of noncavitated carious lesions. Community Dent Oral Epidemiol. 2013;41:79–96.CrossRefPubMedGoogle Scholar
  63. Thylstrup A, Bruun C, Holmen L. In vivo caries models—mechanisms for caries initiation and arrestment. Adv Dent Res. 1994;8:144–57.PubMedGoogle Scholar
  64. van der Veen MH, de Josselin de Jong E. Application of quantitative light-induced fluorescence for assessing early caries lesions. Monogr Oral Sci. 2000;17:144–62.CrossRefPubMedGoogle Scholar
  65. Wenzel A, Fejerskov O. Validity of diagnosis of questionable caries lesions in occlusal surfaces of extracted third molars. Caries Res. 1992;26:188–94.CrossRefPubMedGoogle Scholar
  66. Yin W, Hu DY, Li X, et al. The anti-caries efficacy of a dentifrice containing 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate assessed using quantitative light-induced fluorescence (QLF). J Dent. 2013;41(Suppl 2):S22–8. doi: 10.1016/j.jdent.2010.04.004.CrossRefPubMedGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2015

Authors and Affiliations

  1. 1.The Dental Health Unit, School of DentistryThe University of ManchesterManchesterUK
  2. 2.Department of Odontology, Cariology and Endodontics, Faculty of Health and medical SciencesUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations