4.1 Oral Examination

X-rays

For many dentists, X-rays are the primary tool for diagnosing interproximal caries. These dentists view X-rays first to look for interproximal lesions and then continue the caries examination in the mouth. This practice can be misleading and can lead to the unnecessary restoration of arrested or incipient interproximal lesions.21,22

Instead, X-rays should be used to confirm lesions that have been discovered during the examination.23–25 X-rays should be used to follow the disease process to determine whether caries is progressing, arrested, or remineralizing. Patients with progressing lesions should be placed in higher risk categories than those with stable or remineralized lesions. Bitewing X-rays are also useful to identify interproximal incipient lesions and to confirm diagnosis and assess the depth of occlusal lesions.23,26

Given the lack of accuracy in X-ray diagnosis of caries and the fact that caries progression in patients proceeds at different rates, decisions about whether to treat incipient lesions should be based on a combination of X-rays and the dentist’s clinical assessment. Risk classification plays an important role here. Incipient lesions in a patient at moderate risk for dental caries may be safely observed for progression over a 6- to 12-month recall interval, since lesions in this risk category are likely to be arrested or slowly progressing. In patients at high or very high risk, however, whose lesions are likely to be active and unlikely to be arrested or slowly progressing, a lesion with the same radiographic appearance should be aggressively monitored (with a recall interval closer to 3 months) to assess lesion activity.

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