4.2 Caries Diagnosis

Issues important for thorough caries diagnosis, documentation, and treatment include:

• Size, quality, and location of lesions
• Location and quality of stained fissures
• Activity of non-cavitated and cavitated lesions
• Depth of lesions
• Rate of progression of lesions
• Recurrent caries
• Defective restorations
• Previous extractions

Size, Quality, and Location of Lesions

The size, quality, and location of white spot lesions factor heavily into treatment options. The dentist must determine whether the color change in the tooth is intrinsic and not related to demineralization (i.e., fluorosis or other enamel opacities related to enamel development) or whether it is associated with demineralization and caries.

White spot lesions associated with caries tend to occur in areas where plaque accumulates: the gingival margin, around occlusal pits and fissures, just below the interproximal contact area, and at the margins of restorations. Smooth, opaque, shiny lesions are usually already remineralized and “arrested.” Chalky, rough enamel indicates active decay.

When in doubt about the quality of the lesion, the dentist should dry the tooth and examine it for chalkiness. Only when there is uncertainty about whether a cavitation is present, the dentist can place the explorer tip in contact with the tooth surface and move it very gently in the area of interest to see if a discontinuity or break is detected.

Non-cavitated lesions can remineralize and heal to restore the natural contour of the tooth if the crystalline structure has not been disturbed. White spot lesions can be reversed with effective home care and preventive regimens. Preventive strategies, risk categorization, and recall interval are highly dependent on the dentist’s assessment of white spot lesions that are present. White spot lesions that are active or questionable should dictate an elevated risk category, strong emphasis on home-care regimens, and shorter recall intervals.

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