4.2 Caries Diagnosis

Non-Cavitated and Cavitated Lesions

Arrested Lesions

The dentist should assess the activity of both non-cavitated and cavitated lesions.28 Arrested lesions, or those that no longer contain odontopathic bacteria and have remineralized, often require no treatment, even if they are cavitated. Arrested lesions are smooth and shiny, and they range in color from white opacities to dark brown. The need to restore an arrested cavitated lesion is determined by the need to restore form, function, and sometimes esthetics to the tooth.

Active Lesions

Active lesions are those that harbor odontopathic bacteria and are demineralizing. They require caries management (preventive strategies, restoration, or extraction) based on cavitation, location, and rate of progression.

The goal of caries management is to eliminate caries-causing bacteria and to enhance the ability of the tooth to remineralize. Carious lesions that are not cavitated should not be restored. However, if the enamel or dentinal matrix is not intact or if the destruction is too deep, the infected matrix must be surgically removed (excavated as part of preparation with a bur) and the tooth restored to form and function.

If the tooth is unrestorable, extraction is the treatment of choice. Correctly diagnosing lesions as actively carious or arrested is important for determining risk classification, planning treatment, and setting recall intervals. The dentist should assess each lesion using historical and current information as well as modifying factors.

BACK

NEXT