4.2 Caries Diagnosis

Depth of Lesions

Estimating the depth of lesions is critical in developing a treatment plan. Carious lesions in the enamel can be non-cavitated, cavitated, arrested, slowly progressing, or rapidly progressing. Evidence supports the ability of non-cavitated, organically intact but demineralized enamel lesions to remineralize and heal.11, 29–31

Non-Cavitated vs. Cavitated Lesions

Non-cavitated (incipient) lesions in pits and fissures can be effectively treated with sealants. The dentist may plan a PRR if the depth of the lesion is not known or if the enamel lesion is cavitated and small. Non-cavitated smooth-surface lesions can be healed by tipping the balance toward remineralization with fluorides, improved oral hygiene, and fewer exposures to foods high in sugar.

In approximal permanent tooth surfaces, zero percent of radiolucencies in the outer half of enamel and 10.5 percent in the inner half of enamel have been found clinically to be cavitated, so the dentist can comfortably treat interproximal enamel lesions with non-invasive caries-management regimens and monitor them to see if they progress.32 Short recall intervals are required until it is clear that lesions are arrested.

Fifty-nine percent of carious lesions in permanent molars in the outer half of dentin have been shown clinically to be non-cavitated, while 100 percent of lesions extending into the inner half of dentin have been found to be cavitated.24 Non-cavitated dentinal lesions in the outer third of the dentin can also remineralize.16 Patients with non-cavitated lesions that have not progressed since the last examination need only fluorides, reinforcement, and patient education. Recall intervals for arrested lesions, even in dentin, can be longer than 6 to 12 months.

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