4.2 Caries Diagnosis

Slowly Progressing Lesions

Slowly progressing lesions are those that have demonstrated some continued progression since the last examination. These may warrant restoration or more aggressive prevention activities than previously planned, such as home use of prescription fluorides and detailed, targeted patient education. If the dentist elects not to restore a slowly progressing lesion, the patient’s recall interval should be shorter than 12 months to allow for monitoring lesion progression.

Rapidly Progressing Lesions

Rapidly progressing lesions, even in the outer third of dentin, usually require surgical restorative treatment along with preventive regimens and a short recall interval.

Surgical Restorative Treatment

Surgical restorative treatment is recommended only for lesions that have either cavitated or progressed to the inner two-thirds of the dentin.32 For patients who have had slowly progressing lesions restored, recall intervals can usually be longer than they are for those who have rapidly progressing lesions.

As with the restoration of pit-and-fissure lesions, during restorative treatment, the dentist should note the depth and characteristics of the caries to confirm the diagnosis of lesions. Slowly progressing lesions usually have dentin that is stained and harder, while in rapidly progressing lesions the dentin is not stained, is soft, and excavates easily.

Dentists should inform patients about their options and ask them for input on their treatment. Patients should participate in making decisions about restoration vs. continued attempts at remineralization.

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