4.2 Caries Diagnosis

Defective Restorations

Some types of defective restorations in an otherwise clean mouth probably do not harbor odontopathic bacteria and need be treated only to resolve symptomatology associated with them. For example, an anterior restoration that is not a good color match may be considered defective. It should be replaced only if the patient finds it esthetically objectionable and feels that restoration is worthwhile.

If treatment such as the replacement of defective fillings is all that is required, the treatment plan will not include other strategies or procedures aimed at eliminating a carious infection. If an anterior restoration has caries at the margins, however, an appropriate treatment plan would include restoration replacement, patient education, and procedures to address the infection. In the absence of dental caries, defective fillings alone do not affect a patient’s risk category or recall interval.

Dentists also need to assess sealants for complete retention.34 Teeth with sealants that are missing or only partially retained should be evaluated for active caries. The dentist should either reseal the tooth or provide PRR or restoration, whichever is appropriate. The need to reseal a tooth does not place a patient at higher risk for caries, but caries around an intact or partially retained sealant affects the patient’s risk category and recall interval.

Previous Extractions

During the examination, the dentist should document reasons for previous extractions. Patients who have lost teeth due to caries (i.e., because of non-restorability or pulpal involvement) are at risk for losing more teeth. Extractions are a critical piece of caries history.

For extractions performed at the dental office or clinic, documentation is often found in the patient record. In other cases, the dentist may need to ask the patient why a tooth or teeth were extracted. Assessment of current oral conditions and caries patterns can be used to determine probable cause of previous tooth loss. Extractions for reasons such as orthodontics, trauma, or periodontal disease do not place a patient at higher risk for caries.

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