Abstract
Aim
To review the current evidence base of detecting and monitoring early carious lesions in children and adolescents and a rationale proposed to ensure that such lesions are identified and appropriately managed.
Methods
The systematic literature search identified initially a review by Gomez and co-workers from 2013 and this still represents the current state of the science in relation to caries detection and monitoring. The review described among others, visible detection systems, image-based detection systems and point-measurement approaches.
Results
The current evidence base suggests that while there are numerous devices or technology-enabled detection systems, the use of a careful, methodical visual inspection of clean, dry teeth, supplemented where indicated by radiographic views, remains the standard of care in caries detection and diagnostics. Further, it is possible by means of existing visible and radiographical systems to monitor lesions over time. Using low-cost intra-oral cameras facilitates the recording of lesion appearance in the patient record and may be of significant benefit in monitoring early lesions over time following their detection. This benefit extends to the clinician and the patient for whom it may be a useful educational and motivational tool.
Conclusions
Recommendations are presented that can be adopted and adapted to local circumstances and that are both substantiated by evidence and promote a clear, simple and consistent approach to caries detection, diagnosis and monitoring in children and adolescents. The diagnoses (initial, active; moderate, active and extensive, active) are linked to appropriate management options within primary care.
Similar content being viewed by others
References
Agustsdottir H, Gudmundsdottir H, Eggertsson H, et al. Caries prevalence of permanent teeth: a national survey of children in Iceland using ICDAS. Community Dent Oral Epidemiol. 2010;38:299–309.
Attrill DC, Ashley PF. Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods. Br Dent J. 2001;190:440–3.
Bader JD, Shugars DA. A systematic review of the performance of a laser fluorescence device for detecting caries. J Am Dent Assoc. 2004;135:1413–26.
Bjørndal L, Kidd EA. The treatment of deep dentine caries lesions. Dent Update. 2005;32:402–4, 407–10, 413.
Bloemendal E, de Vet HC, Bouter LM. The value of bitewing radiographs in epidemiological caries research: a systematic review of the literature. J Dent. 2004;32:255–64.
Boye U, Walsh T, Pretty IA, Tickle M. Comparison of photographic and visual assessment of occlusal caries with histology as the reference standard. BMC Oral Health. 2012;27(12):10. doi:10.1186/1472-6831-12-10.
Boye U, Willasey A, Walsh T, Tickle M, Pretty IA. Comparison of an intra-oral photographic caries assessment with an established visual caries assessment method for use in dental epidemiological studies of children. Community Dent Oral Epidemiol. 2013;41(6):526–33. doi:10.1111/cdoe.12049.
Braga MM, Ekstrand KR, Martignon S, et al. Clinical performance of two visual scoring systems in detecting and assessing activity status of occlusal caries in primary teeth. Caries Res. 2010a;44:300–8.
Braga MM, Mendes FM, Ekstrand KR. Detection activity assessment and diagnosis of dental caries lesions. Dent Clin North Am. 2010b;54:479–93.
Carvalho JC, Ekstrand KR, Thylstrup A. Dental plaque and caries on occlusal surfaces of first permanent molars in relation to stage of eruption. J Dent Res. 1989;68:773–9.
Carvalho JC, Ekstrand KR, Thylstrup A. Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol. 1991;9:23–8.
Carvalho JC, Thylstrup A, Ekstrand KR. Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars. Community Dent Oral Epidemiol. 1992;20:187–92.
Côrtes DF, Ekstrand KR, Elias-Boneta AR, Ellwood RP. An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth. Caries Res. 2000;34:443–7.
Côrtes DF, Ellwood RP, Ekstrand KR. An in vitro comparison of a combined FOTI/visual examination of occlusal caries with other caries diagnostic methods and the effect of stain on their diagnostic performance. Caries Res. 2003;37:8–16.
Dirks B. Posteruptive changes in dental enamel. J Dent Res. 1966;45:503–11.
Ekstrand KR. How to maintain sound teeth: an individualized population strategy for children and adolescents. In: Meyer-Lückel H, Paris S, Ekstrand KR, editors. Caries Management—science and clinical practice. Stuttgart: Thieme; 2013. p. 306–10.
Ekstrand KR, Qvist V. The impact of a national caries strategy in Greenland after 4 years. Int J Paediatr Dent 2014. doi:10.1111/ipd.12138 [Epub ahead of print].
Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res. 1997;31:224–31.
Ekstrand KR, Bruun G, Bruun M. Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res. 1998a;32:41–5.
Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, Schou S. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res. 1998b;32:247–54.
Ekstrand KR, Ricketts DN, Longbottom C, Pitts NB. Visual and tactile assessment of arrested initial enamel carious lesions: an in vivo pilot study. Caries Res. 2005;39:173–7.
Ekstrand KR, Martignon S, Ricketts DJ, Qvist V. Detection and activity assessment of primary coronal caries lesions: a methodologic study. Oper Dent. 2007;32:225–35.
Ekstrand KR, Luna LE, Promisiero L et al. The reliability and accuracy of two methods for proximal caries detection and depth on directly visible proximal surfaces: an in vitro study. Caries Res. 2011;45:93–9.
Ellwood RP, Gomez J, Pretty IA. Caries clinical trial methods for the assessment of oral care products in the 21st century. Adv Dent Res. 2012;24:32–5.
Espelid I, Mejàre I, Weerheijm K. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003;4:40–8.
Ferreira Zandoná A, Santiago E, Eckert GJ, et al. The natural history of dental caries lesions: a 4-year observational study. J Dent Res. 2012;91:841–6.
Fyffe HE, Deery C, Nugent ZJ, Nuttall NM, Pitts NB. Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM). Community Dent Oral Epidemiol. 2000;28:42–51.
Gomez J, Tellez M, Pretty IA, Ellwood RP, Ismail AI. Non-cavitated carious lesions detection methods: a systematic review. Community Dent Oral Epidemiol. 2013;41:54–66.
Goodwin M, Sanders C, Davies G, Walsh T, Pretty IA. BMC Oral Health. 2015;15:3. doi:10.1186/1472-6831-15-3.
Guedes RS, Piovesan C, Ardenghi TM, et al. Validation of visual caries activity assessment: a 2-yr cohort study. J Dent Res. 2014;93(7 suppl):101S–7S.
Guedes RS, Piovesan C, Floriano I, et al. Risk of initial and moderate caries lesions in primary teeth to progress to dentine cavitation: a 2-year cohort study. Int J Paediatr Dent. 2015. doi:10.1111/ipd.12166.
Ismail AI, Tellez M, Pitts NB, et al. Caries management pathways preserve dental tissues and promote oral health. Community Dent Oral Epidemiol. 2013;41:e12–40. doi:10.1111/cdoe.12024.
Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of untreated caries: a systematic review and metaregression. J Dent Res. 2015. doi:10.1177/0022034515573272.
Keyes PH. The infectious and transmissible nature of experimental dental caries: findings and implications. Arch Oral Biol. 1960;1:304.
Kühnisch J, Bücher K, Henschel V, et al. Diagnostic performance of the universal scoring system (UniViSS) on occlusal surfaces. Clin Oral Investig. 2011;15:215–23.
Lillehagen M, Grindefjord M, Mejàre I. Detection of approximal caries by clinical and radiographic examination in 9-year-old Swedish children. Caries Res. 2007;41(3):177–85.
Longbottom CL, Huysmans MC, Pitts NB, Fontana M. Glossary of key terms. Monogr Oral Sci. 2009;21:209–16.
Maltz M, Alves LS. Incomplete caries removal significantly reduces the risk of pulp exposure and post-operative pulpal symptoms. J Evid Based Dent Pract. 2013;13:120–2.
Mejáre I. Bitewing examination to detect caries in children and adolescents—when and how often? Dent Update. 2005;32:588–90, 593–4, 596–7.
Mejàre I, Stenlund H. Caries rates for the mesial surface of the first permanent molar and the distal surface of the second primary molar from 6 to 12 years of age in Sweden. Caries Res. 2000;34:454–61.
Mejàre I, Gröndahl HG, Carlstedt K, Grevér AC, Ottosson E. Accuracy at radiography and probing for diagnosis of peoximal caries. Scand J Dent Res. 1985;93:178–84.
Mejàre I, Källestål C, Stenlund H, Johansson H. Caries development from 11 to 22 years of age: a prospective radiographic study. Prevalence and distribution. Caries Res. 1998;33:93–100.
Mejàre I, Stenlund H, Zelezny-Holmlund C. Caries incidence and lesion progression from adolescence to young adulthood: a prospective 15-year cohort study in Sweden. Caries Res. 2004;38:130–41.
Meyer-Lückel H, Paris S, Ekstrand KR. Caries Management—science and clinical practice. Stuttgart: Thieme; 2013.
Miller WD. The microorganisms of the human mouth. Philadelphia, PA: S.S. White Dental Mfg. Co. 1890.
Miller WD. The human mouth as a focus of infection. Dent Cosmos. 1891;33:689, 789, 913.
Monaghan N, Davies GM, Jones CM, Neville JS, Pitts NB. The caries experience of 5-year-old children in Scotland, Wales and England in 2011–2012: reports of cross-sectional surveys using BASCD criteria. Community Dent Health. 2014a;2:105–10.
Monaghan N, Davies GM, Jones CM, Neville JS, Pitts NB. The caries experience of 5-year-old children in Scotland, Wales and England in 2011–2012: reports of cross-sectional surveys using BASCD criteria. Community Dent Health. 2014b;31:105–10.
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res. 1999;33:252–60.
Nyvad B, Machiulskiene V, Baelum V. Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J Dent Res. 2003;82:117–22.
Peers A, Hill FJ, Mitropoulos CM, Holloway PJ. Validity and reproducibility of clinical examination, fibre-optic transillumination, and bite-wing radiology for the diagnosis of small approximal carious lesions: an in vitro study. Caries Res. 1993;27(4):307–11.
Pitts N. “ICDAS”—an international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management. Community Dent Health. 2004;21:193–8.
Pitts NB, Rimmer PA. An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. Caries Res. 1992;26:146–52.
Pitts NB, Stamm JW. International consensus workshop on Caries Clinical Trials (ICW-CCT)—final consensus statements: agreeing where the evidence leads. J Dent Res. 2004;83 Spec No C:C125–8.
Pitts NB, Ismail AI, Martignon S, et al. ICCMS™ guide for practitioners and educators, 2014—see https://www.icdas.org/uploads/ICCMS-Guide_Full_Guide_UK.pdf.
Pretty IA. Caries detection and diagnosis: novel technologies. J Dent. 2006;34:727–39.
Pretty IA, McGrady M, Zakian C, et al. Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting. BMC Public Health. 2012;20(12):366. doi:10.1186/1471-2458-12-366.
Pretty IA, Ellwood RP. The caries continuum: opportunities to detect, treat and monitor the re-mineralization of early caries lesions. J Dent. 2013;41(Suppl 2):S12–21. doi:10.1016/j.jdent.2010.04.003.
Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;69:51–9.
Shwartz M, Gröndahl HG, Pliskin JS, Boffa J. A longitudinal analysis from bite-wing radiographs of the rate of progression of approximal carious lesions through human dental enamel. Arch Oral Biol. 1984;29:529–36.
Söchtig F, Reinhard H, Kühnisch J. Caries detection and diagnostics with near-infrared light transillumination: clinical experiences. Quintessence Int. 2014;45:531–8.
Tellez M, Gomez J, Kaur S, et al. Non-surgical management methods of noncavitated carious lesions. Community Dent Oral Epidemiol. 2013;41:79–96.
Thylstrup A, Bruun C, Holmen L. In vivo caries models—mechanisms for caries initiation and arrestment. Adv Dent Res. 1994;8:144–57.
van der Veen MH, de Josselin de Jong E. Application of quantitative light-induced fluorescence for assessing early caries lesions. Monogr Oral Sci. 2000;17:144–62.
Wenzel A, Fejerskov O. Validity of diagnosis of questionable caries lesions in occlusal surfaces of extracted third molars. Caries Res. 1992;26:188–94.
Yin W, Hu DY, Li X, et al. The anti-caries efficacy of a dentifrice containing 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate assessed using quantitative light-induced fluorescence (QLF). J Dent. 2013;41(Suppl 2):S22–8. doi:10.1016/j.jdent.2010.04.004.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pretty, I.A., Ekstrand, K.R. Detection and monitoring of early caries lesions: a review. Eur Arch Paediatr Dent 17, 13–25 (2016). https://doi.org/10.1007/s40368-015-0208-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40368-015-0208-6