The diagnosis of carious lesions

Dental caries, or cavities, is a chronic infectious disease experienced by more than 90 percent of adults in the United States. Recent changes in the epidemiology of dental caries have altered the presentation of the disease so that among children age 5 to 17 years, about 75 percent of the disease is now experienced in 25 percent of the population. Also, as understanding of the disease process has matured, the range of management strategies for dental caries has broadened.

Interventions to arrest or reverse the demineralization process that characterizes the development of a carious lesion are available, and several strategies for identifying those persons representing the quarter of the population who will experience an elevated incidence of dental caries have been reported.

The growing sophistication in available interventions for prevention and nonsurgical treatment of dental caries is matched by a similar increase in the available methods for diagnosis of carious lesions. The diagnosis of carious lesions has been primarily a visual process, based principally on clinical inspection and review of radiographs. Tactile information obtained through use of the dental explorer or "probe" has also been used in the diagnostic process. The development of some alternative diagnostic methods, such as fiber-optic transillumination (FOTI) and direct digital imaging, continue to rely on the dentist's interpretation of visual cues, while other emerging methods, such as electrical conductance (EC) and computer analysis of digitized radiographic images, offer the first "objective" assessments, where visual and tactile cues are either supplemented or supplanted by quantitative measurements.

This relatively recent growth in alternatives available for both diagnosis and management of dental caries has yet to be fully assimilated by dental practice. Thorough reviews of methods for diagnosis and management of dental caries should assist in that assimilation process.