Caries Diagnosis Definition

The Medical Perspective

Dentistry has often turned to medicine for guidance in clarifying concepts and methodologies, including when it comes to caries diagnosis. From a medical standpoint, caries diagnosis is as such: “the recognition of a disease or a condition by its outward signs and symptoms.”¹⁴ This process involves identifying signs and symptoms, devising tentative hypotheses about the underlying disease based on these signs, gathering information by doing a physical examination, and performing appropriate diagnostic tests. The test results are then used to confirm or refute the tentative diagnosis, and, if necessary, choose an alternative diagnosis. Physicians are encouraged to repeat this cycle of symptom recognition and testing of alternative hypotheses until the final diagnosis is reached, or if the prescribed treatment does not have the desired effect then to reassess and adjust the diagnosis accordingly.

The Dental Perspective

However, the medical perspective of caries may not work perfectly when it comes to dental caries. The main task for the dentist is not to find out what disease the patient has, but having identified a patient with dental caries, to determine the best course of treatment for managing the disease process in the biofilm. Also, the dentist needs to identify whether or not individual teeth have caries lesions, with the help of screening even patients who do not have obvious signs of caries, and determine the most appropriate treatment for the patient. Therefore, from a dental perspective, caries diagnosis, involves both identifying caries as a biofilm disease and managing it, as well as recognizing specific signs and symptoms of caries, the continuum of non-cavitated to cavitated lesions, and managing the lesion activity. This approach works under the premise that caries can be prevented, slowed, stopped, or even reversed through the process of remineralization if detected and treated before progressing to a point requiring invasive intervention.

Diagnosis vs. Detection and Assessment

Caries diagnosis is often described as the process of identifying a disease based on its observable signs and symptoms, while caries detection refers to the identification of these signs and symptoms.¹ The diagnosis of dental caries should be based on known disease indicators and risk factors for the disease. Caries disease indicators include: visible cavitations, active white-spot lesions, interproximal radiographic lesions penetrating to the dentin, and a history of any cavitations in the previous 2 to 3 years.¹⁶ However, there is often ambiguity in the literature regarding the distinction between caries detection and diagnosis.¹⁷ Over the past decade, three key terms have been clarified in relation to preventive caries care: lesion detection, which involves using objective methods to determine the presence of disease;¹⁸ lesion assessment, which focuses on characterizing or monitoring a lesion once it is detected;¹⁹ and caries diagnosis, which should represent a comprehensive evaluation by a healthcare professional, integrating all available data.¹⁶

If demineralization at any stage is observed—at whatever stage—it is labeled as dental caries.