Caries Diagnosis: Definition

The Medical Perspective
Dentistry has often turned to medicine when searching for clarification of concepts and methodology, including when it comes to caries diagnosis. The medical perspective of caries diagnosis is as such: “the recognition of a disease or a condition by its outward signs and symptoms.”4 It involves recognition of signs and symptoms, devising tentative hypotheses about the underlying disease based on these signs, gathering information by doing a physical examination, running what are thought to be the most appropriate diagnostic tests, using the test results to confirm or refute the tentative diagnosis, and, if necessary, choosing an alternative diagnosis. A doctor is encouraged to repeat the 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 and the doctor needs to revise the diagnosis.1,3,4

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 controlling 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 determining which treatment can best help the patient. Therefore, in the dental perspective of caries diagnosis, diagnosis consists of both identifying caries as a biofilm disease and managing it, and identifying specific signs and symptoms of caries, the non-cavitated to cavitated lesion continuum and managing the lesion activity; working under the logic that caries can be prevented, slowed, stopped, or even reversed through the process of remineralization if it is detected and treated before it progresses to a point that requires invasive intervention.1,3,4

Diagnosis vs. Detection and Assessment
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.5 While diagnosing caries requires a dentist to conduct a thorough evaluation of all information related to a patient, lesion detection employs an objective process to establish whether any signs of the disease are present at the time of evaluation. If demineralization at any stage is observed—at whatever stage—it is labeled as dental caries. Once it has been determined that a lesion is present, the function of lesion assessment is to classify the lesion and observe it over time.5,6