Caries Diagnosis: Important Points to Consider

How early is too early when it comes to caries detection?
It has been established that the signs and symptoms of caries form a continuum of changes ranging from barely discernible at the ultrastructural level to overt cavities. This has led to the development of diagnostic methods that aim to identify caries lesions at the earliest stage of development possible, in order to increase the opportunity for success with non-operative interventions, such as fluoride treatment. However, some argue that there may be consequences to “too early” detection. These include the possibility of more false-positive diagnoses because caries lesion diagnosis (like any other measurement process) is prone to certain levels of error, and this could lead to unnecessary non-operative treatment.2 Also, many subclinical lesions regress without active intervention thanks to the natural remineralization processes that take place in biofilm.30 In order to avoid the potential for unnecessary treatment of any kind, the use of techniques more advanced than the visual-tactile examination should continue to be used with caution, with the clinician recognizing these are tools to help them determine the best approaches to follow. By following the ICDEA criteria closely, coupled with any assessment tools they have available, it is likely that better clinical outcomes can be achieved for all ages of patients.

Should pediatricians help in diagnosing caries?
Caries is the most common American chronic childhood disease, yet not all pediatricians are trained in oral care and oral health of infants and children. It is becoming increasingly evident that it is important to educate healthcare providers about how to detect early signs of caries, because this will help to increase the opportunity for non-operative interventions. Pediatricians see children more frequently than dentists because of nationally and internationally recommended vaccination schedules, and because of the frequency of well-visits in infancy and early childhood. One study conducted in the United States found that pediatric primary-care providers who did 2 hours of training on the oral health of infants were able to identify a cavitated lesion with a level of accuracy similar to that of pediatric dentists.31 A more recent study reported that “the American Academy of Pediatrics recommends periodic oral health risk assessments (OHRAs) for young children to prevent early childhood caries and promote oral health.”32 It would be advisable for pediatricians to be familiar with the ICDAS scoring criteria, as their partnership with pediatric dentists could prove to be even more beneficial.