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 catch caries lesion development at the earliest stage 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 more false-positive diagnoses because caries lesion diagnosis (like any other measurement process) is prone to error, and this may 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.27 In addition, the visual or visual–tactile clinical examination is the only method that allows a distinction between active and inactive non-cavitated lesions. Use of more advanced techniques than the visual–tactile examination will only add to the problem of unnecessary non-operative treatment, because none available so far can distinguish between inactive and active lesions.2

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 intervention. Pediatricians see children more frequently than dentists because of the nationally and internationally recommended vaccination schedule, 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.28