For much of the last century, the diagnosis of dental caries entailed detecting only cavitation.1 Over the last few decades, however, the caries process has been recognized as a biofilm disease characterized by prolonged periods of low pH in the mouth leading to dissolution and net loss of minerals from the teeth. The demineralization of the teeth is now understood as a physiological continuum, and the understanding of caries shifted from a discrete episode of cavitation to an understanding of demineralization as a spectrum that ranges from microporosity to cavitation.2 Because the emphasis in dealing with caries has shifted from surgical repair to strategies that prevent decay, the challenge now to professionals is to provide better criteria for establishing the true state of a given tooth. Therefore, the primary purpose of caries diagnosis is to identify the biofilm disease process and also early signs of tooth demineralization in order to halt its progression.1,2,3
The scientific literature points to three main reasons why caries lesion diagnosis is important:
What follows is a discussion of the different methods of caries lesion diagnosis and how diagnosis and management of the disease are intricately linked.
In the past, clinicians relied primarily on the use of caries measurement systems that relied solely on the assessment of the incidence and severity of cavitated lesions. As our knowledge of caries has matured, we now recognize that caries is a dynamic process, with the ability of non-cavitated lesions to either reverse (remineralization) or progress (demineralization), depending on the conditions occurring with each individual patient. Due to the ability of early lesions to reverse through the use of preventative therapies, such as the use of fluoridated toothpastes, mouthrinses or other remineralization therapies, it has become increasingly important to detect caries at the earliest stages possible, which maximizes the potential to maintain as much of the natural tooth as possible in the longer term.
More recently, significant efforts have been directed toward the development of comprehensive measurement systems that include assessment of caries across the continuum of the disease process, beginning with non-cavitated lesions. The most widely used system now available is the ICDAS System, an integrated system that includes all of the best understanding of caries to provide a standardized method for monitoring both the initiation and progression of caries across this continuum.