**5. Conclusion**

Visual examination, by observing clinical characteristics and appearance of the lesions, associated to radiographs is able to provide most of necessary information to the clinician for the detection of caries lesions. However, only severe and deep lesions are detected by radiographic examination. Therefore, auxiliary methods can contribute positively in the process of detection and their utilization should be encouraged. However, the clinician should be aware of their correct use and follow the manufacturer instructions. Besides, it should be kept in mind their disadvantages and affecting factors. This could provide more information for treatment decision-making process.

Moreover, it is important to state that the detection of caries lesions is only a part of the process of diagnosis. Other factors might be assessed, such as risk and caries activity, oral hygiene habits and fluoride exposition.

#### **6. References**


Visual examination, by observing clinical characteristics and appearance of the lesions, associated to radiographs is able to provide most of necessary information to the clinician for the detection of caries lesions. However, only severe and deep lesions are detected by radiographic examination. Therefore, auxiliary methods can contribute positively in the process of detection and their utilization should be encouraged. However, the clinician should be aware of their correct use and follow the manufacturer instructions. Besides, it should be kept in mind their disadvantages and affecting factors. This could provide more

Moreover, it is important to state that the detection of caries lesions is only a part of the process of diagnosis. Other factors might be assessed, such as risk and caries activity, oral

Al-Khateeb, S. ; Ten Cate, J.M, ; Angmar-Månsson, B. ; De Josselin de Jong, E. ; Sundström, G.;

Araújo, F.B.; Araújo, D.R.; Santos, C.K. & Souza, M.A. (1996). Diagnosis of approximal caries

*American Jounal of Dentistry*, Vol.9, No.2, (April), pp. 54-56, ISSN 0894-8275 Bader, J.D.; Shugars, D.A. & Bonito, A.J. (2001). Systematic reviews of selected dental caries

Bader, J.D. & Shugars, D.A. (2006). The evidence supporting alternative management

Berry, H.M.Jr. (1983). Cervical burnout and Mach band: two shadows of doubt in radiologic

Bin-Shuwaish, M.; Dennison, J.B.; Yaman, P. & Neiva, G. (2008). Estimation of clinical axial

Bjørndal, L. & Thylstrup, A. (1995). A structural analysis of approximal enamel caries lesions

Braga, M.M.; Mendes, F.M.; Martignon, S.; Ricketts, D.N. & Ekstrand, K.R. (2009). In vitro

Braga, M.M.; Ekstrand, K.R.; Martignon, S.; Imparato, J.C.; Ricketts, D.N. & Mendes, F.M.

*Research,* Vol.43, No.5, (September), pp. 405-412, ISSN 0008-6568

*Research,* Vol.11, No.4, (November), pp. 502-506, ISSN 0895-9374

Exterkate, R.A. & Oliveby, A. (1997). Quantification of formation and remineralization of artificial enamel lesions with a new portable fluorescence device. *Advances in Dental* 

in primary teeth: radiographic versus clinical examination using tooth separation.

diagnosis and management methods. *Journal of Dental Education,* Vol.65, No.10,

strategies for early occlusal caries and suspected occlusal dentinal caries. *Journal of Evidence-Based Dental Practice,* Vol.6, No.1, (March), pp. 91-100, ISSN 1532-3382 Benedict, H.C. (1928). A note on the fluorescence of teeth in ultra-violet rays. *Science*, Vol.67,

interpretation of carious lesions. *Journal of the American Dental Association,* Vol.106,

extension of class II caries lesions with ultraspeed and digital radiographs: an invivo study. *Operative Dentistry,* Vol.33, No.6, (November-December), pp. 613-621,

and subjacent dentin reactions. *European Journal of Oral Sciences,* Vol.103, No.1,

comparison of Nyvad's system and ICDAS-II with Lesion Activity Assessment for evaluation of severity and activity of occlusal caries lesions in primary teeth. *Caries* 

(2010). Clinical performance of two visual scoring systems in detecting and

**5. Conclusion** 

**6. References** 

information for treatment decision-making process.

(October), pp. 960-968, ISSN 0022-0337

No.1739, (April), pp. 442, ISSN 0036-8075

No.5, (May), pp. 622–625, ISSN 0002-8177

(February), pp. 25-31, ISSN 1600-0722

ISSN 0361-7734

hygiene habits and fluoride exposition.

assessing activity status of occlusal caries in primary teeth. *Caries Research,* Vol.44, No.3, (June), pp. 300-308, ISSN 0008-6568


Traditional and Novel Caries Detection Methods 127

Lussi, A. & Hellwig, E. (2006). Performance of a new laser fluorescence device for the

Mejàre, I. & Kidd, E.A.M. (2008). Radiography for caries diagnosis. In: *Dental caries: the* 

Mortimer, K.V. (1970). The relationship of deciduous enamel structure to dental disease.

Neuhaus, K.W.; Longbottom, C.; Ellwood, R. & Lussi, A. (2009). Novel lesion detection aids. *Monographs in Oral Science,* Vol.21, (June), pp. 52-62, ISSN: 0077-0892 Neuhaus, K.W.; Rodrigues, J.A.; Hug, I.; Stich, H. & Lussi, A. (2010). Performance of laser

Nyvad, B.; Machiulskiene, V. & Baelum, V. (2003). Construct and predictive validity of

Nyvad, B. (2004). Diagnosis versus detection of caries. *Caries Research,* Vol.38, No.3, (May-

Nyvad, B.; Fejerskov, O. & Baelum, V. (2008). Visual-tactile caries diagnosis. In: *Dental caries:* 

Pitts, N.B. & Rimmer, P.A. (1992). An in vivo comparison of radiographic and directly

permanent teeth. *Caries Research*, Vol.26, No.2, pp. 146-152, ISSN 0002-8177 Pitts, N. (2004). "ICDAS" -- an international system for caries detection and assessment

Pitts, N.B. (2004). Modern concepts of caries measurement. *Journal of Dental Research*, Vol.83,

Pitts, N.B. & Stamm, J.W. (2004). International Consensus Workshop on Caries Clinical

Raggio, D.P.; Braga, M.M.; Rodrigues, J.A.; Freitas, P.M.; Imparato, J.C. & Mendes, F.M.

Ratledge, D.K.; Kidd, E.A. & Beighton, D. (2001). A clinical and microbiological study of

*Caries Research*, Vol.35, No.1, (January-February), pp. 3-7, ISSN 0002-8177 Ricketts, D.N.; Kidd, E.A.; Smith, B.G. & Wilson, R.F. (1995). Clinical and radio graphic

Blackwell Munksgaard, ISBN 9781405138895, Oxford.

*Caries Research*, Vol.4, No.3, pp. 206-223, ISSN 0002-8177

Vol.33, No.4, (July-August), pp. 252–260, ISSN 0002-8177

Vol.82, No.2, (February), pp. 117-22, ISSN 0022-0345

Blackwell Munksgaard, ISBN 9781405138895, Oxford.

No. Spec No C, p. C43-C47, ISSN 0022-0345

No.1, (January), pp. 15-20, ISSN 0305-182X

*Science,* Vol.21, (June), pp. 128-143, ISSN: 0077-0892

June), pp. 192-198, ISSN 0002-8177

198, ISSN 0256-539X

193, ISSN 1678-7757

467-471, ISSN 0300-5712

detection of occlusal caries in vitro. *Journal of Dentistry,* Vol.34, No.7, (January), pp.

*disease and its clinical management,* Fejerskov, O. & Kidd, E.A.M., pp. 69-89,

fluorescence devices, visual and radiographic examination for the detection of occlusal caries in primary molars. *Clinical Oral Investigation*s*,* May 27 (Epub ahead of print). Nyvad, B.; Machiulskiene, V. & Baelum, V. (1999). Reliability of a new caries diagnostic

system differentiating between active and inactive caries lesions. *Caries Research,* 

clinical caries diagnostic criteria assessing lesion activity. *Journal of Dental Research,* 

*the disease and its clinical management,* Fejerskov, O. & Kidd, E.A.M., pp. 49-69,

assessed clinical caries status of posterior approximal surfaces in primary and

being developed to facilitate caries epidemiology, research and appropriated clinical management. *Community Dental Health,* Vol.21, No.3, (September), pp. 193-

Trials (ICW-CCT) -- final consensus statements: agreeing where the evidence leads. *Journal of Dental Research*, Vol.83, No. Spec No C, pp. C125–C128, ISSN 0022-0345 Pitts, N.B. & Richards, D. (2009). Personalized treatment planning. *Monographs in Oral* 

(2010). Reliability and discriminatory power of methods for dental plaque quantification. *Journal of Applied Oral Science*, Vol.18, No.2, (March-April), pp. 186-

approximal carious lesions. Part 1: the relationship between cavitation, radiographic lesion depth, the site specific gingival index and the level of infection of the dentine.

diagnosis of occlusal caries: a study in vitro. *Journal of Oral Rehabilitation,* Vol.22,


Espelid, I.; Tveit, A.B. & Fjelltveit, A. (1994). Variations among dentists in radiographic detection of occlusal caries. *Caries Research*, Vol.28, No.3, pp. 169–175, ISSN 0008-6568 Hamilton, J.C. (2005). Should a dental explorer be used to probe suspected carious lesions?

Hekmatian, E.; Sharif, S. & Khodaian, N. (2005). Literature review: digital subtraction radiography in dentistry. *Dental Research Journal*, Vol.2, No.2, pp. 1-8, ISSN 1735-3327 Hibst, R.; Paulus, R. & Lussi, A. (2001). A detection of occlusal caries by laser fluorescence:

Hintze, H.; Wenzel, A.; Danielsen, B. & Nyvad, B. (1998). Reliability of visual examination,

Huysmans, M.C.; Kühnisch, J. & ten Bosch, J.J. (2005). Reproducibility of electrical caries

Ismail, A.I.; Sohn, W.; Tellez, M.; Amaya, A.; Sen, A.; Hasson, H. & Pitts, N.B. (2007). The

Jablonski-Momeni, A.; Stachniss, V.; Ricketts, D.N.; Heinzel-Gutenbrunner, M. & Pieper, K.

in vitro. *Caries Research,* Vol.42, No.2, (January), pp. 79–87, ISSN 0002-8177 Kidd, E.A. & Fejerskov, O. (2004). What constitutes dental caries ? Histophatology of carious

Kühnisch, J.; Heinrich-Weltzien, R.; Tabatabaie, M.; Stösser, L. & Huysmans, M.C. (2006). An

Loesche, W.J.; Svanberg, M.L. & Pape, H.R. (1979). Intra oral transmission of Streptococcus

Longbottom, C.; Ekstrand, K. & Zero, D. (2009). Traditional preventive treatment options. *Monographs in Oral Science,* Vol.21, (June), pp. 149-155, ISSN: 0077-0892 Lussi, A. (1993). Comparison of different methods for the diagnosis of fissure caries without cavitation. *Caries Research*, Vol.27, No.5, pp. 409-416, ISSN 0002-8177 Lussi, A. & Reich, E. (2005). The influence of toothpastes and prophylaxis pastes on

Lussi, A.; Hack, A.; Hug, I.; Heckenberger, H.; Megert, B. & Stich, H. (2006). Detection of

*Research,* Vol.83, No. Spec No C, pp. C35-C38, ISSN 0022-0345

*Sciences*, Vol.113, No.2, (April), pp. 141-144, ISSN 1600-0722

0002-8177

295-13, ISSN 1615-1615

149-2-7, Indianapolis.

1765-1770, ISSN 0022-0345

No.2, pp. 97-103, ISSN 0002-8177

No.3, pp. 204-209, ISSN 0002-8177

October), pp. 403-410, ISSN 0002-8177

Vol.35, No.3, (June), pp. 170-178, ISSN 0301-5661

Yes – an explorer is a time-tested tool for caries detection. *Journal of the American Dental Association,* Vol.136, No.11, (November), pp. 1526, 1528, 1530, passim, ISSN

basic and clinical investigations. *Medical Laser Application*, Vol.16, No.3, (June), pp.

fibre-optic transillumination, and bite-wing radiography, and reproducibility of direct visual examination following tooth separation for the identification of cavitated carious lesions in contacting approximal surfaces. *Caries Research,* Vol.32,

measurements: a technical problem? *Caries Research,* Vol.9, No.5, (September-

International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. *Community Dentistry and Oral Epidemiology,* 

(2008). Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries

enamel and dentin related to the action of cariogenic biofilms. *Journal of Dental* 

in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection. *Caries Research*, Vol.40, No.2, pp. 104-111, ISSN 0002-8177 Lagerlöf, F. & Oliveby, A. (1996). Clinical implications: new strategies for caries treatment.

In: *Early detection of dental caries: Proceedings of the 1st Annual Indiana Conference*, Stookey, G.K., pp. 297-321, Indiana University School of Dentistry, ISBN 0-9655

mutans by a dental explorer. *Journal of Dental Research,* Vol.58, No.8, (August), pp.

fluorescence measurements for caries detection in vitro. *European Journal of Oral* 

approximal caries with a new laser fluorescence device. *Caries Research,* Vol.40,


**7** 

*Spain* 

**How to Diagnose Hidden Caries?** 

Elena Guerrero, Manuela Herrera and Rafael Llamas

The diagnosis of pits, grooves and fissures is one of the main challenges facing dentists in their professional activity, since the existence of an intact enamel surface may hide deep caries in dentin. Lesions of this kind were described by Weerheijm et al. (1992) as "hidden caries". Over 70 years ago a high incidence of caries was confirmed in grooves and fissures (Hyat, 1923), in coincidence with more recent observations (Bragamian & Garcia-Godoy, 2009). In order to understand and explain this high incidence and the morphological peculiarities involved, it is essential to know the physiopathology of the tooth and of the

Caries is a "*multifactorial disease causing dissolution of the organic component and demineralization of the inorganic component of the hard dental tissues*" (Bonilla, 1998). In the chronology of this process is must be noted that the enamel is a filtering membrane allowing the transit of substances from the exterior to the interior, and vice versa (Llamas et al., 2000). This is because the enamel contains areas with increased water and organic material contents, such as the lamellae or cracks, striae of Retzius, adamantine rod sheath, inter-rod space, and inter-crystalline areas, among others. These zones allow the flow of acids from bacterial plaque, giving rise to disintegration of the organic material and posteriorly conditioning demineralization of the inorganic component – thus supporting the proteolysis – chelation theory of dental caries. These enamel areas with disintegration of the organic material, and the large structural defects such as cracks, which are rich in organic material, can facilitate the penetration of bacteria into deep areas of the enamel, without the existence

The unpredictable, irregular and varied morphology of the grooves and fissures is well known and makes it impossible to pre-determine the structure; however, it is known that over 50% of all studied teeth have cracks in the depths of the fissures that facilitate the rapid transit of substances and/or bacteria from the depth of the sulcus to the dentin (Pastor et al., 1998). On furthermore considering that enamel thickness from the depth of the sulcus to the dentin is variable and in some cases inexistent, it can be understood why a carious lesion beginning within a fissure can develop in enamel and even in dentin without any external clinical or morphological signs of caries. This in turn explains how in some cases we can

**1. Introduction** 

carious lesion.

of superficial cavitation (Brännstrom et al., 1980).

**The Role of Laser Fluorescence** 

Camilo Abalos, Amparo Jiménez-Planas,

 *University of Seville, School Dentistry,* 

