DIAGNOSIS OF CARIOUS LESIONS IN MICRODENTISTRY
Accurate diagnosis requires a number of important items and steps, such as the following: (1) Consistent use of magnification and illumination using loupes and headlamps or a microscope. (2) An understanding of the caries process and the variability of fissure anatomy. (3) Quality radiography. Digitally enhanced radiographs aid in proper diagnosis. (4) Laser caries diagnosis (the DIAGNOdent, KaVo America). (5) Caries detection dye. Use of an explorer to detect occlusal decay has been consistently proven to be only about 25% accurate. In addition to the inaccuracy, clinical research conducted by Sturdevant has shown that forceful probing of the initial lesion can result in damage to the weakened porous enamel and result in accelerating the lesion. Radiographs have been proven to be even less accurate for early occlusal decay. Christensen has reported that “although the concept of ‘watching’ radiographically observable caries for a period has been standard practice, continuation of the concept for all patients is questionable.” The DIAGNOdent, when used properly, has been shown to be about 90% accurate for occlusal decay. One note when using a system like the DIAGNOdent: once tooth structure has been altered with a laser, it’s fluorescence will cause a false positive reading for decay. Caries indicator dye will also cause a false-positive because a lased surface becomes porous and retains the dye.
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