University of Michigan School of Dentistry logo Caries Diagnosis Risk Assessment and Management - School of Dentistry University of Michigan Ann Arbor, Michigan, USA
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Diagnosis & risk assessment
Principles
Visual Inspection and Use of Explorers
Coronal caries
On smooth tooth enamel
In pits or fissures surface
Root caries
Recurrent caries
Radiographic diagnosis of caries
Caries Management
Introduction  
Diagnosis, Risk Assessment & Management Protocols
1 Pits and Fissures
2 Proximal tooth surfaces
3 Buccal-lingual smooth tooth surfaces
4 Restored tooth surfaces
5 Sealants
6 Root Surfaces
7 Classification of caries risk status
8 Fluoride application
9 Management of patients with high caries risk
Examination and analysis forms
1 Examination Form 1
2 Examination Form 2
Notes
Cariology links
Supporting references
Diagnosis Tables
1-1 Caries in smooth surfaces
1-2 Caries in pits or fissures
1-3 Root caries
1-4 Recurrent caries
1-5 Radiographic caries
2 Dental fluorosis & opacities

Caries diagnosis and risk assessment

The first step in assessing the caries status of a patient, after all interview examinations are completed, is to inspect visually all tooth surfaces. All tooth surfaces, including the roots, present in the mouth should be examined. The examination should continue with inspection of the occlusal, facial, distal, lingual and mesial surfaces. A visual examination is carried out using a mirror and is aided by an air syringe to dry a tooth surface.

Use of explorers

An explorer is useful in caries diagnosis as a tool to remove plaque and debris and check the surface characteristics of suspected carious lesions. There is no need to apply too much pressure on an explorer because studies have found that this does not increase the accuracy of caries detection (Lussi 1991). The use of gentle pressure, defined by the force just required to blanch a fingernail without causing any pain or damage,

Photograph 1: Enough light pressure is used to blanch a finger nail

is highly recommended. All surfaces of a tooth are cleaned of debris and plaque, the teeth are dried using an air syringe and examined visually. If there are suspicious areas, then an explorer is used to check for the surface texture.