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

Recurrent caries (Table 1-4)

There are two valid indicators of recurrent (secondary) caries: softness at the margin of a filling that is detected using an explorer (gentle pressure is highly recommended) or presence of a large defect (a minimum diameter of 0.4 mm) at a margin of a filling with softness in the area. Large defects are associated with a high level of colonization with cariogenic bacteria. Marginal discoloration by itself is not a valid sign for dental caries.

Recurrent caries is diagnosed whenever there is softness due to caries at a defective margin, and when the tip of a periodontal probe (WHO probe or PSR probe) can enter the defect without any resistance. A restoration with a discolored margin or a small marginal ditch (<0.5 mm or the head of the WHO or PSR probe) is recorded as an early recurrent carious area. A larger defect should be classified as advanced recurrent carious area as seen below.

Stained margins that do not have the characteristics of the above two lesions are classified as questionable.