Operative Dentistry - Best Practices

Caries Management: Caries Lesion Detection

(last modified September 1, 2016)

Detection and removal instruments / aids for lesion management

  • Appropriate radiographs and current pulpal status
  • Clean, gently dried tooth - avoid repeated or forceful drying to prevent pulpal damage
  • Adequate illumination
  • Magnification
  • Explorer (used for assessment of surface texture only)
    • care needed in deeper areas to avoid inadvertent pulpal damage
    • of little or no value in pit and fissure caries diagnosis
    • detection of marginal ditching on amalgam restorations does not, by itself, imply the presence or predict the development of a caries lesion
  • Sharp spoon excavator - preferred method of caries detection when possible
  • Round excavating burs on low-speed hand piece
    • largest round bur that fits in area of interest should be used to avoid unnecessary tooth structure removal and penetration
  • Caries-disclosing dyes
    • tactilely confirm the presence of caries before removal of dye-stained dentin
    • dyes are visual identification aids for the novice and advanced beginner and are not diagnostic for remaining caries
  • Most commonly missed areas are under cusp tips and at DEJ
    • always check with mirror for these access-limited areas using multiple mirror angulations
  • Non-traditional caries detection and diagnostic devices are continually being evaluated

ADA Caries Classification System