Editing Tooth decay (section)

==Diagnosis==
[[File:Dental explorer.png|100px|thumb|alt=Curved tip of a small metal probe, tapering to a point.|The tip of a [[dental explorer]], which is used for caries diagnosis]]
[[File:Dental infectionMark.png|thumb|A dental infection resulting in an abscess and inflammation of the maxillary sinus]]
[[File:Lp473524f2 online.jpg|thumb|Tooth samples imaged with a non-coherent continuous light source (row 1), LSI (row 2) and pseudo-color visualization of LSI (row 3)<ref name="Deana2013" />]]
The presentation of caries is highly variable. However, the risk factors and stages of development are similar. Initially, it may appear as a small chalky area (smooth surface caries), which may eventually develop into a large cavitation. Sometimes caries may be directly visible. However other methods of detection such as [[radiography|X-rays]] are used for less visible areas of teeth and to judge the extent of destruction. Lasers for detecting caries allow detection without ionizing radiation and are now used for detection of interproximal decay (between the teeth).

Primary [[medical diagnosis|diagnosis]] involves inspection of all visible tooth surfaces using a good light source, [[mouth mirror|dental mirror]] and [[Dental explorer|explorer]]. Dental [[radiographs]] ([[X-ray]]s) may show dental caries before it is otherwise visible, in particular caries between the teeth. Large areas of dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Visual and [[Tactition|tactile]] inspection along with radiographs are employed frequently among dentists, in particular to diagnose pit and fissure caries.<ref>Rosenstiel, Stephen F. [http://www.lib.umich.edu/dentlib/nihcdc/abstracts/rosenstiel.html Clinical Diagnosis of Dental Caries: A North American Perspective] {{webarchive|url=https://web.archive.org/web/20060809104659/http://www.lib.umich.edu/dentlib/nihcdc/abstracts/rosenstiel.html |date=2006-08-09 }}. Maintained by the University of Michigan Dentistry Library, along with the National Institutes of Health, National Institute of Dental and Craniofacial Research. 2000. Page accessed August 13, 2006.</ref> Early, uncavitated caries is often diagnosed by blowing air across the suspect surface, which removes moisture and changes the optical properties of the unmineralized enamel.

Some dental researchers have cautioned against the use of dental explorers to find caries,<ref name="summit31">Summit, James B., J. William Robbins, and Richard S. Schwartz. ''Fundamentals of Operative Dentistry: A Contemporary Approach'' 2nd edition. Carol Stream, Illinois, Quintessence Publishing Co, Inc, 2001, p. 31. {{ISBN|0-86715-382-2}}.</ref> in particular sharp ended explorers. In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause a cavity. Since the carious process is reversible before a cavity is present, it may be possible to arrest caries with [[Fluoride therapy|fluoride]] and remineralize the tooth surface. When a cavity is present, a restoration will be needed to replace the lost tooth structure.

At times, pit and fissure caries may be difficult to detect. Bacteria can penetrate the enamel to reach dentin, but then the outer surface may remineralize, especially if fluoride is present.<ref name="HC">{{cite journal |author1=Zadik Yehuda |author2=Bechor Ron |title=Hidden Occlusal Caries&nbsp;– Challenge for the Dentist |journal=The New York State Dental Journal|volume=74 |issue=4 |pages=46–50 |date=June–July 2008 |url=http://www.nysdental.org/img/current-pdf/JrnlJuneJuly2008.pdf |access-date=2008-08-08 |pmid=18788181 |url-status=dead |archive-url=https://web.archive.org/web/20110722002339/http://www.nysdental.org/img/current-pdf/JrnlJuneJuly2008.pdf |archive-date=2011-07-22 }}</ref> These caries, sometimes referred to as "hidden caries", will still be visible on X-ray radiographs, but visual examination of the tooth would show the enamel intact or minimally perforated.

The [[differential diagnosis]] for dental caries includes [[dental fluorosis]] and developmental defects of the tooth including hypomineralization of the tooth and [[hypoplasia]] of the tooth.<ref>{{cite book |editor1-last=Fejerskov |editor1-first=Ole |editor2-last=Nyvad |editor2-first=Bente |editor3-last=Kidd |editor3-first=Edwina |title=Dental Caries: The Disease and its Clinical Management |date=May 2015 |publisher=John Wiley & Sons |location=Nashville, TN |isbn=978-1-118-93582-8 |page=67 |edition=3}}</ref>

The early carious lesion is characterized by demineralization of the tooth surface, altering the tooth's optical properties. Technology using [[Speckle pattern|laser speckle image]] (LSI) techniques may provide a diagnostic aid to detect early carious lesions.<ref name="Deana2013">{{Cite journal|title = Detection of early carious lesions using contrast enhancement with coherent light scattering (speckle imaging)|journal = Laser Physics|volume = 23|issue = 7|doi = 10.1088/1054-660x/23/7/075607|first1 = A M|last1 = Deana|first2 = S H C|last2 = Jesus|first3 = N H|last3 = Koshoji|first4 = S K|last4 = Bussadori|first5 = M T|last5 = Oliveira|pages=075607|year = 2013|bibcode = 2013LaPhy..23g5607D| s2cid=121571950 }}</ref>

===Classification===
[[File:GV-BLACK.JPG|right|thumb|alt=Chart showing digitally drawn images of caries locations and their associated classifications.| [[Greene Vardiman Black|G. V. Black]] Classification of Restorations]]
Caries can be classified by location, etiology, rate of progression, and affected hard tissues.<ref>{{cite book |author=Sonis, Stephen T. |url=https://archive.org/details/dentalsecretsque0000unse/page/130/mode/2up |title=Dental Secrets |publisher=Hanley & Belfus |year=2003 |isbn=978-1-56053-573-7 |edition=3rd |location=Philadelphia |page=130 |url-access=registration}}</ref> These forms of classification can be used to characterize a particular case of tooth decay to more accurately represent the condition to others and also indicate the severity of tooth destruction. In some instances, caries is described in other ways that might indicate the cause. The G. V. Black classification is as follows:

* Class I: occlusal surfaces of posterior teeth, buccal or lingual pits on molars, lingual pit near cingulum of maxillary incisors
* Class II: proximal surfaces of posterior teeth
* Class III: interproximal surfaces of anterior teeth without incisal edge involvement
* Class IV: interproximal surfaces of anterior teeth with incisal edge involvement
* Class V: cervical third of facial or lingual surface of tooth
* Class VI: incisal or occlusal edge is worn away due to attrition

===Early childhood caries===
[[File:Suspectedmethmouth09-19-05closeup.jpg|right|thumb|alt=Photograph of teeth and gums on the lower right hand side of the mouth showing large caries lesions on all teeth at the level of the gum|Rampant caries caused by [[methamphetamine]] abuse]]

Early childhood caries (ECC), also known as "[[Early childhood caries|baby bottle caries]]," "[[baby bottle]] tooth decay" or "bottle rot," is a pattern of decay found in young children with their [[deciduous teeth|deciduous]] (baby) teeth. This must include the presence of at least one carious lesion on a primary tooth in a child under the age of 6 years.<ref>Sukumaran Anil. Early Childhood Caries: Prevalence, Risk Factors, and Prevention</ref> The teeth most likely affected are the maxillary anterior teeth, but all teeth can be affected.<ref>[http://www.ada.org/public/topics/decay_childhood_faq.asp ADA Early Childhood Tooth Decay (Baby Bottle Tooth Decay)] {{webarchive|url=https://web.archive.org/web/20060813180046/http://www.ada.org/public/topics/decay_childhood_faq.asp |date=2006-08-13 }}. Hosted on the American Dental Association website. Page accessed August 14, 2006.</ref> The name for this type of caries comes from the fact that the decay usually is a result of allowing children to fall asleep with sweetened liquids in their bottles or feeding children sweetened liquids multiple times during the day.<ref>Statement on Early Childhood Caries, American Dental Association at {{cite web |url=http://www.ada.org/2057.aspx |title=Statement on Early Childhood Caries |access-date=2013-07-30 |url-status=live |archive-url=https://web.archive.org/web/20130512185623/http://ada.org/2057.aspx |archive-date=2013-05-12 }}</ref>

Another pattern of decay is "rampant caries", which signifies advanced or severe decay on multiple surfaces of many teeth.<ref>[http://www.dent.ohio-state.edu/radiologycarie/classification.htm Radiographic Classification of Caries] {{webarchive|url=https://web.archive.org/web/20060823184853/http://www.dent.ohio-state.edu/radiologycarie/classification.htm |date=2006-08-23 }}. Hosted on the Ohio State University website. Page accessed August 14, 2006.</ref> Rampant caries may be seen in individuals with [[xerostomia]], poor oral hygiene, stimulant use (due to drug-induced dry mouth<ref>[http://www.ada.org/prof/resources/topics/methmouth.asp ADA Methamphetamine Use (METH MOUTH)] {{webarchive|url=https://web.archive.org/web/20080601035323/http://www.ada.org/prof/resources/topics/methmouth.asp |date=2008-06-01 }}. Hosted on the American Dental Association website. Page accessed February 14, 2007.</ref>), and/or large sugar intake. If rampant caries is a result of previous radiation to the head and neck, it may be described as radiation-induced caries. Problems can also be caused by the self-destruction of roots and whole [[root resorption|tooth resorption]] when new teeth erupt or later from unknown causes.

Children at 6–12 months are at increased risk of developing dental caries.<ref>{{Cite book|title=Prevention and Management of Dental Caries in Children|publisher=Scottish Dental Clinical Effectiveness Programme|date=April 2010|isbn=978-1-905829-08-8|location=Dundee Dental Education Centre, Frankland Building, Small's Wynd, Dundee DD1 4HN, Scotland|pages=11}}</ref>

A range of studies have reported that there is a correlation between caries in primary teeth and caries in permanent teeth.<ref>{{Cite journal |pmid = 1747888|year = 1991|last1 = Helfenstein|first1 = U.|title = Caries prediction on the basis of past caries including precavity lesions|journal = Caries Research|volume = 25|issue = 5|pages = 372–6|last2 = Steiner|first2 = M.|last3 = Marthaler|first3 = T. M.|doi = 10.1159/000261394}}</ref><ref>{{Cite journal | doi=10.1111/j.1600-0528.1989.tb00635.x|pmid = 2686924|title = Past caries recordings made in Public Dental Clinics as predictors of caries prevalence in early adolescence| journal=Community Dentistry and Oral Epidemiology| volume=17| issue=6| pages=277–281|year = 1989|last1 = Seppa|first1 = Liisa| last2=Hausen| first2=Hannu| last3=Pollanen| first3=Lea| last4=Helasharju| first4=Kirsti| last5=Karkkainen| first5=Sakari}}</ref>

===Rate of progression===
{{More citations needed section|date=November 2016}}
Temporal descriptions can be applied to caries to indicate the progression rate and previous history. "Acute" signifies a quickly developing condition, whereas "chronic" describes a condition that has taken an extended time to develop, in which thousands of meals and snacks, many causing some acid demineralization that is not remineralized, eventually result in cavities.

Recurrent caries, also described as secondary, are caries that appear at a location with a previous history of caries. This is frequently found on the margins of fillings and other dental restorations. On the other hand, incipient caries describes decay at a location that has not experienced previous decay. Arrested caries describes a lesion on a tooth that was previously demineralized but was remineralized before causing a cavitation. [[Fluoride therapy|Fluoride treatment]] can help recalcification of tooth enamel as well as the use of [[amorphous calcium phosphate]].

Micro-invasive interventions (such as [[dental sealant]] or resin infiltration) have been shown to slow down the progression of proximal decay.<ref>{{Cite journal|last1=Dorri|first1=Mojtaba|last2=Dunne|first2=Stephen M|last3=Walsh|first3=Tanya|last4=Schwendicke|first4=Falk|date=2015-11-05|title=Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth|journal=Cochrane Database of Systematic Reviews|volume=2015|issue=11|pages=CD010431|doi=10.1002/14651858.cd010431.pub2|pmid=26545080|pmc=8504982|issn=1465-1858}}</ref>

===Affected hard tissue===
Depending on which hard tissues are affected, it is possible to describe caries as involving enamel, dentin, or cementum. Early in its development, caries may affect only enamel. Once the extent of decay reaches the deeper layer of dentin, the term "dentinal caries" is used. Since cementum is the hard tissue that covers the roots of teeth, it is not often affected by decay unless the roots of teeth are exposed to the mouth. Although the term "cementum caries" may be used to describe the decay on roots of teeth, very rarely does caries affect the cementum alone.