Clinical diagnosis of recurrent caries
Section snippets
FREQUENCY OF DIAGNOSED RECURRENT CARIES
Ever since the G.V. Black period, the clinical diagnosis of recurrent caries has been shown in studies from many countries, including the United States, to be the most common reason by far for replacement of all types of restorations in permanent and primary teeth.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 The percentage of restorations in adults that were replaced because of the clinical diagnosis of recurrent caries was consistently about 50 percent, with a
LOCATION OF CLINICALLY DIAGNOSED RECURRENT CARIES
Studies have been conducted in which general practitioners were asked to indicate where recurrent carious lesions were located on diagrams of teeth, with outlines of the extent of the restorations examined.28, 29, 30 These studies have shown that recurrent caries was seen predominantly on the gingival margins of all types of Class II through Class V restorations, while it was rarely associated with Class I restorations or on the occlusal part of Class II restorations. Recurrent caries was seen
BACTERIOLOGY OF RECURRENT CARIES
Little attention has been paid to the microbiology of recurrent caries. Kidd and colleagues33 performed cultures on samples of dentin taken from the dentinoenamel junction at intervals during cavity preparation using a rubber dam. They found no significant differences in the microflora in samples from cavity walls involving primary and recurrent caries.
The amount of plaque and its cariogenicity at restoration margins depends on the restorative material.34, 35, 36, 37, 38 These findings indicate
DIAGNOSIS OF RECURRENT CARIES
Recurrent caries at proximal or gingival locations in restorations can be diagnosed by radiography provided the X-rays are at an optimal angle in relation to the lesion. Because restorative materials are radiopaque, they may hide the lesion completely or partially (Figure 3, Figure 4). The burnout that frequently occurs at the cervical margin also may make interpretation difficult. In general, the diagnosis of recurrent caries lacks consistency,52, 53, 54, 55, 56 and the diagnostic variations
THE TREATMENT OF RECURRENT CARIES
The clinical diagnosis of recurrent caries invariably has resulted in the replacement of the restoration affected. But this clinical approach to the problem has been challenged.59 If clinically diagnosed recurrent caries often is a marginal defect rather than a carious lesion, it is unlikely that fluoride or other materials releasing known caries-preventing agents will reduce the frequency with which recurrent caries is diagnosed. In fact, practice-based cross-sectional studies of reasons for
CONCLUSIONS
Uncertainty exists with regard to the clinical diagnosis of recurrent caries. A review of the literature demonstrates marked deviations in this diagnosis among clinicians. Surveys have shown great variations in or lack of defined criteria to characterize these lesions. Teeth with stained margins of tooth-colored restorations and ditched margins in which the explorer tends to stick often are misdiagnosed as having recurrent caries. It appears that only frankly cavitated carious lesions adjacent
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This article was supported by grant DE13412 from the National Institutes of Health, National Institute of Dental and Craniofacial Research.
The illustrations in this article are all from the Operative Dentistry Clinic 2A, College of Dentistry, University of Florida. The treatments illustrated were performed by dental students and supervised by Dr. Mjör. Eduardo B. Mondragon photographed the clinical cases.
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Dr. Mjör is a professor of Operative Dentistry and the Academy 100 Eminent Scholar, University of Florida College of Dentistry, P. O. Box 100415, Gainesville, Fla. 32610