(Nursing) Literature Review Essay Example

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Diagnosis of Dental Caries



Dental caries, commonly known as dental cavity is one of the most common diseases of oral cavity prevalent to both children and adults. Modern management of this menace ought to be extra conservative to incorporate early detection methods of the noncavitated lesions, identify an individual’s risk pertaining the progression of caries, have a clear understanding of an individual’s disease process and ‘’active surveillance’’ so as to monitor the disease keenly and proper application of preventive measures to arrest the situation before it becomes critical as it’s known to be an irreversible disease and it cannot be cured once the matter goes out of hand (Virk, Jain, Pathak, Sharma & Rajput, 2012: pp. 127-132). Each and every year a lot of Australian dollars have to be coughed towards its restoration.

However with the recent adverts regarding fluorides the cases of caries have reduced. A lesion usually starts and progresses underneath an intact layer usually found on the surface enamel. However if detected early, carious lesions can be reversible and the condition can arrested. Therefore a lesion can be rendered inactive from an active state through a non-invasive intervention.

Microorganisms and bacteria present on the surface of the tooth is the major cause of dental caries. The bacteria (streptococci mutans) usually acts on the soft and organic deposits present on the tooth surface liberating acid as well as break down products (Prashanth, Sudhanshu, Usha Mohan & Gopu, 2011: pp.40-45). The acid therefore dissolves the inorganic hard portion of the tooth causing the decay. However there are other several factors that leads to dental caries that includes;

  • Individual’s failure to brush his/her teeth regularly using fluorinated toothpaste. The food particles left on the surface of the teeth begins to rot and provides a conducive atmosphere for bacteria to multiply producing an acidic substance which acts on the enamel of the teeth.

  • Consumption of or drinks containing to much carbohydrates (sugary /starch). The bacteria presence in the plaques converts the carbohydrates into energy required for their multiplication and with time the acid in the plaque acts on the surface of the enamel and erodes it thus enhancing cavity development (Necmi, Vehit & Can, 2005: pp. 115-118).

  • Smoking-smokers are vulnerable of developing tooth decay as the smoke from the tobacco interferes with saliva production which maintains the surface of the teeth clean.

Risk Assessment

Procedures used in risk assessment by the medical practitioners contains sufficient data to quantitate the extent of a person’s disease vulnerability and take preventive measures before its roots are established . Although the caries- risk data in the field of dentistry have not been reliable enough to quantitate the models, process of accessing the risk should be incorporated in the decision making process of the medical practitioners. They include;

  • Tracing the causative agents and take necessary measures to suppress the disease rather than treating the disease outcome (Shivakumar, Vidya & Chandu, 2009: pp. 99-106).

  • Educate specific patient by creating understanding of the disease causes in order to create awareness to the individuals for them to take necessary action in the prevention of the disease.

  • Taking the matter of the dental caries at individual level where he selects as well as weigh the preventive and the restoration treatment of a particular patient and monitor the progress.

The models of the risk assessment of the dental caries involves various factors that range from the susceptible host, diet, the exposure of fluoride and micro flora that incorporates a variety of behavioural, social as well as cultural factors. Risk assessment on dental caries pertains the determination of possibility of the occurrence of caries-that is the number of new cases of incipient lesions at a particular given time period or the possibility of the change size in the activity or the size of the presently occurring lesions. If only the caries can be detected at early stages (white spot lesions), providers of the health care would have ample time save the cavitations’ situation (Usha Carounanidy & Sathyanarayanan, 2009: pp.87-100).

The risk indicators in dental caries are those variables believed to directly trigger the disease (micro flora) or have been portrayed as useful in the prediction of the disease(e.g., socioeconomic status) and incorporates those variables that can generally be regarded as protective factors. However in the recent past there are no risk factors for caries or the factors combination that can be said to have achieved maximum levels of both the positive as well as the negative values in its prediction (Adas, Saliba, Arcieri, Ferreira, Luvizuto &Alle, 2005: pp. 119). A although ascertaining the past experience of caries can be the only method of predicting the caries menace and then devising measures to arrest the situation before it becomes disastrous. This disease however have been seen to be more prevalent in children than in adults, therefore children having white spots lesions are more vulnerable to caries as these are the precavitated lesions that are outright indicators of caries activity. Accumulation of plaque is also directly associated with development of caries among the young children (Goyal, Gauba, Chawla, Kaur & Kapur, 2007: pp.115-118). As a consequence to the plaque presence, mutans streptococci levels and during the age that cariogenic flora colonizes the child are of value in assessing the risk especially in young children. While the question of fermentable carbohydrates is directly considered to be inclusive in the dental caries’ causal chain, a methodical study has proved that the sugar consumption and the risk of dental caries has come with a conclusion that the relationship between the two is relatively weaker in the current of the exposure of the fluoride than what was previously thought to be the case.

Prevention measures

The common methods that have been incorporated in the study that seeks to scrutinize the factors that leads to dental caries include regular brushing using fluoridated toothpaste, systematic as well as topical fluoride and avoiding eating sugary diet. Recent studies indicate that teeth of children residing in communities that are fluoridated have higher content of fluoride as compared to those of the children who normally reside in those communities that are sub-optimally fluoridated. Sound effects of substitutes of sugar have also been evaluated on caries rates that indicate it as prevalence to numerous cases of dental caries. Recent studies have indications that xylitol have a tendency of minimizing the levels of streptococci in plaque as well as the saliva that presents a high possibility of reducing the chances of dental caries in both the children and the adults. With connection to tooth brushing there only exists a frail relationship between brushing frequency and the minimal chances of contracting the dental caries, which is not clearly defined as to where is just a measure aimed at mere application of fluoride or whether it’s a matter of removing the plaque mechanically (Clea, Arcieri, Ferreira, Luvizuto & Alle, 2005:pp.89-95). Risk assessment presents itself as the tool that can be used to identify reliable predictors and gives room to dental practitioners, the physicians as well as involving other non-dental providers of health care to actively identify as well as refer risky cases in children and adults regarding the dental caries menace.

Diagnostic Methods

Dental caries methods can be commonly categorized into two distinct methods that is; the conventional as well as the advanced techniques. Conventional methods comprise visual method, teeth separation, combination of sharp instruments and radiographs. However these methods have their own shortcomings. To be more conservative researchers in the field of dentistry are developing techniques that are more advanced. These techniques are not only aimed at detecting the mineral loss but also meant to quantify it. These techniques include;

Electrical Conductance Detection Method (ECM)

This method basically monitors the behaviour of the electrical resistance of any carious spot suspected. Although this idea was postulated by Magitot back in 1878, the credit for its application in dental caries goes to Pincus P. This principle is based on conductivity where the enamel is poor in terms of electrical conductivity. I t contains minute pore size arranged in the order of 2 to 6 nm radii. Effects of demineralization as a result of caries make the pores larger. These usually combine to form pathways that naturally becomes conductive as result of being filled with the minerals as well as ions present in the saliva. This is a perfect indication that the carious enamel usually possesses higher chances of electric conductivity as compared to a sound one. This method provides a basis of early detection that can respond positively to prevention measures. It is also known to detect fissure caries in a molar tooth that has recently erupted and is capable of predicting the requirement of sealant restoration within a span of 18 to 24 months following the tooth eruption. Its specifity is usually low.

Laser-induced Fluorescence: Diagnodent

The Diagnodent is usually a portable, diode system which is laser-based. Its development is attributed to research conducted by Hibst and Gall back in year 1998. It’s more sensitive as compared to various traditional methods of diagnosis. It makes use of the red light of magnitude of 655nm.The moment the tooth is illuminated using this light; it usually fluoresces in the infrared range whereby a demineralized portion of the tooth fluoresces brightly. A photodiode therefore measures the volume of the light that is dispersed through the filter and a control unit provides a display of the digital representation of the detected wavelength. The performance of the device is excellent on smooth surfaces as well as in pits and fissures that may be present at the surface of the tooth. Its removes any element of doubt he operator bias as the outcome for caries severity can clearly be displayed on the LCD panel. It’s known for its accuracy and it’s not complicated to use. However caution must be taken to ensure the occlusal surfaces are dry and c lean to prevent chances of giving false diagnosis.

Quantitative Light –induced Fluorescence (QLF)

It’s based on the fact that the auto fluorescence of the tooth basically alters as there occur changes in the content of the mineral present on the hard tissue. If the surface of the enamel is porous due lesions the light is scattered which leads to loss of its usual fluorescence. Therefore the changes in the fluorescence in the enamel is easily detected and measured the moment the violet-blue light is illuminated (Chachra, Dhawan, Kaur & Sharma, 2011:pp. 216-221). The resulting image is therefore captured, saved as well as processed and it’s initially in black and white. The lesion site is thereby reconstructed through interpolation of the values of the grey levels around the lesion in the sound enamel. These provide a basis of measurement, and quantification as per the area and the shape. To facilitate the calculation of the carious lesion by the fluorescence radiance, the radiance of the sound tissue at the site of the lesion is also reconstructed by interpolation and the comparison of the difference emanating from the actual values and those that are reconstructed help to show the prevailing fluorescence loss. Therefore this method is very useful in evaluating the measures meant to prevent individuals who are caries-susceptible like the orthodontic patients.

Direct Digital Radiography

Dr Francis Mouyen is accredited with the development of Radiovisiography (RVG) back in the year 1980. It has become as a common method in dentistry in the recent past meant to minimize radiography dosage to the patient. It can as well be used to educate patients since it makes it possible to exchange the information (Vinay, Vaid, Chug, Jhingta, Negi &Sharma, 2012: pp. 34-38). However it may produce biased results if not properly used as the images can be easily manipulated. Deterioration of its sensors over time may also be one of its shortcomings given that it’s a costly instrument.


Supplementary methods in the diagnosis of the dental caries have been widely recommended and acknowledged. This has come as perfect substitution of conventional methods that have earlier been used to detect the dental caries and have been associated with a lot of shortcomings. Complementing the traditional methods of diagnostic with the most advanced ones will help to improve the diagnostic routines of dental caries and hence better precautionary measures in preventing as well as treatment of the dental cavity.


Carounanidy Usha & Sathyanarayanan R. (2009). Dental caries: A complete changeover (Part II) — Changeover in the diagnosis and prognosis. Volume 12, Issue 3 [p. 87-100]

Chachra S, Dhawan P, Kaur T, & Sharma AK. (2011). The most effective and essential way of improving the oral health status education. , Volume 29, Issue 3 [p. 216-221]

Garbin C.A.S, Arcieri R.M, Ferreira NF, Luvizuto ER, & Alle CF. (2005). Assessment of the diet of 0- to 6-year-old children in municipal schools in a Brazilian city. Volume 23, Issue 3 [p. 119]

Garbin C.A.S, Arcieri R.M, Ferreira NF, Luvizuto ER, & Alle CF. (2005). The fidelity of mutans streptococci transmission and caries status correlate with breast-feeding experience among Chinese families.Caries; [p. 89-95]

Goyal A, Gauba K, Chawla HS, Kaur M, & Kapur A. (2007). Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. Volume 25, Issue 3 [p. 115-118]

Necmi Namal, Vehit He, & Can G. (2005). Risk factors for dental caries in Turkish preschool children. Volume 23, Issue 3 [p. 115-118]

Prashanth ST, Bhatnagar S, Das UM, & Gopu H. (2011).
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Vinay K.B, Vaid S, Chug A, Jhingta P, Negi N, & Sharma D. (2012). Prevalence of dental caries among five-year-old school children in Shimla city, Himachal Pradesh. Volume 1, Issue 1 [p. 34-38]

Virk PKS, Jain RL, Pathak A, Sharma U, Rajput JS. (2012). Inter-relationship of intelligence- quotient and self-concept with dental caries amongst socially. Volume 30, Issue 2 [p. 127-132]