July 1st, 2009 by admin

Carious lesions may be diagnosed at any level of the carious process. For con-
venience the levels are graded D (for decay) followed by a number. The higher
the number, the more advanced the lesion. Thus:
• D1 are clinically detectable enamel lesions with intact surfaces
• D2 are clinically detectable cavities limited to enamel
• D3 are clinically detectable lesions in dentine
• D4 are lesions into the pulp.
The more diagnostic aids that are applied and the more refined the
methods, the more lesions will usually be identified. The hierarchy of these
decisions and their relationship to the management required, have been
elegantly represented as an iceberg (Figure 3.1). The diagnostic threshold
can be thought of as the level at which the iceberg  oats in the water.
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There is no universal diagnostic threshold that can be recommended for
all purposes. For the dentist in the surgery the D1 threshold (enamel lesion,
no cavity) is appropriate. This stage allows non-operative, preventive treat-
ments which, if successful, should ar rest the lesion. In epidemiological
surveys (see page 13) diagnosis is at the D3 level, which inevitably under-
estimates the caries status by only recording lesions which are likely to
require operative care. With contemporary knowledge of the carious process
ESSENTIALS OF DENTAL CARIES
one must question whether it is appropriate for the survey epidemiologist to
assess only the need for operative treatment.
This chapter will describe how
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the lesion can be diagnosed before, as well as after, the surface has cavitated