Nyvad criteria for assessment of caries lesion activity and severity; Chapter 5

Abstract

Introduction Dental caries lesions develop as a result of continuous interactions between the microbial biofilm and the tooth surface. Depending on the pH fluctuations in the biofilm, there are periods of dominating mineral loss and alternatively, mineral gain. As long as these episodes are in balance, no caries progression occurs. However, shifting the reactions towards mineral dissolution would eventually produce demineralized areas called caries lesions. This chapter describes the clinical alterations that are visible due to the changes that occur in enamel and dentin during the demineralization and remineralization process. It also delineates how to conduct the clinical examination. Background The first clinically visible alterations of the “sound” dental enamel appear as changes in luster, color, or texture. These changes occur due to increased porosity of the subsurface enamel layer, and the subsequent change of light transmission in the demineralized area. It was shown years ago by Thylstrup and coworkers that the surface characteristics of caries lesions reflect the underlying mechanisms of deand re-mineralization and that actively progressing enamel lesions exhibit matt/ chalky and rough surfaces [1, 2]. However, in situations of predominating mineral uptake from the oral environment, the surface texture becomes shiny and smooth. Such lesions are usually characterized by a pronounced surface abrasion and by an increased mineralization of the surface layer [3, 4]. Clinical status of the caries. [...].