Carious lesion activity
Assessing carious lesion activity
An arrested carious lesion is one that does not progress. Assessing whether a lesion is active or arrested requires clinical and radiographic monitoring over time, and clinical photography may assist.
However, to inform caries prevention and management choices it is often necessary to judge whether a lesion is likely to be arrested or active at a single point in time from its clinical characteristics.
Assess the activity of each carious lesion clinically.
- Enamel lesions – roughness/smoothness. Arrested enamel surface lesions will usually feel smooth to a probe lightly drawn across the surface. A ball ended probe can be used. If the surface feels rough or the probe is felt to drag compared with adjacent sound enamel, then the lesion is active.
- Lesions on exposed dentine – hardness/softness. The hardness of dentine, as determined by a caries excavator lightly drawn across the surface, is indicative of lesion activity; the softer the lesion, the more active it is likely to be. Harder lesions may also appear shiny. Softer lesions appear more matt and are more likely to be active.
- Colour of carious dentine is not always a reliable indicator of lesion activity; some arrested lesions are dark while some are pale.
Use radiographs to assess carious lesion progression over time.
- Film holders will improve standardisation, and therefore repeatability of radiographic views, allowing reliable comparison of lesions over time (see Radiographic assessment).
Assume that all carious lesions are active, unless there is evidence that they are arrested.