"Dental caries" is a result of metabolic activities in the microbial deposits covering the tooth surface at any given site. These metabolic processes are a physiological phenomenon, and caries is ubiquitous and natural at the crystal level. Mineral loss and subsequent cavity formation are the result of an imbalance in the dynamic equilibrium between tooth mineral and plaque fluid. The carious lesion reflects the activity of the bio film, and lesion progression can be controlled. "Diagnosis" implies deciding whether a lesion is active, progressing rapidly or slowly, or already arrested. Without this information, a logical decision about treatment is impossible
The report produced concerns the detection of demineralization there is no mention of lesion activity. Perhaps this is inevitable in a report that sees histological validation as an appropriate "gold standard." It is difficult to judge lesion activity histological and unwise to attempt diagnosis in a laboratory simulation of a clinical setting. Diagnosis requires a warm human being and a clinical nose.
Why Is the Diagnosis of Caries Important?
This diagnosis is the main reason given by dentists for replacing fillings. Fifty to sixty percent of restorations are replaced because dentists diagnose secondary caries. Are they correct? This high prevalence is not found in controlled clinical trials, where 1 to 4 percent of secondary caries has been reported. Incidentally, only these latter trials would survive the scrutiny of a systematic review on the causes of
the failure of restorations. Why are there huge differences between a general practice setting and a clinical trial? Are general practitioners poorly trained, idiosyncratic, and ignorant about this diagnosis? That explanation seems dangerously facile.
