Clinic and Radiographic Diagnosis of Underlying Dark Shadow from Dentin

The International Caries Detection and Assessment System (ICDAS) is an index of clinical diagnosis of caries lesions that register underlying dark shadow from dentin with or without localized enamel breakdown (score 4). Although in vitro studies have indicated a great involvement of the dentin tissue, there is no in vivo study demonstrating the clinical and radiographic characteristics of such lesions. Objective: to describe clinical and radiographic characteristics of occlusal surfaces of permanent molars with score 4 of ICDAS. Methods: the participants were drawn from a cross-sectional study conducted with 12 year-old students from Porto Alegre, Rio Grande do Sul, Brazil and from the dental clinics of the School of Dentistry of Federal University of Rio Grande do Sul. The presence of localized enamel breakdown was evaluated in the clinical examination. The presence of radiolucent image (RI) and its depth was assessed in the radiographic examination. One examiner was trained and calibrated for the clinical and radiographic evaluations and reached a kappa > 0.7 for all measures. Results: one hundred and one teeth were evaluated, from which 76 (75.3%) presented enamel breakdown while 25 (24.7%) did not. In the radiographic analysis, absence of RI or RI restrict to the dentino-enamel junction (DEJ) was observed in 76 (75.3%) teeth, from which 57 (75%) showed enamel breakdown. Twenty-five (24.7%) teeth recorded RI involving beyond the DEJ, being 19 (76%) with breakdown enamel. No association between the clinical aspect and the radiographic image was found (Chi-square test p=0.78). Conclusion: the results suggest that most caries lesions with underlying dark shadow from dentin do not show radiolucency in dentin beyond the DEJ. The radiographic exam demonstrated to be an important auxiliary method for diagnosis and treatment decisions of these lesions.