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Detecting Decay

I know this is going back to the basics and something I should be excelllent with as a licensed RDH but I’m also a recent grad and still have trouble detecting decay. Specifically clinically. I can spot the obvious occlusal decay where it is dark/sticky but what others ways do you all detect it? My Dentist goes around interproximally with the Explorer and I think they are looking to see if it “dips in” but I just havent mastered this and I feel like this is a skill I really should know. So, what do you look for when detecting cavities? Thank you 🙂



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10 Answers

You will get better as you get more experience. I had no idea what I was looking for as a new grad. I’m sure your doctors don’t expect you to catch everything.

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Its not our responsibility to detect decay but with that said experience will help you see what the dentist see’s or feels. I only feel areas with the explorer if it looks suspicious just so I know what the dentist feels. I was not too confident detect decay clinically right out of college but experience in the chair has helped with that.

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Experience is the key. I review current radiographs 1st, if there are any. If I notice suspicious areas on them I ck clinically. During hand scaling it’s easier to detect ip decay over US. Also, be on the look out for collation changes in enamel, translucent halo like.

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I’ve been doing this for five years and I still don’t think I’m very good at detecting decay BUT I’m much better than I was when I first started! Experience is the best teacher in this situation I think!

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Knowing your dental anatomy can really help, also getting to know where caries can develop. An example would be root surfaces of the elderly. A dry mouth combined with exposed root surfaces and poor oral hygiene can often result in caries. Another would be poor oral hygiene with crown margins. This will all become second nature to you over time. You will be scaling along and something will feel “odd” or “different” and this will be when you look a bit deeper…look at the area closer clinically and at the radiograph. Make a note and point it out to the doc. 🙂

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Im feeling the same way. 🙁 How do you identify these areas to the doctor? I know that as a RDH we can’t diagnose caries, what words are appropriate?

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I usually just suggest to the doctor that they check an area, ex: “could you please peak at the DL margin of #31, I felt a little bit of stickiness there and plaque is being retained in that area”. This still leaves the door open for the doctor to say, “lets just watch that area” or “you know, you are right…I am feeling stickiness there too, lets go ahead and do a small filling there.”

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I write down anything I see on radiographs or clinically on a stick note for doctor. He then can look at it and determine if treatment is necessary. If I really feel something and he is not, I will elaborate when he is doing IO exam. Also after 22 years, I have gotten the hang of it finally 🙂

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We definitely do detect decay as well as desease, infection, and more…As a hygienist first in MA now in IL, I am sometimes in my office without direct supervision. ..if I am not detecting, and treatment planning who is?…I detect, chart findings, educate the patient on findings and needs, and treatment plan those needs…If no doctor is in the office I schedule necessary appointments and leave a note to review my findings…if he is in the office he comes in for the courtesy visit and gives the ok on my treatment plan and lets me know what times slots work for him…while we are not making the final decisions (diagnosing) on needs, we are handling it under
general supervision and that often involves making decisions on their needs and scheduling them with the doctor in a follow up visit to confirm and fix/fill 🙂

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As for the question at hand…better detection comes with time…if in doubt, mark it for the doctor… 🙂

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