after midterms Flashcards
What is the rationale for infection control?
To prevent the transmission of infectious diseases
Pathogen
A microorganism capable of causing disease
Antiseptic
A substance that inhibits the growth of bacteria.
Asepsis
The absence of pathogens. Term used to describe procedures that prevent infection (i.e. aseptic techniques)
Bloodborne pathogen
Pathogens present in blood
Disinfect
Use a chemical or physical procedure to inhibit or destroy pathogens
Exposure incident
A specific incident that involves contact with blood or OPIM
Occupational exposure
Contact with blood or OPIM that involves skin, eye, or mucous membranes
Parenteral exposure
Exposure to blood and OPIM through piercing or puncturing of skin barrier
Sterilize
The use of a physical or chemical procedure to destroy all pathogens including spores
Critical instruments
Critical instruments Instruments that are used to penetrate soft tissue or bone Must be sterilized
Semicritical instruments
Instruments that contact but do not penetrate soft tissue or bone. Must be sterilized or High-level disinfection In dental imaging includes: beam alignment devices
Noncritical instruments
Instruments or devices that do not come in contact with mucous membranes In dental imaging: PID, tube head, exposure button, control panel, lead apron, computer keyboard and mouse
After each patient has been treated all dental unit surfaces and countertops that may come into contact with saliva and blood must be …..
cleaned and disinfected.
Intermediate-level disinfectants
EPA labeled hospital disinfectant and tuberculocidal Recommended for all contaminated surfaces
Low-level disinfectants
EPA labeled hospital disinfectant Recommended for general house-keeping
High-level disinfectants can be used to disinfect ……
heat-sensitive semicritical dental instruments.
Low-level disinfectants are recommended for …..
general housekeeping purposes, such as cleaning floors and walls.
Infection Control Procedures Used Before Exposure
Preparation of the treatment area Preparation of supplies and equipment Preparation of the dental radiographer
Infection Control Procedures Used During Exposure
During and immediately after exposure, the radiographer must handle each receptor in a manner consistent with comprehensive infection control guidelines, which include: Drying of exposed receptors Collection of exposed receptors Beam alignment devices
If the dental radiographer is interrupted and must leave the room during exposure of receptors, the radiographer must
Remove gloves and wash hands before leaving the area Rewash hands and put on new gloves before resuming the procedure
Infection Control Procedures Used After Exposure
Disposal of contaminated items Beam alignment devices Remove from contaminated area Handwashing Lead apron removal Surface disinfection
Quality control tests are necessary to monitor all …
dental x-ray machines, film, screens and cassettes, and viewing equipment.
Darkroom must be checked every ____ for light tightness.
month
Darkroom is checked every _ months for proper safe-lighting
6
Functioning processor
The unexposed film appears clear and dry and the exposed film appears black and dry.
Nonfunctioning processor
If the unexposed film does not appear clear and dry and if the exposed film does not appear completely black and dry the processor is nonfunctioning.
Processing solutions should be replenished ___ and changed every _ to _ weeks.
daily 3 to 4
Receptor Exposure Errors
Exposure problems Unexposed receptor Film exposed to light
Unexposed Receptor
Appearance The image appears clear. Cause Failure to turn on the x-ray machine Electrical failure Malfunction of the x-ray machine Correction Make certain the x-ray machine is turned on and listen for the audible exposure signal.
Film Exposed to Light
Appearance The image appears black. Cause The film was exposed to white light. Correction Do not unwrap in a room with white light. Check the darkroom for light leaks. Turn off all lights in the darkroom except the safelight.
Overexposed Film
Appearance Image appears dark. Cause Excessive exposure time, kilovoltage, milliamperage. Correction Check settings and reduce as needed before exposing receptor.
Underexposed Receptor
Appearance The image appears light. Cause The receptor was underexposed. Correction Check the exposure time, kilovoltage, and milliamperage settings on the x-ray machine before exposing the receptor
Correct Receptor Placement
The edge of the periapical receptor must be placed parallel to the incisal or occlusal surfaces of the teeth and extend 1/8th inch beyond the incisal or occlusal surfaces.
Absence of Apical Structures
Appearance No apices appear on the receptor. Cause The receptor was not positioned in the patient’s mouth to cover the apical regions of the teeth. Correction Make certain no more than 1/8th inch of the receptor edge extends beyond the incisal-occlusal surfaces of the teeth.
Dropped Receptor Corner
Appearance The occlusal plane appears tipped or tilted. Cause The edge of the receptor was not placed parallel to the incisal-occlusal surfaces of the teeth. Correction Make certain the edge of the receptor is placed parallel to the incisal-occlusal surfaces of the teeth.
Incorrect Horizontal Angulation
Appearance Overlapped contacts Cause The central ray was not directed through interproximal spaces. Correction Direct the x-ray beam through interproximal regions.
Incorrect Vertical Angulation Foreshortened images
Appearance Short teeth with blunted roots Cause Excessive vertical angulation Correction Do not use excessive vertical angulation with the bisecting technique.
Incorrect Vertical Angulation Elongated images
Appearance Long, distorted teeth Cause The vertical angulation was insufficient. Correction Use adequate vertical angulation with the bisecting technique
Position Indicating Device (PID) Alignment Problems Cone-cut with Beam Alignment Device
Appearance A clear area appears on the image. Cause The PID was not properly aligned with the periapical beam alignment device. Correction Make certain the x-ray beam is centered over the receptor.
PID Alignment Problems Cone-cut without beam alignment device
Appearance A clear area appears on the image. Cause The PID was not directed at the center of the receptor. Correction Make certain the x-ray beam is centered over the receptor.
Incorrect Receptor Placement
Premolar bite-wing
Appearance
Distal surfaces of the canines are not visible on the image.
Cause
The bite-wing receptor was positioned too far posteriorly in the mouth.
Correction
Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular canine.
Incorrect Receptor Placement
Molar bite-wing
Appearance
Third molar regions are not visible on image.
Cause
The bite-wing receptor was positioned too far anteriorly in the mouth.
Correction
Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular second premolar.
Incorrect Horizontal Angulation
Appearance
Overlapped contacts on the image
Cause
The central ray was not directed through the interproximal spaces
Correction
Direct the x-ray beam through the interproximal spaces.
Incorrect Vertical Angulation
Appearance
Images appear distorted on the image.
Cause
The vertical angulation was incorrect.
Correction
Always use a +10-degree vertical angulation with the bitewing technique.
Cone-Cut With Beam Alignment Device
Appearance
A clear area appears on the image.
Cause
The PID was not properly aligned with the beam alignment device.
Correction
Make certain the PID and the aiming ring are aligned.
Cone-Cut Without Beam Alignment Device
Appearance
A clear area appears on the image.
Cause
The PID was not directed at the center of the receptor.
Correction
Make certain the x-ray beam is centered over the receptor
Film Bending
Appearance
Images appear stretched and distorted.
Cause
The film was bent excessively.
Correction
Check film placement before exposure.
•Cotton rolls can be used with the paralleling technique or bisecting technique to help with stability.
Film Creasing
Appearance
A thin radiolucent line appears on the image.
Cause
The film was creased.
Correction
Do not bend or crease the film excessively.
Phalangioma
Appearance
The patient’s finger appears on the radiograph.
Cause
The patient’s finger was positioned in front of the receptor.
Correction
Make certain the patient’s finger is placed behind the receptor.
Double Exposure
Appearance
A double image appears on the radiograph.
Cause
The receptor was exposed twice in the patient’s mouth.
Correction
Always separate exposed and unexposed receptors.
movement
Appearance
Blurred images appear on the radiograph.
Cause
The patient moved during exposure of the receptor.
Correction
Instruct the patient to remain still while the receptor is being exposed.
Reversed Film
Appearance
Light images with a herringbone pattern appear on the radiograph.
Cause
The receptor was placed backward in the mouth and then exposed.
Correction
Always place the white side of the receptor adjacent to the teeth.
Interpret
ØTo offer an explanation
Interpretation
ØAn explanation
Image interpretation
ØAn explanation of what is viewed on a dental image; the ability to read what is revealed by a dental image
Diagnosis
the identification of a disease by examination or analysis
•Image interpretation is of paramount importance to the dental professional and plays a vital role in the detection of diseases, lesions, and conditions of the teeth and jaws that cannot be identified clinically.
•Image interpretation is of paramount importance to the dental professional and plays a vital role in the detection of diseases, lesions, and conditions of the teeth and jaws that cannot be identified clinically.
Who Interprets Images?
Any dental professional with training in interpretation can examine films.
Diagnosis
ØThe identification of disease by examination or analysis
The final interpretation and diagnosis are the responsibilities of the _____
dentist
Whonare restricted by law from rendering a diagnosis?
Dental hygienists and dental assistants
When and Where Are
Images Interpreted?
It is best to have images taken at the begining of the appointment and interpreted immediately after mounting in the presence of the patient.
What is Descriptive Terminology?
Descriptive terminology is terms used to describe the appearance, location, and size of a lesion.
ØIt eliminates the chance for miscommunication.
ØIt allows for documentation that images were reviewed.
Descriptive terminology allows the dental auxiliary to describe what is seen on an image
without implying a diagnosis.
Radiograph
ØAn image that is produced on photosensitive film by exposing the film to x-rays and then processing the film so that a negative is produced
X-ray
ØA beam of energy that has the power to penetrate substances and to record shadow images on photographic film
Radiolucent
ØThis that portion of a processed image that is dark or black.
•Caries appears radiolucent because the area of tooth with caries is less dense than surrounding structures.
Radiopaque
ØThis is that portion of a processed image that appears light or white.
•A metallic restoration appears radiopaque because it is very dense and absorbs the radiation.
•Radiolucent structures are …..
soft or thin, lack density, and permit the passage of the x-ray beam with little or not resistance.
•Radiopaque structures are…….
thick or hard, dense, and absorb or resist the passage of the x-ray beam.
Two Gold Crowns On Mandibular Molars Appear Radiopaque
Terms Used to Describe
Radiolucent Lesions
Unilocular radiolucent lesions
Unilocular lesion, corticated borders
Unilocular lesion, noncorticated borders
Multilocular radiolucent lesions
Mutilocular Radiolucent Lesions
Ameloblastomas
Unilocular radiolucent lesions
ØOne compartment
ØTend to be small and nonexpansile
ØHave borders that may appear corticated or noncorticated on image
Unilocular lesion, corticated borders
ØThe lesion exhibits a thin, well-demarcated radiopaque rim of bone at the periphery.
ØUsually indicative of a benign, slow-growing process.
Unilocular lesion, noncorticated borders
ØThe lesion does not exhibit a thin radiopaque rim of bone at the periphery.
ØThe periphery appears fuzzy or poorly defined.
ØMay represent either a benign or a malignant process.
Multilocular radiolucent lesions
ØA lesion that exhibits multiple radiolucent compartments
ØFrequently expansile
ØTypically benign lesions with aggressive growth potential
- Tend to displace the buccal and lingual plates of bone.
- Most represent a reactive or neoplastic process.
Mutilocular Radiolucent Lesions
Ameloblastomas
Unilocular Corticated Radiolucent Lesion in Periapical Location
Unilocular Corticated Radiolucent Lesion in Periapical Location
Inter-radicular Location
A lesion located between the roots of adjacent teeth
Edentulous Zone
A lesion located in an area without teeth
Pericoronal Location
A radiolucent lesion located around the crown of an impacted tooth
Unilocular Coricated Radiolucent
Dentigerous Cysts
Alveolar Bone Loss
Loss of bone in the maxilla or mandible that surrounds and supports the teeth
ØAppears radiolucent
•Not only seen with periodontal disease but also with systemic illnesses, such as diabetes, histiocytosis X, and leukemia.
Radiolucent Area Caused by Alveolar Bone Loss
Can vary in size from several millimeters in diameter to several centimeters in diameter
ØCan be measured on an image with a millimeter ruler
- The size often dictates the type of treatment necessary.
- Documentation of the size of a lesion is important for future comparisons.
Terms Used to Describe
Radiopaque Lesions
Appearance:
Can be described as focal opacity, target lesion, multifocal confluent, irregular, ground glass, or mixed lucent-opaque.
ØRadiopaque lesions occur not only in bone but in soft tissue as well.
•A radiopaque lesion located in soft tissue can be described as a “soft tissue radiopacity.”
Focal Opacity
A well-defined, localized radiopaque lesion on an image
Example
ØCondensing osteitis
Target Lesion
A well-defined, localized radiopaque area surrounded by a uniform radiolucent halo
Multifocal Confluent
Multiple radiopacities that appear to overlap or flow together
Example
ØOsteitis deformans, florid osseous dysplasia
ØMultifocal confluent radiopacities involving multiple quadrants of the jaws usually represent benign fibro-osseous disorders.
Irregular Ill-Defined
A radiopacity may exhibit an irregular, poorly defined pattern.
ØIt may represent a malignant condition.
Examples
ØOsteosarcoma and chondrosarcoma
Osteosarcoma
Ground Glass
A granular or pebbled radiopacity that resembles pulverized glass
ØOften said to resemble the appearance or texture of an orange peel
Fibrous Dysplasia
Ground Glass Pattern
Fibrous Dysplasia
Orange Peel Pattern
Fibrous Dysplasia
Cotton Wool Pattern
Mixed Lucent-Opaque
Exhibits both a radiopaque and a radiolucent component
ØOften represent calcifying tumors
- Often appear as a radiolucent are with central opaque flecks of calcifications.
- The mineralization progresses with time, a predominantly radiolucent lesion with radiopaque flecks becomes more radiopaque.
Mixed Lucent-Opaque Lesion
Compound Odontoma
Soft Tissue Opacity
Appears as a well-defined, radiopaque area located in soft tissue
Examples
ØSialolith- is a salivary stone.
ØCalcified lymph node
Soft Tissue Opacity
Sialolith
Radiopaque lesions may appear in the same places as radiolucent lesions: in a …..
periapical, inter-radicular, edentulous, or pericoronal location.
periapical, inter-radicular, edentulous, or pericoronal location.
ØBenign cementoblastoma
Inter-radicular Location
A radiopaque lesion located between the roots of adjacent teeth
Example
ØSclerotic bone
Mixed Lucent-Opaque Lesion in Inter-radicular Location
Edentulous Zone
A radiopaque lesion located in an area without teeth
Example
ØComplex odontoma
Mutifocal Confluent Radiopacities in Edentulous Zone
Compound Odontomas
Pericoronal Location
A radiopaque lesion located around the crown of an impacted tooth
Example
ØAdenomatoid odontogenic tumor is a mixed lucent-opaque lesion.
Mixed Lucent-Opaque Lesion I Pericoronal Location
Mixed Lucent-Opaque Lesion
Adenomatoid Odontogenic Tumors
Caries
ØThe localized destruction of teeth by microorganisms
Clinical examination and dental images are necessary to detect dental caries.
ØDental images enable the dental professional to identify carious lesions that are not visible clinically.
ØThey also allow the dental professional to evaluate the extent and severity of carious lesions.
Clinical Examination:Some carious lesions can be detected simply by looking in the mouth, and others cannot.
ØThe mirror can be used to reflect light, allow for indirect vision, and retract the tongue.
ØThe explorer can be used to detect changes in consistency in pits, grooves, and fissures of teeth.
Clinical Examination: Color changes may be observed.
ØOcclusal surfaces may show dark staining in fissures, pits, and grooves.
ØSmooth surfaces may exhibit a chalky white spot or opacity.
ØAn interproximal ridge may appear discolored.
•Why types of dental images are taken to check for caries in between the teeth?
(Bite-wings.)
Some teeth may exhibit a discolored area. cavitation, or have no visible changes.
Caries that occur between teeth may be difficult or impossible to detect clinically.
ØDental images play an important role in these situations.
Discoloration on the distal of the maxillary first premolar that represents dental caries.
Image Examination: A carious area appears radiolucent because decreased density allows for greater penetration in the carious area.
ØThe bite-wing image provides the dental professional with the greatest amount of diagnostic information.
ØA periapical exposure taken with paralleling technique may also be used.
•Dental caries is the most frequently encountered radiolucent lesion on dental images.
Interpretation Tips
Proper mounting
Viewing in a room with subdued light that is free of distractions
An illuminator or viewbox
Masking light around the mounted films
A pocket sized magnifying glass
•Dental images should be viewed in the presence of the patient.
Factors Influencing Caries Interpretation
Dental images must be of diagnostic quality.
ØExamples may include:
- Improper horizontal angulation on a bite-wing image
- Errors in exposure with improper contrast and density
•What errors occur with improper horizontal angulation?
(Overlapped contact areas.)
•What errors cause improper contrast and density?
(Incorrect exposure factors result in images that are too dark or too light.)
Classification of Caries
on Dental Images
Interproximal Caries
Occlusal Caries
Buccal and Lingual Caries
Root Surface Caries
Recurrent Caries
Rampant Caries
Interproximal
ØBetween two adjacent surfaces
Interproximal caries typically seen on dental images at or just below the contact point.
ØAs caries progresses through the enamel, it typically assumes a triangular configuration.
ØWhen it reaches the DEJ, it spreads laterally and progresses through dentin.
These are classified as incipient, moderate, advanced, and severe.
Interproximal Caries Found at or just below the Contact Area
Caries Found at or Just Below the Contact Area
Caries Confined to Enamel
Exhibits a Triangular Configuration
Caries Have Reached DEJ and Spread Along DEJ Resulting in Another Triangular Configuration
Incipient Interproximal Caries
Incipient interproximal caries extends less than halfway through the thickness of enamel.
ØAn incipient or Class I lesion is seen only in enamel.
An Incipient Carious Lesion
Extends less than halfway through enamel
An Incipient Carious Lesion
distal surface mandibular second premolar
Moderate Interproximal Caries
Moderate interproximal caries extends more than halfway through enamel but does not involve the DEJ.
ØA moderate or Class II lesion is seen only in enamel.
A Moderate Carious Lesion
Advanced Interproximal Caries
Advanced interproximal caries extends to or through the DEJ and into dentin, but does not extend into dentin more than half the distance toward the pulp.
ØAn advanced or Class III lesion affects both enamel or dentin.
An Advanced Carious Lesion
An Advanced Carious Lesion
Severe Interproximal Caries
Severe interproximal caries extends through enamel and dentin more than half the distance toward the pulp.
ØA severe or Class IV lesion involves both enamel and dentin and may appear clinically as a cavitation in the tooth .
A Severe Carious Lesion
Extends Through Enamel and Dentin More Than Half The Distance to the Pulp Chamber
A Severe Carious Lesion
Occlusal Caries:Occlusal caries are caries that involve the chewing surface of posterior teeth.
ØA thorough clinical exam is the method of choice for the detection of occlusal caries.
ØEarly occlusal caries is difficult to see on a dental image.
Incipient Occlusal Caries
Incipient occlusal caries cannot be seen on a dental image.
It must be detected with an explorer.
Moderate Occlusal Caries: Moderate occlusal caries extends into dentin.
ØIt appears as a thin, radiolucent line.
•The radiolucency is located under the enamel of the occlusal surface of the tooth. Little if any change is noted in the enamel when viewed on a dental image.
Moderate Occlusal Caries
Extends Through Enamel, Into Dentin along the DEJ
Occlusal Caries
Severe Occlusal Caries
Severe occlusal caries extends into dentin and appears as a radiolucency.
ØThe radiolucency extends under the enamel of the occlusal surface of the tooth.
•Apparent clinically and appears as a cavitation in a tooth.
Severe Occlusal Caries Extends Through Enamel and into Dentin beyond DEJ
Buccal and Lingual Caries
These are difficult to detect on a dental image because they are superimposed on tooth structure.
ØIf seen on a dental image, they appear as a circular radiolucent area.
Buccal or Lingual Caries Seen as a Round Radiolucency on Molars
Buccal Caries Seen as a Small Circular Radiolucency
Root Surface Caries:
Root surface caries involves only the roots of teeth.
ØOn a dental image, it appears as a cupped-out or crater-shaped radiolucency below the CEJ.
ØEarly lesions may be difficult to detect on a dental image.
•Bone loss and corresponding gingival recession precede the caries process and result in …..
exposed root surfaces.
•Most common locations include the exposed roots of the
mandibular premolar and molar areas.
Root Caries Involving Only Cementum and Dentin, Not Enamel
Root Caries appearing as crater-shaped radiolucency just below CEJ
Recurrent Caries: Recurrent caries occurs adjacent to an existing restoration.
ØIt appears as a radiolucent area just beneath a restoration.
ØIt is most often located beneath the interproximal margins of a restoration.
•Recurrent Caries Occurs because of ____________ before place of the restoration.
inadequate cavity preparation, defective margins, or incomplete removal of caries
Recurrent Caries
Rampant Caries
are advanced and severe caries affecting a number of teeth.
ØThis is associated with children with poor diets and adults with decreased salivary flow.
Rampant Caries
ØHow does the image examination aid in detection of periodontal disease?
ØTo present the image interpretation of periodontal disease, with an emphasis on a description of bone loss, ADA case types, and identification of predisposing factors
Description of the Periodontium
Periodontal ligament space
Alveolar crest
Lamina dura
Lamina dura
ØLamina dura appears as a dense radiopaque line in healthy teeth.
Alveolar crest
ØThis is about 1.5 to 2 mm apical to the CEJ of adjacent healthy teeth.
- In anterior teeth, the alveolar crest is pointed and sharp and appears to be very radiopaque.
- In posterior teeth, the alveolar crest appears flat and smooth, and parallel to a line between adjacent cementoenamel junctions.
- It appears a little less radiopaque than in anterior teeth.
•The periodontium refers to the tissues that
invest and support the teeth.
Healthy Alveolar Crest appears flat, smooth and radiopaque
Periodontal ligament space
ØThis appears as a thin radiolucent line between the root of the teeth and the lamina dura.
ØIt is continuous around the root structure and of uniform thickness in healthy teeth.
Healthy Alveolar Crest, Normal Lamina Dura and PDL Space
Periodontal disease is a group of diseases that affect the tissue around teeth.
ØMay range from superficial inflammation of gingiva to destruction of supporting bone and periodontal ligament.
ØThe gingiva appears swollen, red, and bleeding, with soft tissue pocket formation.
Detection of periodontal disease requires both clinical and dental image examination.
ØThe clinical examination provides information about soft tissue.
ØThe image examination provides information about bone.
Clinical examination must be performed by the dentist and dental hygienist.
ØShould include evaluation of soft tissue for signs of inflammation such as redness, bleeding, swelling, pus.
ØA thorough clinical assessment must include periodontal probing.
Dental Image Examination: This provides an overview of the amount of bone present.
ØIndicates the pattern, distribution, and severity of bone loss.
ØThe periapical image is the image of choice for the evaluation of periodontal disease.
ØThe paralleling technique is the preferred periapical exposure method for demonstrating anatomic features of periodontal disease.
ØBisected periapical images may appear to show less bone loss than is actually present.
____ _____accurately records the relationship of the height of the crestal bone to the tooth root.
•The paralleling technique
•The paralleling technique
Bisecting Technique
The horizontal bite-wing has limited value in the detection of periodontal disease.
ØSevere interproximal bone loss cannot be adequately visualized on horizontal bite-wing images.
ØThe vertical bite-wing image can be used to examine bone levels in the mouth.
Images alone cannot be used to diagnose periodontal disease.
ØThey do not provide information about the condition of soft tissue or early bone changes.
They are two-dimensional representations of three-dimensional objects.
ØBuccal and lingual areas may be difficult to evaluate.
ØBone loss may be difficult to detect in furcation areas.
Interpretation of Periodontal Disease on Dental Images
Bone Loss
Classification of Periodontal Disease
Predisposing Factors
All images should be
ØEvaluated for bone loss
ØExamined for other predisposing factors that may contribute to periodontal disease
Bone Loss
Can be estimated as the difference between the physiologic bone level and the height of remaining bone
ØIt can be described in terms of the pattern, distribution, and severity of loss
•A radiograph allows the dental professional to view the amount of bone remaining rather than the amount of bone lost.
Bone loss estimated as the difference between the physiologic level of bone and the height of the remaining bone
Pattern
Described as either horizontal or vertical
ØHorizontal bone loss
•The loss occurs in a plane parallel to the CEJs of adjacent teeth
ØVertical bone loss
•The loss does not occur in a plane parallel to the CEJs of adjacent teeth
•Vertical bone loss is also referred to as
angular bone loss.
Horizontal bone loss, which occurs in a plane parallel to the cemento-enamel junction of adjacent teeth
Vertical Bone Loss
Distribution
Described as localized or generalized
ØLocalized
•Occurs in isolated areas
ØGeneralized
•Occurs evenly throughout the dental arches
•Localized has _____ than 30% of the sites involved.
less
•Generalized has more than 30% of the sites involved and occurs evenly throughout the
dental arches.
Severity
Can be classified as mild, moderate, or severe
- Measured by the clinical attachment loss, distance in mm from the CEJ to the base of the sulcus or periodontal pocket.
- Measured by a calibrated periodontal probe.
ØMild bone loss:
crestal changes
ØModerate bone loss:
bone loss of 10% to 33%
ØSevere bone loss:
bone loss of 33% or more
Based on the amount of bone loss, periodontal disease can be classified as ADA case
ØType I: gingivitis
ØType II: early periodontitis
ØType III: moderate periodontitis
ØType IV: advanced periodontitis
Classification of Periodontal Disease
- Each disease type has a specific radiographic appearance.
- Radiographs can also be used to detect the contributing factors of periodontal disease, such as calculus and defective restorations.
ADA Case Type I
Gingivitis
ØNo associated bone loss
ØNo change is seen in bone when viewed on a dental image
ADA Case Type I
- The crestal lamina dura is present, and the alveolar crest is approximately 1 to 2 mm apical to the CEJ.
- Bleeding may or may not be present.
- Only the gingival tissues are affected.
ADA Case Type II
Early periodontitis
ØAssociated with mild crestal changes
- The lamina dura becomes unclear and fuzzy and no longer appears to be a continuous radiopaque line.
- Horizontal bone loss is seen more often.
- Bleeding may occur with probing, pocket depths resulting from attachment loss may be present, and localized areas of recession may also be seen.
ADA Case Type II
Horizontal Bone Loss and Mild Crestal Changes
ADA Case Type III
Moderate periodontitis
ØIs associated with 10% to 33% bone loss.
ØThe pattern may be horizontal or vertical, the distribution may be localized or generalized.
ØFurcation involvement may be seen.
ADA Case Type III
- The alveolar bone level is approximately 4 to 6 mm apical to the CEJs of adjacent teeth.
- When the bone in the furcation is destroyed, a radiolucent area is evident on the dental image.
- Clinically, pocketing and attachment loss is evident up to 6 mm.
- Recession, furcation involvement areas, and slight mobility may also be present.
ADA Case Type III
ADA Case Type III with
Horizontal Bone Loss
Furcation area of the mandibular first molar appears radiolucent
ADA Case Type IV
Advanced periodontitis
ØAssociated with more severe bone loss (33% or more)
ADA Case Type IV
- May be vertical, and the alveolar bone level is 6 mm or great from the CEJ.
- Furcation involvement is readily viewed on posterior images.
ADA Case Type IV
Advanced Periodontitis
Predisposing Factors
Predisposing factors and local irritants may contribute to periodontal disease
•The effects of certain medications, tobacco use, and conditions such as diabetes are all considered risk factors for periodontal disease.
Calculus
Results from the mineralization of plaque
ØAppears white or light on a dental radiograph
•Stonelike concretion that forms on the crowns and roots of teeth due to the calcification of bacterial plaque.
Calculus
Most often appears as a pointed or irregular radiopaque projection extending from proximal root surfaces
ØMay also appear as a
- Ringlike opacity
- A nodular image projection
- A smooth opacity on a root surface
Subgingival calculus appears as irregular radiopaque projections in the maxillary anterior region
Defective Restorations
Faulty restorations may act as food traps and lead to the accumulation of food debris and bacteria
ØThey may be detected both clinically and on dental images
Dental images may allow identification of restorations with
ØOpen or light contacts
ØPoor contour
ØUneven marginal ridges
ØOverhangs
Inadequate margins
