Dental Caries

Question 1

What is dental caries

Answer 1

defined as the microbial disease of the
calcified tissues of teeth characterized by
demineralization of the inorganic portion and
destruction of organic substance of the tooth.

Question 2

Etiology of caries

Answer 2

 Caries is a multifactorial disease with an
interplay of several factors :
 1-The host .
 2-The micro flora .
 3-the substrate or diet.
 4- Time.

Question 3

Diagnosis : is an

Answer 3

art and science that results from the
synthesis of scientific knowledge, clinical experience
& common sense.

Question 4

Caries Diagnosis :implies deciding whether a lesion is

Answer 4

active, progressing rapidly or slowly or whether is
already arrested.

Question 5

ASSESSMENT TOOLS:
Stepwise progression toward diagnosis &
treatment planning depends on thorough
assessment of the following:

Answer 5

 Patient History
 Clinical Examination
 Salivary Analysis
 Radiographic Assessment

Question 6

VISUAL-TACTILE METHODS
Visual methods:

Answer 6

 Detection of white spot, discoloration / frank cavitations
 Without aids or tools(By Observation &Inspection)

Question 7

Initial Carious lesion

Answer 7

• Subsurface loss of mineral in the outer tooth surface
• Clinical view: opaque ,dark or brownish spots or chalky white spot

Question 8

Cavitated Lesions

Answer 8

 Where there is visual breakdown of a tooth surface, it
is classified as cavitated carious lesion.
 An active cavity on a smooth surface has soft walls or
floors shown below

Question 9

Inactive root surface lesion (Arrested)

Answer 9

• Well-defined dark brown/ black discoloration
• Smooth and shiny
• Hard on probing with moderate pressure

Question 10

Tactile methods:

Answer 10

Explorers are widely used for the detection of carious
tooth structure(irrigularities , exposed dentin )
- Right angled probe- no.6
- Back action probe- no.17
- Shepherd’s crook- no. 23
 Dental floss

Question 11

Transillumination

Answer 11

 It is a visual diagnostic method that relies on
the passage of light through relatively thin,
translucent tissues.
 It can be also used to visualize proximal caries
in anterior & posterior teeth. And occlusal surfaces
Sensitivity specificity not for early lesions
Not quantitative not useful as caries monitor

Question 12

The DIAGNOdent is a

Answer 12

laser, cavity-detecting device that
illuminates caries lesions with defined light wavelengths. With the
laser light hand piece illuminating the caries, the lesion will
fluoresce and the degree of fluorescence can then be measured

Question 13

Carious lesions are detectable radio graphically when
there has been

Answer 13

been enough demineralization to allow it to
be differentiate from normal.
 40% demineralization is required for definitive
decision on caries.
 They are valuable in detecting proximal caries which
may go undetected during clinical examination.

Question 14

I lesion is seen in the radiographs as
a radiolucent (dark) zone since the
demineralized area of the tooth do not

Answer 14

the tooth do not
absorb as many x-ray photons as the
unaffected portion.

Question 15

Radiographic examinations include;

Answer 15

 Bitewing radiographs
 IOPA radiographs using paralleling technique
 OPG
 CBCT

Question 16

CBCT had a higher sensitivity than the

Answer 16

intraoral systems for
detection of lesions in dentin, but the overall true score was not
higher.
 The investigation to apply in caries diagnosis stems from its
numerous advantages when compared to all current forms of x-ray
imaging

Question 17

Radiographic Interpretation of teeth and
supporting structures:

Answer 17

A-General overview and evaluation of
radiograph as follow:
 The Chronology and developmental age of the patient
 The number of teeth present
 The position ,outline and density of all anatomical
shadows including any developing teeth
B –Tooth :
 Evaluation of any RL of Crown &root evaluation
 The state of existing filling materials or restorations

Question 18

Radiolucent triangular shadows changing the density caused by cavities in

Answer 18

the interproximal enamel.

Question 19

Radiolucent shadow in the dentine seen as a saucer-shaped areas for the

Answer 19

proximal occlusal surfaces

Question 20

oval round areas for the

Answer 20

smooth buccal lingual
surfaces.

Question 21

Radiolucent saucer-shaped shadow in the root caused by

Answer 21

root surface caries

Question 22

Factors affecting appearance of
caries on radiographs :

Answer 22

 Bucco- lingual thickness of tooth :
The thicker the tooth, the more difficult to see
the extent of the caries.
 Limitations of two dimensional film ;
The extent of carious involvement can not be
seen in a buccolingual direction.
 X-ray beam angle(horizontal or vertical ):
This is especially important when trying to identify
Recurrent Caries , since changes in angulations may
cause the superimposition of the existing restoration
with the caries lesion .
 Overlapping due to improper horizontal angulations
makes it very difficult to diagnose early Interproximal Caries.
 Exposure factors ;
 Caries detection is improved with a lower kVp setting ,which provides a higher contrast .
 If the overall density of the film is too light or too dark ,the diagnostic potential of the film is limited

Question 23

Incipient inter proximal
Caries

Answer 23

incipient interproximal lesion extends less than halfway
through the thickness of enamel. The term incipient means beginning to exist or appear. An incipient lesion is seen in enamel only.

Question 24

A moderate interproximal lesion
extends

Answer 24

A moderate interproximal lesion
extends greater than halfway
through the thickness of
enamel, but does not involve
the DEJ. A m o d e r a t e lesion is
seen in enamel only.

Question 25

An advanced interproximal
lesion extends to the

Answer 25

to the DEl or
through the DEJ and into the
dentin, but does not extend
through the dentin greater than
half the distance toward the
pulp.

Question 26

A severe interproximal lesion
extends through

Answer 26

enamel,
through the dentin and greater
than half the distance towards
the pulp. A severe lesion
involves both the enamel and
dentin and may clinically appear
as a cavitation (or hole) in the
tooth.

Question 27

A thorough clinical examination for occlusal caries bcos

Answer 27

Superimposition of dense buccal lingual cusps occlusal caries mot seen on radiograph unless there is dej involvement

Question 28

Incipient occlusal lesions:

Answer 28

Radiographs are not very
effective.
Caries starts on the walls of the
pits & fissures and tends to
spread perpendicular to the
DEJ
Only detectable change is a
fine gray shadow at the DEJ.

Question 29

Occlusal Caries

Answer 29

The apex of the triangle is toward the outer
surface of the tooth and the base is at the
dentino-enamel junction.

Question 30

Moderate occlusal caries extends

Answer 30

dentin and is seen as a very
thin radiolucent line. The radialucency is located under the
enamel of the occlusal surface of the tooth. Little if any
radiographic change is noted in the enamel.

Question 31

Severe occlusal caries extends into

Answer 31

dentin and is seen as a large
radiolucency. The radiolucenck extends under the enamer of the
occlusal surface of the tooth. Severe occlusal caries is apparent
clinically and appears as a cavitation (or hole) in a tooth.

Question 32

Buccal and lingual caries seen with

Answer 32

Clinical bcos buccal and lingual superimposition on radiograph

Question 33

Recurrent caries happen next to

Answer 33

adjacent caries
Thin radiolucent line below restoration
Poor Oral hygiene
Inadequate cavity prep
Defective margin
InComplete removal of caries
High caries incidence

Question 34

Root surface caries only seen in

Answer 34

only involves the roots of teeth. The cementum and dentin located just below the cervical region of the tooth is involved. No involvement of enamel is seen. Bone loss and corresponding gingival recession precede the caries process and result in exposed root surtaces.

Question 35

The most common locations include the exposed roots of the

Answer 35

mandibular premolar and molar areas.

Question 36

On a dental radiograph, root surface caries appears as a

Answer 36

On a dental radiograph, root surface caries appears as a cupped-out or crater-shaped radialucency just below the cemente-enamel juction (CE)). Early lesions may be difficult to detect on a dental radiograph.

Question 37

Rampant Caries
 The term Rampant caries means

Answer 37

Rampant caries means rapidly growing or
spreading unchecked .
 Rampant Caries advanced and severe caries which
affects numerous teeth in the dentition.

Question 38

Rampant caries is typically seen in

Answer 38

Rampant caries is typically seen in children with poor
dietary or in adults with a decreased salivary flow.

Question 39

Radiation Caries

Answer 39

 Patients who have received radiotherapy to the head
and neck may suffer a loss of salivary gland function,
leading to xerostomia (dry mouth), this induces
rampant destruction of the teeth , termed (Radiation
Caries).
 Typically the destruction begins at the cervical
region and may aggressively encircle the tooth,
causing the entire crown to be lost, with only root
fragments remaining in the jaws.

Question 40

Conditions resembling Caries

Answer 40

Restorative materials .
Abrasion.
Attrition.
Cervical Burnout.

Question 41

Restorative materials, such as

Answer 41

composites, silicates and acrylics, may appear radiolucent and resemble dental caries on a radiograph. The appearance of an anterior cavity preparation restored with these materials differs from the appearance of interproximal caries and can be identified by the well-defined, smooth outline
In addition, a careful clinical exam helps the dental professional determine the difference between a restorative material and dental caries.

Question 42

Abrasion refers to the

Answer 42

the wearing away of tooth structure from the friction of a foreign object. The surface of the tooth affected depends on the causative factor.
The most frequent type of abrasion is caused by tooth brushing and is seen at the cervical margin of the teeth. Tooth brush abrasion affects the root surface of a tooth and may be confused with root surface caries.
On a dental radiograph, tooth brush abrasion appears as a well-defined horizontal radiolucency along the cervical region of a tooth
Clinically, the areas affected by abrasion appear as hard, highly polished defects in dentin and should not be confused with root caries that appears brown and leathery-
V shaped defect

Question 43

Attrition, or the

Answer 43

Attrition, or the mechanical wearing down of teeth may be mistaken for dental caries on a radiograph.
Attrition may be seen on the incisal or poclusal surfaces of deciduous or permanent teeth. When the incisal or occlusal enamel is worn away, the underlying dentin wears away rapidly, and shallow concavities may form These concavities may resemble acclusal or incisal cares on a dental radiograph.
Clinical examination enables the dental professional to distinguish attrition from caries.

Question 44

Erosion

Answer 44

Progressive loss of hard dental tissue by chemical processes
Eg:
Tooth contact with acids
Regurgitation of HCl

Question 45

Cervical burnout

Answer 45

Cervical burnout, a radiolucent artifact seen on dental radiographs, may also be confused with dental caries. Cervical burnout appears as a collar or weage-shaped radiolucency on the mesial and distal root surfaces near the CE3 of a tooth (see red arrows).
When seen as a radiolucent collar, cervical burnout may be confused with root caries.
This radiolucent
artifact is seen because of the difference in densities of adjacent tissues.
usvally PMs
The tissue density at the cervical region of the tooth is less dense than the regions above and below it; wakeve the neck of the tooth, enamel covers the crown, and below the neck of the tooth, bone covers the roots. Cervical burnout can also appear as an ill-defined wedge-shaped radialuency on the mesial or distal root surfaces near the CE3 of posterior teeth. This wedge-shaped radiolucency is seen because of the anatomic root concavities found in this area.

Question 46

Radiographic Changes of the Pulp

Answer 46

1- Calcification of the pulp.
aducts more
a- Pulp stones: are extremely common. They are usually seen in adults but occasionally in children. They are seen as single or multiple opacities within the pulp of one or more teeth, with the pulp retaining its normal outline.
b- Calcific degeneration may occur as a stage in the degenerative process of the pulp associated with such irritants as deep carious cavities, large restorations, and trauma. It is usually followed by death of the pulp. Radiographically, it is seen as small flecks of radiopacities.

Question 47

Radiographic assessment of the restorations

Answer 47

• The type and radiodensity of the restorative material, e.g.
(Amalgam,cast metal,or adhesive materials such as composite or glass ionomer) .
• Overcontouring
• Overhanging ledges
• Undercontouring

Presence of contact points.
• Adaptation of the restorative material to the base of the cavity.
• Presence or absence of a lining material.