March 24- Dental Caries Final Flashcards
What are dental caries?
“Pathologic process of localized destruction of dental hard tissues by organic acids produced by microbial deposits adhering to teeth.” This is a dynamic process fluctuating between demineralization and mineralization.
What is ICDAS?
‘International Caries Detection and Assessment System. It’s purpose is to stage caries to help dentists assess and mange caries appropriately. It is a common language for staging.
What’s the ICDAS severity codes?
What do the different stages of caries look like?
What do caries look like on a radiograph?
Radiolucent (dark). In enamel, there is decreased mineral content so more x rays pass through and hit the sensor. And in dentin, there is a decrease in th eattenuation of the x ray beam so more x rays pass through to hit the sensor in a similar way.
remember that radiographs are an aid to the clinical exam.
Why are radiographs important when diagnosing caries?
It is non invasive
can see parts of the tooth that are inaccesible in the clinical exam.
can assess lesion depth
successive images allow us to see progression
what are the classifications of caries by location?
• Smooth surface
- Interproximal
- Buccal or lingual surfaces
- Root
• Pit or Fissure
- Occlusal
- Buccal or lingual pit
• Recurrent
what’s an anterior inperproximal carie? what does it look like?
interproximal caries are between two adjacent teeth obviously. An anterior periapical radiograph would be most useful.
Sometimes an interproximal carie looks a lot like a restoration. How can you tell the difference?
Old resorations may look like a carie, but look at the shape of the carie, if it is rounded from a burr it is likely an old resoration, if irregular, more likely to be a carie. New restorations are composite and don’t look like caries.
what type of radiograph would be most useful for a posterior interproximal carie?
bitewings
can also see with a periapical
ideally we want to see all of the interprocimal contacts to be visible on the radiograph.
use film holdres and BID
How should you angle the x ray beam (appriximately) in order to get open contacts on premolars vs molars?
How much demineralization is required for an interproximal lesion to be detected radiographically?
30-50%. the thickness of the tooth buccolinguallt could mask a carious lesion when it is very small. So lesions may actually be deeper clinically then they look on a radiograph.
What stage of caries can be detected by a radiograh?
Interproximal surfaces: ICDAS 2-6
Occlusal surfaces: ICDAS 4-6 (sometimes 2 and 3)
Digital radiology allows post-exposure manipulation to enhance the image.
changes in density and size of the lesion can be monitored
over time “subtraction radiography” but difficult in private practice setting
When does a lesion neeed restorative intervention?
- Continuing debate!
- Depends on the individual patients wants, needs
and circumstances
• Focus currently is on cavitation (surface
discontinuity) rather than dentine involvement
(lesion depth)
What is cavitation?
When a radiographic lesion has moved into the dentin.
if there is cavitation, it is not likely that the lesion will heal.
here, radiographs can give us info about lesion depth.
Radiographic lesion depth and density of the dentine are inaccurate in distinguishing cavitated and noncavitated interproximal lesions.
What des the stage 1 carie look like?
• Observed clinically after the
enamel surface is dried for a few
seconds as “white spots” and are called
“incipient lesions”
• Only the outer layer of enamel is
effected on radiographs. and the lesion is
conical or triangular in shape.
• Caries confined to enamel-does NOT
yet involve the dentino-enamel junction
• Lesion can be arrested or even
remineralized by an effective preventive
program
What does a stage 2 lesion look like?
lesions are more pronounced
and can be seen with the naked eye even
when the tooth is wet with saliva
• The lesions has advanced and changes can
be observed through the whole thickness of
the enamel.
the image is likely a class 2 because it is visible in the radiograph
what do moderate interproximal caries at stages 3 and 4 look like?
Caries has reached the dentino-enamel junction and is spreading laterally along it.
• Often a brown tint in the underlying dentine can be seen
clinically
• Clinical cavitation may have occurred by this stage
What do class 5 and 6 interproximal caries look like?
Caries spreads rapidly along the enlarged dentinal tubules towards the pulp.
• The lesion is cavitated
Notice in the image that the pulp looks flattened, this is because reparative dentine is being layed down.
What do buccal/lingual caries look like on a radiograph?
Caries appears as a round or oval radiolucency in the centre o the tooth.
Impossible to determine lesion depth on radiograph Clinical exam is key to the diagnosis of this type of caries.
What is root caries and what does it involve? What does it look like?
- Begins at the cemento-enamel junction (CEJ) and spreads around the tooth circumference.
- It occurs only after cementum exposure has occurred due to gingival recession.
- Requires differentiation from cervical burnout
What is this an example of?
Root Caries…duh!
What is the most common site of caries?
The occlusal surface, because irregular pits and fissures are prone to plaque accumulation.
What makes early caries difficult to detect radiographically on the occlusal surface?
it is difficult to identify because of superimposition of the buccal and lingual/palatal enamel
For this reason early caries is diagnosed clincally.
Occlusal caries into dentin however can been seen.
This is an example of ______ caries.
Occlusal
What does recurrent caries at the margins of a restoration indicate?
- A susceptibility to caries
- Poor oral hygiene
- A defective restoration with “ leaky margins”
- Incomplete caries removal
When caries gets close to the edge of the pulp canal of the tooth it is referred to as pulp caries. What is a possible complication in this type of caries?
One complication that can arise is the possible pulpal exposure during caries excavation. Which would then likely require a root canal.
What is Arrested caries and what causes it?
Occurs when there has been a shift in the oral environment.
Can present clinically as a large open occlusal cavity, brownish dentine and a polished surface.
Can also be seen radiographically as an incipient lesion that fails to progress.
What is Gross Caries?
aside from being gross, it is when caries is so advanced that the majority of the tooth structure is effected. Restoration of the tooth will therefore be extremely difficult/impossible.
What is Cervical Burnout?
Cervical burnout is a radiolucent shadow often evident at the neck of the teeth.
It is an artifactual phenomenon.
It is created by the absence of dense enamel and alveolar bone at the tooth neck and by root shape.
Can be caused by:
- change in density
- due to root shape
How can you tell the difference between root caries and cervical burnout?
If in doubt a diagnosis of root caries should be confirmed clinically by direct vision and gentle probing
What Developmental/Acquired Defects can stimulate caries?
Hypoplasia
Abrasion
Attrition
What is this an example of?
Radiolucent linings and restorations can also stimulate caries.
