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2ND Yr CSA- Radiography > Radiographic Diagnosis of Caries > Flashcards

Radiographic Diagnosis of Caries Flashcards

1
Q

What is caries?

A

It is a multifactorial disease

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2
Q

What causes dental caries?

A

Lactic acid produced by bacteria decreases the pH of the mouth leading to demineralisation of enamel leading to caries and tooth decay

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3
Q

What factors are essential for caries formation?

A
  1. Tooth surface
  2. Bacteria
  3. Sugar
    4, Time
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4
Q

How can carious lesions be classified?

A
  1. By their anatomical site
  2. By their activity
  3. By their level of disease
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5
Q

How can carious lesions be classified according to their anatomical site?

A
  1. Pits or fissures
  2. Smooth surface (gather around the gingival margin)
  3. Enamel
  4. Root
  5. Primary (on a new sound tooth surface)
  6. Secondary (the nits associated with a restoration)
  7. Residual
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6
Q

How can carious lesions be classified according to their activity?

A
  1. Active caries which can be rampant (affect all teeth) , bootle or early childhood
  2. Arrested or inactive
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7
Q

How can carious lesions be classified according to their level of disease?

A

D1
D2
D3
D4

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8
Q

Describe a D1 carious lesion

A

White/ opaque or brown lesion but the surface is hard and the occlusal surface is hard on probing

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9
Q

Describe a D2 carious lesion

A

Theres slight loss of surface
Sticky tissues
No dentin involvement

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10
Q

Describe a D3 carious lesion

A

Dentine involvement but not pulp

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11
Q

Describe a D4 carious lesion

A

Possible or definitive plural involvement

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12
Q

How are D1 and D2 lesions managed?

A

With preventative measures

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13
Q

How are D3 and D4 lesions managed?

A

They most likely need restorative treatment

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14
Q

How can dental caries be detected?

A
  1. Visual inspection
  2. Radiography
  3. Temporary tooth separation
  4. Fibreoptic transillumination (FOTI)
  5. Laser fluorescence
  6. Electrical conductance measurements
  7. Research techniques – e.g. MRI
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15
Q

What is the gold standard for caries diagnosis?

A

Visual inspection

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16
Q

How do we diagnose caries by visual inspections ?

A

We dry the tooth surface and then look at every tooth surface under good light

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17
Q

What is the most commonly used special test for caries detection?

A

Radiography

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18
Q

How is temporary elective tooth separation used to detect caries ?

A

It is where you use little orthodontic bands between the teeth to open up a contact point so that you can now see if theres any caries in that gap

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19
Q

How is Fibre-Optic TransIllumination (FOTI) used to detect caries ?

A

This is a process where you shine a bright light between the teeth
If you have a sound tooth surface light will spread and there’ll be a smooth colour
Where’ve their is caries there will be a distribution in the light

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20
Q

How is Fluorescence used to detect caries ?

A

You shine a light of a certain wavelength through a tooth and as the light passes through the substance you get some scattering and some absorption
As you get scattering the wavelength and colour of the light changes
Caries often fluoresces the most in comparison to dentine and enamel

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21
Q

Give the different types of radiographs we can take to diagnose caries

A
  1. Bitewings
  2. Periapicals
  3. Oblique lateral
  4. Panoramic
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22
Q

What is the gold standard when using radiographs for caries detection

A

Use bitewings

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23
Q

Why are bitewings the gold stander for radiographic caries detection

A

As you can see the crowns of all of the posterior teeth including the occlusal and inter proximal surfaces

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24
Q

How do you carry out a bitewing?

A

You place a single filler in the holder
Then place the holder in the patients mouth
The patient bites on the bite block and a radiographic image is produces

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25
Q

Which area of the mouth can you see when taking a bitewing?

A

You can see the from the mesial contact point of the first premolar to the most distal contact point in the mouth (2nd or 3rd molar)

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26
Q

What are some of the benefits of taking bitewings?

A
  1. They provide maximum coverage of risk areas for the lowest dosage
  2. Theres no or minimal overlap of enamel
  3. It is a reproducible technique
27
Q

How much enamel overlap is acceptable on a radiograph?

A

Up to half thickness of enamel is allowed

28
Q

What are the positive and negative of taking periapical radiographs

A

They have a similar resolution to bitewings but few crowns are shown on individual film for the sam e dose

29
Q

What are some of the disadvantages of taking oblique lateral radiographs?

A

It is an extra oral image that has a lower resolution than bitewings

30
Q

When might taking an oblique lateral radiographs be useful?

A

May be useful for caries diagnosis in young children

31
Q

What are the disadvantages of panoramic radiographs

A

Extraoral film means lower resolution
Magnified image
Has artefacts
Not indicated fro caries diagnosis

32
Q

What is available o some newer panoramic units?

A

Extra oral bitewings

33
Q

What are some of the advantages of extra oral bitewings?

A
  1. More comfortable for the patient
  2. Better interracial separation between contacts than a panoramic
  3. 50% dose reduction than normal panoramic
34
Q

What are some of the disadvantages of extra oral bitewings?

A

Compared to intramural bitewings extra oral bitewings have a :

  1. Higher dose
  2. Lower resolution
  3. increased artefacts
  4. Less reproducible
35
Q

What is the rationale for radiographs?

A
  1. They show mineral loss through decreased density of dental hard tissues e
  2. Reveals lesions otherwise undetectable by clinical exam
36
Q

When can caries be seen on a radiograph

A

When there’s 40% mineral loss

37
Q

What does caries cause?

A
  1. Demineralisation of inorganic portion

2. Destruction of organic portion

38
Q

What is caries seen as on a radiographs?

A

A radiolucent area

39
Q

Why is caries seen as a radiolucent spot on a radiographs

A
  1. Caries causes Demineralisation of enamel and/or dentine
  2. This leads to decrease in density
  3. This results in a decrease in attenuation of X-ray photons
  4. So the area becomes radiolucent (darker) on a radiograph
40
Q

What causes occlusal caries

A

Food debris and bacteria in pits and fissures causing decalcification of enamel

41
Q

How does occlusal caries look on a radiograph when it reaches dentine?

A

It appears to spread laterally and is seen as a triangular shape on a radiograph

42
Q

Where is Approximal caries found?

A

On the medial and distal surfaces of a tooth

43
Q

Where do approximal caries spread?

A

Spreads lateral into dentine

44
Q

Where can buccal and lingual caries arise?

A

Can arise in pits and tissues

45
Q

Describe how buccal and lingual caries may be seen on a radiograph

A

Small lesions are usually rounded becoming more elliptic or semilunar as they get bigger

46
Q

How is root surface caries detected?

A

Usually detected clinically

47
Q

What is involved in a root surface lesion?

A

Lesion involves cementum and dentine and are associated with gingival recession

48
Q

When looking for root surface caries on a radiograph what should we beware of?

A

Beware of cervical burnout artefacts

49
Q

Where does current caries occur?

A

Occursadjacenttoan existing restoration

50
Q

How do we report caries?

A

We assess each tooth individually

Start in the UR quadrant the UL-> LL-> LR

51
Q

What do we assess when reporting caries

A
  1. Full crowns, enamel and dentine density
  2. Cervical margins
  3. Existing restorations
  4. Pulp chamber
52
Q

When do a radiograph report what do we do?

A
  1. Determine the quality grade of the image
  2. State which teeth you can see
  3. List your findings
53
Q

What are some of the problems associated with radiographs?

A
  1. The use of ionising radiation
  2. Technique errors such as geometry, faulty processing
  3. Overlapping contact points obscuring early lesions
  4. Due to projection a superficial lesion can be projected deeper e.g. an enamel lesion can appear to be into dentine
  5. They are a 2D representation of a 3D subject
  6. Very early lesions not evident at all
  7. Lesions usually larger clinically than radiographically
  8. Cannot establish bucco- lingual depth or localise to buccal or lingual surface
54
Q

Name some artefacts on a radiograph that can mimic caries

A
  1. Cervical burn out artefact
  2. Mach effect artefact
  3. Corrosion products
55
Q

What causes cervical burnout artefact?

A

Due to x rays overpenetrating for burning out the thinner tooth edge

56
Q

Describe how cervical burner may look on a radiograph

A
  1. Cervical root edge will be intact albeit dark

2. Usually inner edge is more diffuse and rounded than caries

57
Q

What is the mach band effect?

A

It is a visual illusion that shows that when dark dentine meets light enamel, the dark shade appears even darker and light shade lighter making the darker areas look like caries

58
Q

What causes corrosion products on a radiograph?

A
  1. Radiolucency deep to amalgam restoration can mimic caries

2. Deposits of heavy metal ions e.g. tin, zinc in softened dentine.

59
Q

What can cervical burnout artefact look like on a radiograph?

A

Root surface caries

60
Q

When should we take radiographs for high risk patients?

A

Posterior bitewings should be taken at 6 month intervals until no new or active lesions can be seen or patient changes into a different risk factor

61
Q

When should we take radiographs for moderate risk patients?

A

Take posterior bitewings annually

unless risk status alters

62
Q

When should we take radiographs for low risk patients?

A

Take posterior bitewings at 12-18 months in primary dentition
Take x ray sat 2 year intervals in permanent dentition

63
Q

When should bite wings be considered for a child?

A
  1. 5 years
  2. 8-9 years
  3. 12-14 years

2ND Yr CSA- Radiography (2 decks)

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