Radiographic Interpretation of Dental Caries Flashcards
Dental caries is a common __ disease
chronic
90% of adults experience dental caries before __ years of age
30
Percentage of dental caries among youth aged 2-19 years
50%
Multifunctional disease involving many complex risk and protective factors
Dental Caries
Carious lesions are characterized by __ destruction of teeth by __
localized
microorganisms (acid demineralization)
Caries is a dynamic process, explain -
Balance between demineralization and remineralization
Metabolic microbial organic acids
- Decrease in pH
- shift toward demineralization
- dissolution of Ca and PO4
Demineralization
Teeth are very __ and absorb __ x-rays
dense
more
(gums, cheeks, pulp are less dense - x-rays pass through more easily)
Demineralization results in __
less tissue density (less absorbed x-ray photons)
5 possible sites of carious lesions
Occlusal / pits and fissures
Recurrent / secondary
Smooth surface / facial/lingual
Root / radicular
Inter-proximal
Are occlusal caries detectable on radiographs
No
Initial stage of occlusal caries are incipient lesion (enamel only), and not
detected radiographically
When can we detect occlusal caries radiographically
When lesions are most likely in to dentin
How can you tell that occlusal caries are into dentin
Diffuse radiolucency below enamel occlusal surface
(As lesions progress, disruption of enamel may become evident)
(Advanced lesions may show direct pulp involvement)
Radiographs __ lesions
underestimate
Caries adjacent to margins of restorations
Secondary lesions / recurrent carries
Diffuse radiolucency below restorations
recurrent carries
Usually found close to gingival margin facial or lingual
Smooth surface carries
When looking at recurrent carries
Ill defined =
Well defined =
Carries
Liner
Sharply defined round or oval radiolucency
smooth surface caries (facial or lingual caries)
(Correlation with clinical examination is important - could also be erosion)
Below the CEJ, with gingival recession - not involving enamel
Radicular caries (root surface caries)
Radicular caries involve __ which is thin and not as __ as enamel
cementum
dense
Most smooth surface caries are buccal or lingual ?
Buccal
Collar-shaped or wedge-shaped radiolucent artifact between the CEJ and alveolar bone
Cervical burnout
(These are no carious lesions!)
2 reasons we can get cervical burnout
Cervical area not covered by bone or enamel
Anatomy of cervical area in posterior teeth (PIC)
Arise at or slightly below the contact point of two adjacent teeth
Interproximal caries
Always between enamel and alveolar bone
Cervical burnout
Clinically direct visualization usually not possible
Interproximal caries
With interproximal caries, as lesion progresses and dentin is affected, what do we see
translucent enamel may show gray discolored dentin on marginal ridges
Where is the radiolucency (trianglar) with base of an enamel vs dentin interproximal cary
Enamel - base at proximal surface near contact point
Dentin- base at DEJ
What is the best radiographic exam to detect carious lesions
Good set of bitewings (posterior teeth)
PAs (anterior teeth)
On this type of radiograph, carries are usually only seen when large enough to be clinically apparent
Panoramic
Extraoral vs intraoral bitewings
Extraoral - results are controversial (ghost images, noise, configuration of arches)
Intraoral - better detailing
When is it okay to use a pan for carries
Pt unable to cooperate
Severe gag reflex
Severe anatomic limitations
Correct __ angulation matters!
horizontal
(vertical angulation also matters)
Always look at __ bitewings
Both! (premolars and molars)
Bitewing is better than PA for detecting carious lesion due to
vertical angulation ( able to be more parallel with crowns)
Approx. 1/2 of __ cannot be seen clinically
proximal surface caries
__ can show carious lesion in early stages
Bitewings
How much demineralization is required before visualization
25-50%
With a radiograph we can see if a lesion is active or inactive, true or false
False
HOWEVER - activity may be monitored radiographically (Second image taken at another time point)
E0
E1
E2
D1
D2
D3
E0- no radiolucency
E1- outer 1/2 of enamel
E2 - inner 1/2 of enamel
D1 - outer 1/3 of dentin
D2 - Middle 1/3 of dentin
D3 - inner 1/3 of dentin
Not cavitated, may present a triangular shape or diffuse radiolucency
E1
E2
33% to 85% cavitated. Spreads along the DEJ
D1
Most likely cavitated (>halfway to the pulp)
D2
Cavitated. MAy directly involve pulp
D3
Well defined radiolucencies on interproximal surfaces (anterior teeth) may be
older radiolucent restorative material
