Radiographic Interpretation of Dental Caries

Question 1

Dental caries is a common __ disease

Answer 1

chronic

Question 2

90% of adults experience dental caries before __ years of age

Answer 2

30

Question 3

Percentage of dental caries among youth aged 2-19 years

Answer 3

50%

Question 4

Multifunctional disease involving many complex risk and protective factors

Answer 4

Dental Caries

Question 5

Carious lesions are characterized by __ destruction of teeth by __

Answer 5

localized
microorganisms (acid demineralization)

Question 6

Caries is a dynamic process, explain -

Answer 6

Balance between demineralization and remineralization

Question 7

Metabolic microbial organic acids
- Decrease in pH
- shift toward demineralization
- dissolution of Ca and PO4

Answer 7

Demineralization

Question 8

Teeth are very __ and absorb __ x-rays

Answer 8

dense
more
(gums, cheeks, pulp are less dense - x-rays pass through more easily)

Question 9

Demineralization results in __

Answer 9

less tissue density (less absorbed x-ray photons)

Question 10

5 possible sites of carious lesions

Answer 10

Occlusal / pits and fissures
Recurrent / secondary
Smooth surface / facial/lingual
Root / radicular
Inter-proximal

Question 11

Are occlusal caries detectable on radiographs

Answer 11

No

Question 12

Initial stage of occlusal caries are incipient lesion (enamel only), and not

Answer 12

detected radiographically

Question 13

When can we detect occlusal caries radiographically

Answer 13

When lesions are most likely in to dentin

Question 14

How can you tell that occlusal caries are into dentin

Answer 14

Diffuse radiolucency below enamel occlusal surface
(As lesions progress, disruption of enamel may become evident)
(Advanced lesions may show direct pulp involvement)

Question 15

Radiographs __ lesions

Answer 15

underestimate

Question 16

Caries adjacent to margins of restorations

Answer 16

Secondary lesions / recurrent carries

Question 17

Diffuse radiolucency below restorations

Answer 17

recurrent carries

Question 18

Usually found close to gingival margin facial or lingual

Answer 18

Smooth surface carries

Question 19

When looking at recurrent carries
Ill defined =
Well defined =

Answer 19

Carries
Liner

Question 20

Sharply defined round or oval radiolucency

Answer 20

smooth surface caries (facial or lingual caries)
(Correlation with clinical examination is important - could also be erosion)

Question 21

Below the CEJ, with gingival recession - not involving enamel

Answer 21

Radicular caries (root surface caries)

Question 22

Radicular caries involve __ which is thin and not as __ as enamel

Answer 22

cementum
dense

Question 23

Most smooth surface caries are buccal or lingual ?

Answer 23

Buccal

Question 24

Collar-shaped or wedge-shaped radiolucent artifact between the CEJ and alveolar bone

Answer 24

Cervical burnout
(These are no carious lesions!)

Question 25

2 reasons we can get cervical burnout

Answer 25

Cervical area not covered by bone or enamel Anatomy of cervical area in posterior teeth (PIC)

Question 26

Arise at or slightly below the contact point of two adjacent teeth

Answer 26

Interproximal caries

Question 27

Always between enamel and alveolar bone

Answer 27

Cervical burnout

Question 28

Clinically direct visualization usually not possible

Answer 28

Interproximal caries

Question 29

With interproximal caries, as lesion progresses and dentin is affected, what do we see

Answer 29

translucent enamel may show gray discolored dentin on marginal ridges

Question 30

Where is the radiolucency (trianglar) with base of an enamel vs dentin interproximal cary

Answer 30

Enamel - base at proximal surface near contact point Dentin- base at DEJ

Question 31

What is the best radiographic exam to detect carious lesions

Answer 31

Good set of bitewings (posterior teeth) PAs (anterior teeth)

Question 32

On this type of radiograph, carries are usually only seen when large enough to be clinically apparent

Answer 32

Panoramic

Question 33

Extraoral vs intraoral bitewings

Answer 33

Extraoral - results are controversial (ghost images, noise, configuration of arches) Intraoral - better detailing

Question 34

When is it okay to use a pan for carries

Answer 34

Pt unable to cooperate Severe gag reflex Severe anatomic limitations

Question 35

Correct __ angulation matters!

Answer 35

horizontal (vertical angulation also matters)

Question 36

Always look at __ bitewings

Answer 36

Both! (premolars and molars)

Question 37

Bitewing is better than PA for detecting carious lesion due to

Answer 37

vertical angulation ( able to be more parallel with crowns)

Question 38

Approx. 1/2 of __ cannot be seen clinically

Answer 38

proximal surface caries

Question 39

__ can show carious lesion in early stages

Answer 39

Bitewings

Question 40

How much demineralization is required before visualization

Answer 40

25-50%

Question 41

With a radiograph we can see if a lesion is active or inactive, true or false

Answer 41

False HOWEVER - activity may be monitored radiographically (Second image taken at another time point)

Question 42

E0 E1 E2 D1 D2 D3

Answer 42

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

Question 43

Not cavitated, may present a triangular shape or diffuse radiolucency

Answer 43

E1 E2

Question 44

33% to 85% cavitated. Spreads along the DEJ

Answer 44

D1

Question 45

Most likely cavitated (>halfway to the pulp)

Answer 45

D2

Question 46

Cavitated. MAy directly involve pulp

Answer 46

D3

Question 47

Well defined radiolucencies on interproximal surfaces (anterior teeth) may be

Answer 47

older radiolucent restorative material