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CSA > radiography of Caries > Flashcards

radiography of Caries Flashcards

awareness of different methods of caries diagnosis know what caries looks like on a radiograph be aware of the problems with caries diagnosis on a radiograph familiarity with guidance relating to recall intervals for radiographs of caries diagnosis

1
Q

what is caries

A

a multifactorial disease

infectious disease

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2
Q

how does caries happen

A

due to lactic acid being produced by bacteria whilst fermenting sugars
it is a process of demineralisation and remineralisation

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3
Q

which bacteria can cause caries

A

Strep mutans

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4
Q

what is included in millers triad

A 
susceptible tooth surface*
sugars* 
time 
bacteria*
* involved in the venn diagram
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5
Q

how can caries be classified

A

anatomical sites

activity

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6
Q

where can caries occur on anatomical sites

A 
pit/fissure
smooth surface 
enamel
root
primary 
secondary/recurrant
residual
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7
Q

how can caries be classified by activity

A 
arrested 
active which can include:
rampant 
bottle/nursing
early childhood
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8
Q

what are the levels of disease

A

D1
D2
D3
D4

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9
Q

if someone has a disease of D1 what does that mean

A

white/opaque or brown lesion but surface hard and occlusal surface hard on probing

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10
Q

if someone has a disease of D2 what does that mean

A

slight loss of surface

sticky fissures but NO dentine involvement

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11
Q

if someone has a disease of D3 what does that mean

A

dentine involvement but NO pulp involvement

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12
Q

if someone has a disease of D4 what does that mean

A

possible or definite pulpal involvement

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13
Q

how are stages D1 and D2 managed

A

usually by preventative stages

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14
Q

how will we manage stages D3 and D4

A

restorative measures

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15
Q

where does caries move faster

A

in the dentine rather than enamel

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16
Q

why does the caries move faster in the dentine

A

due to the porous nature of the dentine

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17
Q

what do we need to consider when diagnosing and detecting

A

activity of the caries and the presence of it

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18
Q

how can we detect caries

A 
visual 
radiography 
temporary tooth separation
fiberoptic transillumination 
laser fluorescence 
electrical conductance measurements
research techniques eg MRI
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19
Q

How long does an MRI take

A

around 30 mins

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20
Q

advantages for using MRI to detect caries

A

no ionising radiation

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21
Q

disadvantages for using MRI to detect caries

A

very long exam
specialist equipment
difficult with children

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22
Q

how do we use temporary tooth separation

A

USING RUBBER orthodontic bands which can separate contact points allows us to visually see caries but also on the radiograph reduces enamel overlap

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23
Q

how does fibreoptic transillumination work

A

a white light on a very fine probe (0.5mm diameter) between a contact point therefore can detect inter proximal caries

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24
Q

what is shown when we have a sound tooth surface with fiberoptic transillumination

A

a sound colour all the way through

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25
Q

what is shown when we have a carious tooth surface with fiberoptic transillumination

A

the light will stop as there is no longer a smooth surface and there will be shadowing on the tooth surface

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26
Q

what does fluorescence change with

A

changes with density
dentine fluoresces more than enamel
and caries more than that

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27
Q

what are the ways we can use radiographs for detecting caries

A

bitewings-primary

periapicals

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28
Q

why is bitewings the primary way of testing for caries

A

it shows the occlusal surfaces of posterior teeth
inter proximal surfaces
and the crowns of posterior teeth
these are the areas to diagnose clinically

29
Q

how do we carry out a bitewing

A

single film in the holder
patient bites on the bite block
and get an image of both the crowns

30
Q

describe bitewing radiographs

A

the gold standard
gives the lowest dose for radiation for the max coverage of at risk areas
from mesial of first premolar to distal contact point
reproducible technique

31
Q

how many bitewings may we require in adults

A

maybe two

32
Q

how much thickness of enamel is acceptable in overlap on a radiograph

A

upto half of the thickness of enamel

33
Q

periapical description

A

similar resolution to bitewings

but fewer crowns shown with similar x ray dosage

34
Q

oblique lateral description

A

extraoral radiograph with lower resolution than bitewing

useful for caries in children

35
Q

panoramic description

A

not INDICATED purely for caries diagnosis unless unable to tolerate intraorals
extraoral therefore lower resolution
moving x ray source and image detector

36
Q

what are extra oral bitewings

A

uses the technique of panoramic but the film image is more similar to bitewings

37
Q

advantages of extra oral bitewings

A

more comfortable for patients
better inter proximal separation between contact points than a panoramic
50% dose reduction than a panoramic

38
Q

disadvantages of extra oral bitewings(compared with intraoral

A

higher dose
lower resolution
increased artefact
less reproducible

39
Q

justifications of radiographs

A

show mineral loss ( 40% minimum) through the decreased density of hard tissue
reveals lesions otherwise which might be missed by visual examination:
pre cavitation
approximal surfaces
but early caries are hard to see

40
Q

why does caries show darker on a radiograph

A

demineralisation of dentine/enamel
decerase in density
decrease of attenuation of x ray photons
area becomes more radiolucent( darker)

41
Q

where are occlusal caries found

A

found in pits and fissures

when reaches the dentine appears to spread laterally- seen as triangular on a radiograph

42
Q

where are interproximal caries found

A

on the mesial and vital surfaces
early lesions may involve enamel only
spreads laterally when it is in the dentine

43
Q

what do we need to see low contrast lesions

A

good quality images

separation of contact points

44
Q

how do we see buccal and lingual surface caries

A

can be seen in fissures
When small lesions are usually round becoming more elliptic or semilunar when large
do not widen to the occlusal surface

45
Q

root surface caries

A

areas of recession in perio disease- involve cementum and dentine
root exposed- associated with recession
at the cervical margin but can be the root surface

46
Q

what do we need to be aware of when looking for coot caries

A

cervical burnout artefacts

47
Q

what is another name for secondary caries s

A

recurrent caries

48
Q

where does recurrent caries occur

A

occurs adjacently near existing restoration

49
Q

how do we report caries

A

systematic approach UR-UL-LL-LR

50
Q

issues with radiographs

A

ionising radiation eg cancer
technique errors such as geometry and faulty processing
overlapping enamel can cause us to miss early lesions

51
Q

how to we want to position the film

A

parallel to the contact point of the teeth and we want the film to be perpendicular and we need to position the ring as close as possible therefore lower magnification

52
Q

what can be the issue with projection

A

a superficial lesion can be projected deeper e.g. an enamel lesion can appear to be into dentine due to BEAM ANGULATION SHIFT

53
Q

why is it difficult to detect recurrent caries in a restored dentition

A

can be concealed by the restorations

54
Q

what can mimic caries

A

cervical burn out
mach effect
corrosion

55
Q

describe cervical burnout artefacts

A

can mimic root caries
occurs due to x rays over penetrating or burning out the thinner tooth enamel
Usually inner edge is more diffuse and rounded than caries
• Bounded by enamel superiorly and alveolar bone inferiorly.

56
Q

what is the mach band effect

A

visual illusion

when uniform dark area meets uniform light area- the dark shade is even darker and the light is even lighter

57
Q

clinically what can we see in the mach band effect

A

mask the enamel and the mach band will disappear

58
Q

describe corrosion products

A

Radiolucency deep to amalgam restoration

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

59
Q

when do we image

A

Importance of early caries detection
Image shows current state of demineralization
Decline in caries prevalence in recent decades

60
Q

what do we need to consider in early caries detection

A

preventive management

or restorative management

61
Q

issues with showing only the current state of demineralisation

A

patient might be in a phase of remineralisation or demineralisation due to change in diet
cannot tell the difference between active or arrested

62
Q

high risk group benefits for radiographs

A

Benefit of radiographs over clinical diagnosis is 167%-800% compared to just visual exam

63
Q

moderate risk group benefits

A

Benefit is 150%-270%

64
Q

low risk caries group benefits

A

diagnostic yield but still significant 2-3x more carious lesions and 1.6%-25% clinically sound surfaces have caries on radiographs

65
Q

what is the FGDP

A

faculty of general dental practice

66
Q

what is the FGDP selection criteria for high risk

A

Posterior bitewings at 6 monthly intervals until no new or active lesions or patient changes into different risk category

67
Q

what is the FGDP selection criteria for moderate risk

A

Annual posterior bitewings

unless risk status alters

68
Q

what is the FGDP selection criteria for low risk

A

Posterior bitewings at 12-18 monthly intervals in primary dentition
– 2 year intervals in permanent dentition

69
Q

what should be the key thoughts when taking an x ray

A

has it been done before
is it needed now
is it the best investigation
are they all needed

CSA (51 decks)

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