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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
what is shown when we have a carious tooth surface with fiberoptic transillumination
the light will stop as there is no longer a smooth surface and there will be shadowing on the tooth surface
26
what does fluorescence change with
changes with density dentine fluoresces more than enamel and caries more than that
27
what are the ways we can use radiographs for detecting caries
bitewings-primary | periapicals
28
why is bitewings the primary way of testing for caries
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
how do we carry out a bitewing
single film in the holder patient bites on the bite block and get an image of both the crowns
30
describe bitewing radiographs
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
how many bitewings may we require in adults
maybe two
32
how much thickness of enamel is acceptable in overlap on a radiograph
upto half of the thickness of enamel
33
periapical description
similar resolution to bitewings | but fewer crowns shown with similar x ray dosage
34
oblique lateral description
extraoral radiograph with lower resolution than bitewing | useful for caries in children
35
panoramic description
not INDICATED purely for caries diagnosis unless unable to tolerate intraorals extraoral therefore lower resolution moving x ray source and image detector
36
what are extra oral bitewings
uses the technique of panoramic but the film image is more similar to bitewings
37
advantages of extra oral bitewings
more comfortable for patients better inter proximal separation between contact points than a panoramic 50% dose reduction than a panoramic
38
disadvantages of extra oral bitewings(compared with intraoral
higher dose lower resolution increased artefact less reproducible
39
justifications of radiographs
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
why does caries show darker on a radiograph
demineralisation of dentine/enamel decerase in density decrease of attenuation of x ray photons area becomes more radiolucent( darker)
41
where are occlusal caries found
found in pits and fissures | when reaches the dentine appears to spread laterally- seen as triangular on a radiograph
42
where are interproximal caries found
on the mesial and vital surfaces early lesions may involve enamel only spreads laterally when it is in the dentine
43
what do we need to see low contrast lesions
good quality images | separation of contact points
44
how do we see buccal and lingual surface caries
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
root surface caries
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
what do we need to be aware of when looking for coot caries
cervical burnout artefacts
47
what is another name for secondary caries s
recurrent caries
48
where does recurrent caries occur
occurs adjacently near existing restoration
49
how do we report caries
systematic approach UR-UL-LL-LR
50
issues with radiographs
ionising radiation eg cancer technique errors such as geometry and faulty processing overlapping enamel can cause us to miss early lesions
51
how to we want to position the film
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
what can be the issue with projection
a superficial lesion can be projected deeper e.g. an enamel lesion can appear to be into dentine due to BEAM ANGULATION SHIFT
53
why is it difficult to detect recurrent caries in a restored dentition
can be concealed by the restorations
54
what can mimic caries
cervical burn out mach effect corrosion
55
describe cervical burnout artefacts
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
what is the mach band effect
visual illusion | when uniform dark area meets uniform light area- the dark shade is even darker and the light is even lighter
57
clinically what can we see in the mach band effect
mask the enamel and the mach band will disappear
58
describe corrosion products
Radiolucency deep to amalgam restoration | Deposits of heavy metal ions leech into dentine e.g. tin, zinc in softened dentine.
59
when do we image
Importance of early caries detection Image shows current state of demineralization Decline in caries prevalence in recent decades
60
what do we need to consider in early caries detection
preventive management | or restorative management
61
issues with showing only the current state of demineralisation
patient might be in a phase of remineralisation or demineralisation due to change in diet cannot tell the difference between active or arrested
62
high risk group benefits for radiographs
Benefit of radiographs over clinical diagnosis is 167%-800% compared to just visual exam
63
moderate risk group benefits
Benefit is 150%-270%
64
low risk caries group benefits
diagnostic yield but still significant 2-3x more carious lesions and 1.6%-25% clinically sound surfaces have caries on radiographs
65
what is the FGDP
faculty of general dental practice
66
what is the FGDP selection criteria for high risk
Posterior bitewings at 6 monthly intervals until no new or active lesions or patient changes into different risk category
67
what is the FGDP selection criteria for moderate risk
Annual posterior bitewings | unless risk status alters
68
what is the FGDP selection criteria for low risk
Posterior bitewings at 12-18 monthly intervals in primary dentition – 2 year intervals in permanent dentition
69
what should be the key thoughts when taking an x ray
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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