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Clinical Skills II > Radiology: Caries Diagnosis > Flashcards

Radiology: Caries Diagnosis Flashcards

1
Q

What is the critical pH for tooth demineralization?

A

5.5

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2
Q

On average, how long does it take for the cycles of acid generation to create an incipient lesion with a chalky white or brown spot on enamel

A

18 Mos +/- 6 Mos

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3
Q

What is the bacteria most associated with pit and fissure caries?

A

Strep mutans

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4
Q

Which two bacterial species are commonly found in deep dentinal caries?

A

L. casei

Actinobacillu viscosus

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5
Q

What is the most frequent site of attack for caries?

A

Occlusal surface on the 1st and 2nd Permanent molars

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6
Q

What age demographic is the most likely to have caries

A

Interproximal: Young children and teens

Root Surface: Elderely

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7
Q

What are the 3 major age peaks for caries during a lifetime?

A

6-8
11-19
56-65

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8
Q

If a patient is in a high risk age group how often should we take radiographs?

A

BW every 6-12 mos

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9
Q

What are BW radiographs most useful for?

A

Detection of early interproximal decay from the distal of the canine distally through molars.

Secondarily good at detecting occlusal decay in the premolars and molars.

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10
Q

What are the conditions necessary to classify a caries as C1

A

Cavity is less than 1/2 the way through the enamal. Also called incipient caries

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11
Q

What is the difference between a C1 and a C2 cavity?

A

A C2 is at least 1/2 way through the enamel but it doesn’t involve the dentin

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12
Q

Compare C3 to C4 caries?

A

C3 involves the DEJ but is less than 1/2 the way to the pulp chamber.

C4 penetrates more than 1/2 toward pulp chamber

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13
Q

What is an incipient cavity?

A

Triangle shape with apex towards DEJ

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14
Q

How long does an incipient cavity take to form in adults? In kids?

A

3-4 Years Adults

18 months Kids

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15
Q

Why are mild enamel carries shaped kind of like a triangle?

A

Because they follow the path of the converging enamel rods….which coverage towards the DEJ

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16
Q

What happens when a C2 lesion makes it to the DEJ

A

It spreads along it undermining more enamel. Then it will extend rapidly towards the pulp in the shape of a mushroom cap whose base is on the DEJ.

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17
Q

Why can’t a radiograph always tell if there is pulp involvement in a C4 lesion?

A

Due to angulation and the 2-D nature of radiographs.

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18
Q

What are the three common errors made in the radiographic interpretation of occlusal decay?

A
  1. Failure to recognize that decay in enamel will not ordinarily be detectable due to heavy cuspal enamel
  2. Failure to observe the long thin radiolucency that appears at the DEJ as the first radiographic sign of occlusal delay.
  3. Confusion in dintinguishing between occlusal and smooth surface lesions when lesions in the buccal groove of molars are superimposed over the occlusal area.
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19
Q

When do root caries double in prevalence?

A

Age 30-60

40-60% of elderly population has them

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20
Q

Where on the tooth is root caries most common?

A

Buccal or Proximal Surfaces of Teeth

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21
Q

What tooth is most commonly affected by root caries?

A

Mandibular Premolars

22
Q

What is the signature of root caries on Radiograph?

A

“scooped out” crater located in the region of the buccal or proximal CEJ

23
Q

Do root caries involve enamel?

A

No, but they can undermine enamel

24
Q

Where are secondary caries usually spotted?

A

Radiolucencies along the margins of restorations

25
Q

Why might there be a lot of damage involved around the margins of restorations once secondary caries can be seen on the x-ray?

A

Because the opaqueness of the restoration and the enamel on the other side of the tooth

26
Q

How might carious lesions become arrested?

A

Significant shift i the oral environment

27
Q

Besides remineralization and a change in oral hygiene, why might some lesions become arrested?

A

Some interproximal lesions may arrest if the adjacent tooth is lost.

28
Q

Clinically, what might a remineralized radiolucency feel like when probed with an explorer

A

Hard

29
Q

How do arrested occlusal caries appear?

A

Open cavity with yellow/brown/black highly polished evurnated dentin

30
Q

Why might these large open arrested occlusal caries become arrested?

A

Bacteria might not be able to stick to polished dentin

31
Q

What is a sclerotic subadjacent line?

A

Secondary dentin line laid down under an arrested, exposed occlusal dentinal carious lesion

32
Q

How can we describe rampant decay?

A

Sudden, Aggressive, Almost uncontrollable destruction of many teeth, especially involving surfaces that are normally spared from cavities

33
Q

When these teeth are involved, it may be a sign of rampant caries?

A

Interproximal and cervical areas of mandibular anterior teeth

34
Q

Where is rampant caries most often presented?

A

Primary dentition of children (bottle rot)

Adults with Xerostomia

35
Q

What is usually the source of radiation-induced caries?

A

Significant radiation to the major salivary glands producing xerostomia

36
Q

Where on the tooth does radiation induced caries typically begin?

A

Cervical regions

37
Q

What does radiation induced caries look like on the radiograph?

A

Multiple RL shadows at the necks of the teeth

38
Q

How can radiation cavities be reduced?

A

Topical 1% Sodium Fluoride Gel in a custom tray + Artificial Saliva

39
Q

Why do radiographs typically underestimate the size of caries?

A

There must be a 50% demineralization in an area before it shows up as an RL

40
Q

What is cervical burnout?

A

Constricted neck absorbs less xrays than the areas above and below it (enamel and bone)

41
Q

How does cervical burnout look on xray?

A

Thin RL band at cervix of anterior teeth and interproximally in posterior teeth

42
Q

How can we tell interproximal decay from cervical burnout?

A

Interproximal decay should be more well defined and less fuzzy, and start right under the contact

Also root caries will not occur unless the free gingival margin has receded.

43
Q

What type of error of technique can cause cervical burnout?

A

Improper horizontal and/or vertical angulation

44
Q

What types of enamel defects can simulate caries?

A

Enamel hypoplasia

Attrition

45
Q

What can overexposure of the image do?

A

Burn out the peripheral surface of the tooth and can obliterate small enamel lesions.

46
Q

Above what kilovoltages (on adjustable machines) results in xrays with long scale contrast?

A

65-75

47
Q

With what type of contrast should BW’s be taken?

A

Short scale contrast technique (65-75 kvp)

48
Q

What is the benefit of short scale contrast technique?

A

Only a few shade of gray between light and dark areas

49
Q

What contrast setting should PA’s be taken at?

A

80-90 kvp

50
Q

What happen if angulation is not optimal?

A

Early/moderate lesions can go undetected

51
Q

What does bad vertical angulation do?

A

Superimposes lesions on sound tooth, making them difficult to see

52
Q

What does had horizontal angulation do?

A

Produced overlapped contact points and hides interproximal lesions

Clinical Skills II (6 decks)

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