ch 33: interpretation of caries

detection of caries is done through

Clinical Examination and Radiographic Examination is necessary

how do radiographs help detect caries?

-Enable the dental professional to identify carious lesions that are not visible clinically

-Plus radiographs allows the dental professional to evaluate the extent and severity of carious lesions

clinical examinations

-Some carious lesions can be detected simply by looking in the mouth

-Direct vision – black, brown, & “halo” effect

-The mirror can be used to reflect light (indirect vision) and retract the tongue, can help to see black, brown, & “halo” effect

-The explorer can be used to detect changes in consistency(?) in pits, grooves, and fissures of teeth

-Explorer will catch, pull, tug with decay. Dry teeth with air!!!

-Color changes may be observed

-Occlusal surfaces may show dark staining in fissures, pits, and grooves

-Smooth surfaces may exhibit a chalky white spot or opacity

-An interproximal ridge may appear discolored

-Some teeth may exhibit a discolored area, cavitation, or have no visible changes

-Caries that occur between teeth may be difficult or impossible to detect clinically

-Radiographs play an important role in these situations

radiographic examination

A carious area appears radiolucent because decreased density allows for greater penetration in the carious area

-Demineralization causes

• Loss of tooth structure

• Loss of density

• More penetration of x-rays

-The bite-wing radiograph is the image of choice for evaluating caries

-A periapical radiograph taken with paralleling technique may also be used

interpretation tips

-Proper mounting

-Viewing in a room with subdued light that is free of distractions

-An illuminator or viewbox

-Masking light around the mounted films

-A pocket sized magnifying glass

-Digital

• Zoom

• Eagle eye

• Invert

factors influencing caries interpretation

-Radiographs must be of diagnostic quality

-Examples may include

• Improper horizontal angulation on a bitewing (or pa) film = overlapping

• Direct beam perpendicular to film thru the contact

• Errors in exposure with improper contrast and density (mA & kVp)

• Inadequate developing procedures

interproximal caries

-Between two adjacent surfaces

-Typically seen on dental radiographs at or just below the contact point

-As caries progresses through the enamel, it typically assumes a triangular configuration

-When it reaches the DEJ, it spreads laterally and progresses through dentin

-Classified as incipient, moderate, advanced, and severe

-Thus open contacts are essential

incipient interproximal caries

-Extends less than halfway through the thickness of enamel

-this lesion is seen only in enamel

-class I lesion

moderate interproximal caries

-Extends more than halfway through enamel but does not involve the DEJ

-this lesion is seen only in enamel.

-class II lesion

advanced interproximal caries

-Extends to or through the DEJ and into dentin, but does not extend into dentin more than half the distance toward the pulp

-this lesion affects both enamel or dentin

-class III lesion

severe interproximal caries

-Extends through enamel and dentin more than half the distance toward the pulp

-involves both enamel and dentin and may appear clinically as a cavitation in the tooth

-class IV lesion

occlusal caries

-Caries that involve the chewing surface of posterior teeth

-“A thorough clinical exam is the method of choice for the detection of occlusal caries”

-Early occlusal caries is “difficult” to see on a dental radiograph

types of occlusal caries

-incipient (not)

-moderate

-severe

incipient occlusal caries

-Cannot be seen on a dental radiograph

-Must be detected with an explorer

• Dry teeth

• Use explorer to get into grooves, pits, fissures

• Use multiple directions with tip of explorer

• Grab, tug, stick or feel soft like

moderate occlusal caries

-Extends into dentin

-Appears as a thin radiolucent line or circle

-Can be difficult to see

-Little or no change in enamel is evident on the image

severe occlusal caries

-Extends into dentin and appears as a radiolucency

-The radiolucency extends under the enamel of the occlusal surface of the tooth

-Seen clinically

-Mandibular molar

buccal and lingual caries

-These are difficult to detect on radiograph because they are superimposed on tooth structure

-If seen on film, they appear as a circular radiolucent area

root surface caries

-Involves only the roots of teeth

-On radiograph, it appears as a cupped-out or crater- shaped radiolucency below the CEJ

-Early lesions may be difficult to detect on radiograph (Burn-out)

recurrent caries

-Occurs adjacent to an existing restoration

-It appears as a radiolucent area just beneath a restoration

-It is most often located beneath the interproximal margins of a restoration

rampant caries

-Advanced and severe caries affecting a number of teeth

-Associated with children with poor diets and adults with decreased salivary flow

-Extremely poor home care

conditions resembling caries

-Cervical Burnout

-Restorative materials

-Attrition

-Abrasion

cervical burnout

-Difference in densities of adjacent tissues

-Tissue at the CEJ is less dense than the areas above and below

-Optical elusion

-Collar-shaped in the anterior

-Wedge-shaped in the Posterior

restorative materials

-Composites (newer ones have fillers)

-Silicates

-Acrylics

-Radiolucent

-A through clinic exam helps the differentiate

attrition

-mechanical wear of teeth

-Incisal and or occlusal surfaces / deciduous & permanent

-Enamel is worn away the underlying dentin wears rapidly – softer

abrasion

-wear of tooth structure from friction of a foreign object

-Improper toothbrushing (pressure or brush is hard)

-Seen at cervical margin

-Horizontal radiolucency

-Hard and highly polished appearance

-Radiographically mistaken as root caries

-Clinic exam will help to differentiate