e2 dental caries perio disease

etiology unknown pt may have little or no plaque & inflammation VBL- primarily first molars and incisors rapid diastema and early loss of 1st molars drifting and mobility of teeth

aggressive periodontitis

what is the different between ant and post alveolar crest

ant-pointed post- sharp angled

cervical burn out RL band across the cervical neck of teeth vs RL triangular or wedge-shaped area on proximal cervical neck of the tooth

anterior teeth / posterior teeth

what is a sign of early changes of RBL/perio disease

blunting of interproximal alveolar crest inc. width of PDL space resorption or loss of LD

t/f detection of occlusal R-1 incipient caries is most effective by direct clinical examination t/f Radiographs are not reliable for diagnosis of R1& R2 occlusal caries

both true

t/f even if there is slight changes of RBL present the process may not be of recent onset as significant loss of attachment t/f small regions of bone loss on buccal and lingual aspects of teeth are more difficult to detect radiographically

both true

t/f early caries in a pit or fissure is surrounded by dense sound enamel no early radiographic evidence of caries may be seen later caries spreads along DEJ (into dentin), which may be seen as RL ? between enamel & dentin

true- line

t/f incipient interproximal lesions are visible on radiographs most of the time as a RL notch or area on the outer surface of enamel t/f base of the lesion is at the outer tooth surface and the apex is pointed towards the DEJ

both true

t/f over exposure can cause peripheral burnout t/f overlap of contacts may obsure caries

both true

t/f pulp exposure may not be identified from radiographs alone in a severe interproximal caries t/f and masticatory forces may cause a collapse

both true

t/f restorative materials may mimic caries t/f older cements and some older composites are radiolucent

both true

t/f root proximity must be taken into consideration as a risk marker for perio disease t/f pts with bilateral RP had a 3.6x higher chance to have periodontitis

both true

also known as radicular caries starts near CEJ base of the lesion on the surface is det. by recession of the gingiva

cemental root caries

Causes of frequent root caries in elderly? 6

cementum is less resistant to caries cementum exposed due to gingival recession loss of interproximal contacts perio disease poor restorations xerostomia (gland atrophy or drugs) (sugar in pacifier)

misdiagnosed as caries RL is seen at the neck of the tooth (just below CEJ) as there is less** radiation absorption at the neck of the tooth

cervical burn out

the following are causes of ? greater density diff bet teh cervical neck of the tooth and tissues below and above it anatomical diff like CEJ root config and poor horizontal angulation

cervical burn out

name two effects produced in the retinal receptors and may be seen on images

cervical burnout

perio can be what 2 types

chronic perio (slight mod severe) aggressive perio

both ? are needed for periodontal disease assessment

clinical and radio exam

a pathological process consisting of localized destruction of hard dental tissues* by organic acids produced by microbial deposits adhering to teeth

dental caries

dental caries can occur in what 3 areas

enamel dentin cementum/root

an image is ? if it has a red open arrow

enhanced

PDL space can be slightly wider around the cervical portions of tooth roots esp.in ____teeth

erupting

RBL in stage 3&4

extending to middle third of root and beyond

"black hole/RL" periphery of lesion is usually well demarcated cervical caries may be crescent-shaped

facial/ lingual caries

well mineralized cortical surface of the alveolar crest indicates the presence of perio t/f

false (absence- yet variations exist may nor maynot have perio...yup confusing)

tooth mobility can be confirmed radiographically t/f

false (clinically)

short scale contrast

few shades of gray mostly black and whites (high contrast** low kVp setting)

once occlusal enamel caries is into dentin the initial detectable radiographic change may be a ? shadow (RL) under DEJ

fine gray (R3)

horizontal BL = more ? vs vertical BL=?

generalized-localized

disorders of periodontium

gingivitis periodontits

cervical burnout (RL) often disappears if radiograph is retaken with an improved ? angulation

horizontal

radiographic appearance=? of cemental or root caries

ill defined saucer shaped or scooped out

loss of enamel transparency chalky white appearance enamel may be roughened or stained due to demineralization

incipient R1 interproximal caries

irregular pits and fissures of occlusal surfaces inherently more prone to caries can be classified as R-1? R-2 &3? R4?

incipient/slight moderate severe

CEJs limit area of burnout ? and the alveolar crest limits the area ?

incisally/ occlusally apically

Between 2 adjacent surfaces.

interpoximal

incipient R1 cares is slow to develop takes 3-4yrs to become clinically appartent begins just below the contact point or on outer surface of enamel between the contact point and the height of free gingival margin

interproximal caries

3 types of bone loss distributions

localized <30% generalized >30% molar/incisor pattern

what are 5 classification of cares

location depth primary or new caries recurrent or secondary caries rampant caries

where the edges of darker objects next to lighter objects will appear lighter and vice versa, creating a false shadow optical illusion- caries like RL in healthy teeth exaggerates the contrast between edges of the different shades of grey

mach banding

what are 3 factors affecting caries interpretation

mach banding cervical burnout other factors

what are 3 conditions that can mimic caries

mach banding cervical burnout peripheral burnout

Furcation involvement is easier to detect on ? teeth

madibular

1-2mm loss of normal supp. bone height

mild RBL

what are 4 factors affecting caries interpretation

mimics contrast and density amt of tooth loss underestimation of actual lesion size (actual lesion depth is more & 30-40% demin is req to detect radiographically)

detectable radiographic changes broad based, RL zone extending into dentin is ___ occlusal caries R2-R3

moderate

more than 2mm BL less than 50% loss of supporting bone height

moderate

what are 4 classification of caries according to location

occlusal interproximal/proximal root or cementum facial/lingual

most prevalent location of caries more common in children and adolescents in posterior teeth

occlusal caries

Apex of lesion is towards the ___surface of the tooth and base is towards the ___

outer DEJ

plane of normal interdental crestal alveolar bone is ? with an imaginary line between CEJ's of adj. teeth

parallel

inflammatory process affecting soft and hard tissues surrounding an implant- associated with loss of supporting bone BOP and occasionally suppuration

peri-implantitis

what disease is this describing clinically change in gingival architecture bleeding erythema and edema pocket formation gingival recession purulent exudate resorption of alveolar crest tooth mobility

perio

what is the primary role in perio disease

poor OH (other factors diabetes and smoking)

what classification of radiographic caries according to depth is the following? caries through the DEJ but less than 1/2 way to the pulp

R-3

what classification of radiographic caries according to depth is the following? caries more than 1/2 way through dentin to the pulp

R-4

what type of caries can be arrested or reversed by remineralization restoration is generally not recommended

R1 incipient caries

how is the depth of caries noted

R1-R4

extensive and wide spread poor dietary habits frequent sweet snacks and poor oral hygiene most obs. in young children teenagers and adults with xerostomia initial lesion small at surface with rapid penetration and spread at DEJ

Rampant caries

t/f perio disease is episodic with periods of exacerbation and remission

true

t/f radiograph will not be able to specify Facial from lingual caries

true

t/f after treatment bone levels will not increase or become normal

true (only in remission)

what is the recommended radiographic technique?

****long bid with paralleling tech. high kVP and lower mA tech (-> better visualization of bony density and soft tissue outlines- long scale contrast/wider gray scale)

what is the normal crown to root ratio (ratio of the length of the part of a tooth that appears above the alveolar bone vs what lies below it

1:2; 1:1 (any less bone support reduces the prognosis of the tooth and restoration)

are radio images 2-D or 3-D

2-D

limitations of radiographic images for diagnosis of perio disease

2-D no early detection less radio than clinically superimposition of facial and lingual aspects of teeth occurs ***do not reveal soft tissue changes (gingivitis) and extent of mobility**

radiographic detection depends on loss of enough mineralization to result in detectable change in radiographic denstiy loss of small amts of mineral from incipient lesion may be difficult to detect ?% demineralization is required to detect on conventional radiograph

30-40

there must be present RBL for ? months before evidence of bone loss appears in a radiograph

6-8

Root proximity is interpreted as an inter-redicular distance of ?

<0.8mm

occlusal caries RL from the lesion is only seen radiographically when it reaches the ?

DEJ (R-3 or R-4)

perio disease is associated with apical migration of? on the root surface

JE

Long scale contrast

Many shades of gray (high kvp, low contrast**)

how can you tell that a tooth might be mobile

PDL space (confirm clinically)

what classification of radiographic caries according to depth is the following? enamel caries less than 1/2 way through the enamel (incipient caries)

R-1

what classification of radiographic caries according to depth is the following? enamel caries at least 1/2 way through the enamel but not involving DEJ

R-2

function of proximal contacts and embrasures

prevention of food impaction protection of periodontium distribution of forces stabilization of dental arch

develops at margins of/or in the vicinity of an existing restoration may indicate susceptibility to caries poor oral hygine deficient cavity prep or defective restoration radiographically difficult to see in some situations due to existing restoration

primary and recurrent caries

occurs due to aging or chronic and mild irritation (such as slowly advancing caries) which causes a change in the composition of the primary dentin

sclerotic dentin

what may form between the lesion and the pulp chamber (not visible always) RO narrow area of increased opacity around the lesion pt may or may not have pain

sclerotic or reparative dentin (usually advanced occlusal caries R4)

50% or more bone height loss

severe

readily observed both clinically and radiographically as large cavities or RL in crowns severe lesions spread through dentin towards pulp chamber enamel is undermined underlying dentin is carious and masticatory forces cause collapse and cavitation of occlusal surfaces this describes what type of occlusal caries

severe/advanced occlusal caries R4

with advancement of occlusal caries , radiolucency spreads below the enamel and extends towards the pulp in a ? pattern -margin bet. carious and non carious dentin may be ?

spherical -diffused

3 types of calculus

spicules ledge ring

what is the treatment for cervical burn out?

their is none

furcations are more common with**age t/f

true

prominence of nutrient canals = bad t/f

true

t/f R2 interproximal caries can be RL triangle or diffused RL or combination

true

t/f enamel interproximal cries (R1 or R2) cannot be detected radiographically if over 1/2 of the enamel is overlapped by adjacent surface

true

t/f in normal anatomy the crestal bone is cont. of the lamina dura and is cont. from tooth to tooth

true

t/f moderate R3 interproximal caries is not more than half the thickness of dentin

true

in scleroitic dentin peritubular dentin becomes ? due to deposition of calcified materials which progress form enamel to pulp this area becomes harder denser ? sensitive and more protective of pulp against irritations

wider-less