Chapter 33: Interpretation of Dental Caries
Is it possible to determine the depth of a buccal and lingual caries?
No, *best to detect clinically*
If a carious lesion is seen in the dentin and enamel through the DEJ and over halfway through the dentin toward the pulp, which classification would this fall under?
Severe Caries
d. Caries that extends through enamel, through dentin, and more than half the distance to the pulp
Severe Interproximal
f. Caries seen as a large radiolucency in dentin under the enamel of the chewing surfaces of teeth
Severe Occlusal
In which type of Occlusal carie starts to make the enamel breakdown, is in the dentin and proceeds to the pulp?
Severe Occlusal Carie C-3
What can cause arrested caries?
Significant shift in the oral environment that caused stop or slow down the caries process.
Caries appear radiopaque, because more radiation is passing through the demineralization than the surround-ing tissues. a.The first part of the statement is true, but the second part of the statement is false. b.The first part of the statement is false, but the second part of the statement is true. c.Both parts of the statement are true. d.Both parts of the statement are false.
b.The first part of the statement is false, but the second part of the statement is true.
Root Surface or Cemental Caries
-*Bone loss and recession is necessary* for there to be root caries. -*Found below the CEJ* Boarder of enamel and the free margin of the gingiva on the cemental surface -*C-III defined radiolucent crescent shaped* -*Can be confused with cervical burnout*
Buccal/Lingual Caries
-*Early lesions difficult to detect on radiographs* because of the bulk of normal tooth structure between caries and radiograph. -2D image of 3D structure, *not possible to determine the depth of buccal and lingual caries* *Best to detect clinically,* hard to tell the extent radiographically
Nonmetallic Restorations
-*Old composites, acrylic resin, silicate* that appear radiolucent. -Radiographic base under the restorations - have straight borders -Radiographically, *caries appear as more diffused borders and uneven radiolucency.*
Cervical Burnout
-*Optical illusion* - when the eye must distinguish between a white area and a black area. -*Cervical area most common,* because it is the indentation of the tooth and there are concavities on some teeth in this area -*The concavity of the root surfaces allows greater penetration by the x-rays* Therefore will appear more dark next to radiopaque structures between enamel and lamina dura.
Cavitation
A hole in a tooth that results from the caries process
What will result in a hight contrast image with black and white with few shades of gray in between?
A low setting, such as 60kVp
What are the 3 conditions that resemble caries?
A. Nonmetallic restorations B. Cervical Burnout C. Mach band effect
If a carious lesion is seen in the dentin and enamel through the DEJ and is less than halfway through the dentin toward the pulp, which classification would this fall under?
Advanced Caries
b. Caries that extends to or through the DEJ but does not extend more than half the distance to the pulp
Advanced Interproximal
How many of the radiographic classifications apply to interproximal caries?
All 4 C-1 incipient C-2 Moderate C-3 Advanced C-4 Severe
Where is the area the should be examined for interproximal caries?
Area where 2 adjacent teeth contact, and apical down to where the gingival margin would most likely be
What does it mean if the caries have stopped or are inactive?
Arrested Caries
Why are early buccal/lingual carious lesions difficult to detect on a radiograph?
Because of the bulk of normal tooth structure between caries and radiograph
Starts out as a radiolucent notch - the shape of a V in an edge - triangular configuration
C-1 = incipient
If an interproximal caries is less than halfway through the enamel, which classification is this?
C-1 Incipient
What stage do arrested caries stop at?
C-1 stage and needs to be closely monitored
Takes a wider triangular shape with the tip pointing towards the DEJ
C-2 = Moderate
If an interproximal caries penetrates over halfway through the enamel, which classification is this?
C-2 Moderate
Spreads through the dentin, also double triangular shape towards the pulp
C-3 = Advanced
If an interproximal caries is at or through the DEJ but less than halfway through the dentin toward the pulp, which classification is this?
C-3 Advanced
Diffused radiolucency and larger as the apex spreads toward the pulp
C-4 = Severe
If an interproximal caries penetrates over halfway through the dentin toward the pulp, which classification is this?
C-4 Severe
Root Surface Caries
Caries that involve only the roots of teeth
Buccal Caries
Caries that involve the buccal tooth surface
Occlusal caries
Caries that involve the chewing surfaces of posterior teeth is referred to as this.
Lingual caries
Caries that involve the lingual tooth surface
Recurrent Caries
Caries that occur adjacent to a pre-existing restoration
What can Root caries be mistaken for?
Cervical burnout
What causes overlapping between adjacent teeth and prevents viewing of interproximal caries
Horizontal angulation
Incipeint Interproximal Caries
Identify the Classification
Moderate Interproximal Caries
Identify the Classification
Root/Cemental Caries
Identify the Classification
Severe Interproximal Caries
Identify the Classification
Rampant Caries
Identify the classification
What will cause overlapping of enamel, causing a radiopaque area, and an inability to detect caries?
Improper horizontal angulation
If a carious lesion penetrates less than half way through the enamel of the tooth towards the DEJ which classification would this fall under?
Incipient Careis
c. Caries that cannot be seen on an image
Incipient Occlusal
In which type of Occlusal carie may not be detected clinically and cannot be seen on radiograph?
Incipient Occlusal Caries C-1
e. Caries that extends less than halfway through enamel
Incipient interproximal
What are recurrent or secondary caries?
Radiolucent Caries under the metallic restoration
*40-50% demineralization* of tooth structure, that is loss of calcium and phosphorous takes place before decreased density is seen on a radiograph making caries what?
Radiolucent, and are *always* worse than is shown on the x-rays
What is the type of caries that are severe, unchecked, multiple teeth affected by severe cemental caries?
Rampant Caries
What type of Caries is accompanied by bone loss and recession, found below the CEJ?
Root surface caries
C-3 = Advanced Caries
Seen in the dentin and enamel through the DEJ and *less than halfway through the dentin* toward the pulp
C-4 = Severe Caries
Seen in the dentin and enamel through the DEJ and *over halfway through the dentin toward the pulp*
Cavity
A carious lesion, or an area of tooth decay that is often referred to as this.
Rampant
"growing or spreading unchecked"
What Classification of Radiographic Caries is this?
(Buccal or lingual caries on this mand. 2nd pre appears as a round radiolucency or superimposed over the pulp chamber)
What Classification of Radiographic Caries is this?
(Severe Occlusal)
What Classification of radiographic caries is this?
(Severe occlusal caries appearing as a large radiolucent lesion the first molar)
What Classification of Radiographic Caries is this?
(The large radiolucency on the distal surface of the distal root of the 1st mand. molar is cemental caries. Note the bone loss exposing the root surface)
What Radiographic appearance classifications apply to occlusal caries?
*All but Advanced* C-1 = incipient C-2 = Moderate C-3 = Severe
What is the Caries Depth Grading System?
*C-1* = Incipient caries *C-2*= Moderate caries *C-3*= Advanced Caries *C-4* = Severe Caries
Why are *incipient lesions difficult to see on radiographs?*
*Posterior proximal* surfaces are broad, and the loss of small amounts of mineral are difficult to see.
Caries depth grading system
*X-ray A* passing through a small ratio to enamel, resulting in the caries being difficult to view *X-ray B* passing through a large ratio of caries to enamel, results in the caries being easier to view.
C-1 Incipient Occlusal
-Early occlusal carie -Extend along the DEJ -*The lesion may be detected clinically* -*Cannot be seen on radiographs*
C-3 Severe Occlusal
-Enamel starts to breakdown, caries in dentin proceed to pulp
C-2 Moderate Occlusal
-Is seen as a flat radiographic, radiolucent line in the dentin. -Little if any chance is noted in the enamel
Interproximal Caries
1. *C-1 Incp* = less than halfway through the enamel 2 *C-2 Mod* = Penetrates over halfway through the enamel 3. *C-3 Adv* = At or through the DEJ but less than halfway through the dentin toward the pulp 4. *C-4 Sev* = Penetrates over halfway through the dentin toward the pulp
Vertical angulation
1. Excessive vertical angulation prevents viewing this proximal surface carious lesion 2. Proper vertical angulation shows the proximal surface caries *note* the difference in alveolar bone crest heights between the 2 radiographs indicating a change in the vertical angulation
Horizontal Angulation
1. Incorrect horizontal angulation causes overlapping between adjacent teeth, which prevents viewing for interproximal caries 2. Improved horizontal angulation, but caries difficult to view 3. Correct angulation clearly images caries.
Caries Classification according to the location on the tooth
1. Interproximal (proximal surface) caries 2. Occlusal caries 3. Buccal/Lingual caries 4. Cemental (root surfaces) caries 5. Recurrent (secondary) caries 6. Rampant caries 7. Arrested caries
Which one of these is a nonmetallic restoration and which is a carie?
1. Radiolucent nonmetallic restorations on the mesial surface of the lateral incisor and distal surface of the central incisor. *Note* that under both restorations is a base of radiopaque material 2. The radiolucencies on the mesial surfaces of both central incisors are carious lesions
Conditions Resembling Caries
1. Severe occlusal caries 2. Radiolucent lines creating a match band effect caused by overlapped enamel 3. Incipient distal surface caries 4. Cervical burnout
Localized destruction of tooth structure, demineralization of the enamel, dentin, cementum, allow more x-rays to pass through the tooth and appears radiolucent on the radiograph, can be referred to as what?
Caries
Interproximal Caries
Caries found between 2 teeth or "between 2 adjacent surfaces"
Rampant Caries
Caries that are "growing or spreading unchecked" -is advanced and severe caries that affects numerous teeth -Typically seen in children with poor dietary habits or in adults with decreased salivary flow
Incipient occlusal caries
Caries that cannot be seen on a dental image and must be detected clinically with an explorer.
Severe Occlusal Caries
Caries that extend into dentin and appear as a large radiolucency
Moderate occlusal caries
Caries that extend into dentin and appears as a very thin radiolucent line
Incipient interproximal caries
Caries that extend less than halfway through the thickness of enamel
Moderate Interproximal caries
Caries that extend more than halfway through the thickness of enamel but does not involve the DEJ -A class II lesion is seen *only* in enamel
Severe interproximal caries
Caries that extend through enamel, through dentin, and more than half the distance toward the pulp -A class IV lesion involves *both* enamel and dentin and may appear clinically as a cavitation in the tooth
Advanced interproximal caries
Caries that extend to or through the DEJ and into denting but does not extend through dentin more than half the distance toward the pulp
What would cause the prevention of viewing a proximal surface carious lesion?
Excessive vertical angulation
Incipient
Means "beginning to exist or appear." This or a class I lesion is seen *only* in enamel
Interproximal
Means "between 2 adjacent surfaces"
What mistake could be made when examining radiographs for interproximal caries?
Mistaking caries in the region apical to the gingival margin, where the optical illusion cervical burnout is most likely to appear
If a carious lesion is seen penetrating over halfway through the enamel but not reaching the DEJ, which classification would this fall under?
Moderate Caries
g. Caries seen as a thin radiolucent line in dentin under the enamel of the chewing surfaces of teeth
Moderate Occlusal
In which type of occlusal carie is it seen as a flat radiographic, radiolucent line in the dentin and little if if any changed appear in the enamel?
Moderate Occlusal Carie C-2
a. Caries that extends more than halfway through enamel but does not involve the DEJ
Moderate interproximal
Caries
Or tooth decay, is the localized destruction of teeth by microorganisms.
Localized destruction of dental hard tissues by organic acids produced by microorganisms is referred to as what?
Pathological Process.
C-1 = Incipient Caries
Penetrate *less than half way through the enamel* of the tooth towards the DEJ
C-2 = Moderate Careis
Penetrating *over halfway through the enamel* but not reaching the DEJ
What is necessary for the detection of caries?
Proper angulation
Caries that can be found just apical to the contact area between 2 adjacent teeth, are what kind of caries?
Proximal surface caries (interproximal caries)
How else can Caries be classified other than their radiographic appearance?
They can also be classified according to location on the tooth
What may prevent the radiograph from imaging caries
Vertical angulation
Can some carious lesions be reversed?
Yes, may be reversed by remineralization