Oral Radiology: Interpretation of Dental Caries

artifacts (from ghost shadows)

Newer panoramic units have "extraoral" bitewing protocol which are not bad but need to beware of __________________ that imitate caries (false positives)

True

True or False Caries is a DYNAMIC process with periods of demineralization and remineralization corresponding to active and arrested caries lesions?

True

True or False Closed contacts on radiographs decreasing our confidence in accurate proximal caries diagnosis

True

True or False In moderate caries, once the lesion reaches the dentin, demineralization spreads more quickly along the DEJ and in dentin than in enamel?

False (initial cavitation cannot be accurately determined on radiographs)

True or False Initial cavitation is easily recognized on radiographs?

True

True or False Panoramic would be used only if the carious lesion is large.

True

True or False Recurrent caries CAN occur below the gingival margin

True

True or False Socio-economic factors can play a role in rampant caries

True

True or False We can improves caries diagnosis by slightly darkening the image?

Proximal Caries

caries lesion that presents as radiolucent triangle with its base TO TOOTH SURFACE

Broad Based Radiolucent beneath a fissue = occlusal caries

please describe this image

Caries

A multifactorial infectious disease resulting in demineralization and destruction of tooth tissues with potential for pulpal infections

50% (used to restore asap now put on "watch")

About ______% of lesions that are D1 are cavitated and need to be restored

Notch Band Thin Line

An incipient caries lesion can also appear as a ____________ ____________ or _________ ___________

Rarely (two cusp and giant, thick enamel on the occlusal that incipient caries get lost in)(we see them more when they reach dentin)

Are incipient ocllusal caries usually seen on radiographs?

E1 (1/2 into enamel)

Are these incipient caries E1 or E2

Bitewing and Clinical exam

Best option for diagnosing recurrent caries?

overlap

Bitewings avoid ________________ of the proximal surfaces (closed contacts)

Round Elliptic or semilunar

Buccal and lingual caries start off ____________ and then become ____________ or ______________

Medications Radiation to Head and Neck

Causes of Xerostomia?

lesion

Cavitation of the enamel surface often defines an unarrestable _____________ which requires restoration

Brush Stroke

Cervical Burnout as a "______________ ________________" appearance

Diffuse

Cervical burnout is much more _____________ towards the pulp than caries lesion

Alveolar crest and CEJ

Cervical burnout often aligns with _____________ __________ and ______________

Gingival recession and bone loss

Cervical caries are associated with ____________ and ____________

1. excellent 2. limited

Clinical access to occlusal surface is ________________ clinical access to interproximals is _____________

Harder

Compared to proximal caries, are occlusal caries easier or harder to identify?

Clincial Examination

For cervical root caries, _________ _________ is key

they are less uniform and not well-defined like cement and liners are

How can we distinguish recurrent caries from radiolucent liners or cement used in the restoration

radiolucent (dark) with diffused borders

How do caries (demineralized areas) appear on a radiograph?

Diffuse Rounded radiolucency below CEJ

How do cervical caries present on a radiograph?

dark triangle with base on DEJ and apex direct toward pulp

How do moderate proximal lesions appears on a radiograph usually?

Broad based radiolucent zone often beneath a fissure

How do occlusal caries usually present?

Caries caused by diet/meth etc are found in the proximal spaces

How do we distinguish Xerostomia caries from rampant caries caused by diet/meth etc...

Incipient Moderate Severe

How do we measure the extent of caries progression?

maintained

In cervical burnout, the outer tooth surface is ________________ typically

interproximal

Radiograph aids in detection of caries especially on _____________________ surfaces?

At or below the proximal contact (between contact and FGM)

Radiographically, where do proximal caries occur?

Clinical Exam

To detect caries, a _________ ________ is always necessary

SLOB

To diagnosis Buccal and Lingual caries clincial exam and use of the _______________ rule can help

Rampant caries

Extensive caries that encroach on the pulp very FAST?

restoration

A cavitation of the enamel indicates need for ________________ but can be hard to see on radiograph

E1 proximal Carie

1

E1 proximal carie

2

occlusal carie into dentin (moderate)

3

E2 proximal carie

4

E1 proximal

5

kissing lesions

50% of reccurrent caries are " ______________ _________________"

No (unless it is compared to previous image in which simialar image geometry is important to accurately estimate lesion size)

Can we reveal radiographically whether a caries lesion is active or arrested?

Yes

Can we see these on a radiograph?

cervical

Caries due to xerostomia are located in the _____________ region

incipient

Caries lesion in the enamel only

Moderate

Caries lesion involving the dentin

Sever

Caries lesion involving the pulp

Occlusal caries

Caries lesion that presents with rounded radiolucent shape. wider in the dentin and narrow at the occlusal surface. (usually seen at deep pit)

diffuse/ill-defined

Caries tend to be more ____________/_________________ than their imitators

Dry mouth

Define Xerostomia

no

Do small incipient caries show up on pans?

No

Do we use CBCT for dedicated caries diagnosis?

Cavitated

Lesions extending more than halfway to the pulp are ALWAYS _________________

Cervical Burnout

Localized artifact from thinner edge of tooth structure. More Defined and angular at tooth margin than caries

Enamel Pits and fissures

Locations that are common for buccal and lingual caries?

They are NOT at or below proximal contact They are NOT on the occlusal surface THey are NOT by a restoration They ARE below the CEJ in places, round and diffuse They are cervical root caires

Please Describe these caries lesion

Proximal Incipient Lesion with fuzzy borders (E1)

Please Describe this image?

1. incipient 2. Incipient 3. moderate

Please label one-three as incipient, moderate or severe

dietary

Poor _________ habits can lead to rampant caries

broader

The enamel portion of a moderate lesion is usually ____________ than an incipient lesion

1. Tooth 2. Microflora 3. diet of fermentable carbs

The formation of caries requires 1. 2. 3.

Cervical Burnout

The red arrows are showing _______________

Incipient caries

This is caries lesion that presents as a radiolucent area on the surface and is in enamel only.

pediatric

We often see rampant caries in ________________ patients

Radiation leads to damage of salivary glands which causes dry mouth and caries

What are radiation caries?

Those around an existing restoration

What are recurrent caries?

Extensive decay

What indicates that caries are being caused by dry mouth?

Large Lesions

What is CBCT useful in diagnosing?

Clinical evaluation

What is key to determining whether it is a caries lesion or cervical burnout?

radiolucent triangle with broad base at tooth surface

What is the classic appearance of incipient caries lesion (in the enamel only)?

Moderate

What is the extent of caries progression?

Severe

What is the extent of caries progression?

Incipient

What is the extent of the caries progression?

Caries diagnosis

What is the most demanding visual task in dental radiology?

Recurrent Caries

What is this an image of?

Clinical Exam

What is very important in diagnosing recurrent caries?

metallic restorations

What often obscures recurrent caries on a radiograph?

50%

What percentage of incipient caries are visible on radiograph?

1. Proximal 2. Occlusal/Incisal 3. Buccal/Lingual/Facial 4. Cervical (root)

Where can caries be located?

Bitewings

Which radiographic exam is the BEST access from proximal and occlusal caries.

Sjogren's Syndrome

Which syndrome has sever xerostomia as a consequence?

Teeth are gone due to undermining lesions that weaken teeth and can't handle occlusal forces

Why did this patient lose many teeth due to xerostomia?

Cementum and dentin are less calcified

Why do cervical (root) caries spread quickly?

there are artifacts from metallic restorations and other dense objects (including enamel) that look like caries.

Why do we not use CBCT for caries diagnosis?

Recurrent caries

___________ ________ are a diffused radiolucency next to a restoration

Dimmed room lighting

_____________ ________________ _________ is ESSENTIAL for caries detection

Periapical

______________ are good for occlusal caries but just okay for interproximals

Methamphetamine

_______________ use can lead to rampant caries

Adumbration

__________________ (aka cervical burnout) is often a "caries imatator"

Rampant caries

this is a case of what?