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