dental carries

Dental carries

Islam Kassem Consultant oral & maxillofacial surgeon

ikassem@dr.com

Caries

Bitewing Film primarily

Periapical film also used

Low kVp, high contrast

(short scale)

Approximately 50 % demineralization is required for radiographic detection of a lesion. The thickness of the tooth buccolingually masks the carious lesion when it is small.

The actual depth of penetration of a carious lesion is deeper clinically than radiographically.

Proximal caries susceptible zone

caries

Factors affecting caries diagnosis: Buccolingual thickness of tooth

Two-dimensional film

X-ray beam angle

Exposure factors

Radiographic Caries

I

M = Moderate

I = Incipient

A = Advanced

S = Severe

S

A M A

Incipient Interproximal Caries I

Up to half the thickness of enamel

Cone-shaped radiolucent area

Treat or no treat ?

Usually not restored: * Unless patient has high caries activity

Incipient Interproximal Caries

I

Incipient

Moderate Interproximal Caries

M

More than half-way through the enamel (up to DEJ)

Moderate

Advanced Interproximal Caries

A A

From DEJ to half-way through the dentin

Advanced

Advanced

Advanced

Advanced

Incipient

Moderate

Advanced

Severe Interproximal Caries

More than halfway through the dentin

S

Severe

Anterior interproximal caries can usually be diagnosed by directing bright light through the contact areas.

Transillumination

Must have penetrated into dentin Diagnosed from clinical exam Radiographs are not a reliable diagnostic aid for the detection of occlusal caries.

Occlusal Caries

The apex of the triangle is toward the outer surface of the tooth and the base is at the dentino-enamel juncition.

Occlusal Caries

Occlusal

Occlusal

Use clinical exam

Can’t determine depth

Appears as round dots

Buccal/Lingual Caries

Buccal/lingual

Older patients with recession or periodontitis

Root Caries

Root caries

Root caries

Cervical burnout appears as a collar or wedge-shaped radiolucency on the

mesial and distal root surfaces near the CEJ of a tooth.

The tissue density at the cervical region of the tooth is less than the regions

above and below it. (variable penetration of X-ray)

Burn-Out:

*Mainly located at the neck of the tooth (Demarcated above

by enamel cap or restoration and below by the alveolar

bone)

**Usually all teeth are affected esp. smaller premolars.

***it is more obvious when the exposure factors are

increased!

Root caries may be confused with cervical burnout

Anterior Cervical Burnout

bone level

cervical burnout area

Radiolucency seen above left (arrow) disappears on periapical film of same tooth (above right).

Cervical burnout

Cervical burnout in the anterior region due to gap between enamel (red arrows) and alveolar bone over root.

May be due to high caries rate, poor oral hygiene, failure to remove all the caries, defective restoration or a combination.

Recurrent Caries

Is not always easy to detect radiographically:

1. Location of caries lesion relative to restoration.

2. Angulation of X-ray beam.

Recurrent Caries

Recurrent caries (red arrows)

Recurrent caries

Recurrent caries

Rampant Caries

* Usually found in children and teens with poor diet and inadequate oral hygiene. * Patients with xerostomia

Found in head/neck radiation therapy patients with xerostomia Fluoride used for control

Radiation Caries

Before radiation

1 year after radiation

Thank you

ikassem@dr.com