1. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chapter 33 Interpretation of Dental Caries

2. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2 Dental Radiography  Questions  How does the dental image examination contribute to the detection of caries?  What factors may influence caries interpretation?  What is the image appearance of: incipient, moderate, advanced, and severe caries?

3. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 3 Dental Radiography  Chapter 33 Reading  Iannucci & Howerton(pp. 402-411)

4. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 4 Dental Radiography  Chapter 33 Outline  Interpretation of Dental Caries  Description of caries  Detection of caries  Interpretation of caries  Classification of caries on dental images

5. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 5 Introduction  Iannucci & Howerton(pp. 402)  Purpose  To describe dental caries and caries detection  To present interpretation tips and factors that influence caries interpretation  To introduce classification of caries on dental images

6. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 6 Description of Caries  Iannucci & Howerton(p. 403) (Fig. 33-1)  Caries  The localized destruction of teeth by microorganisms

7. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 7 Detection of Caries  Iannucci & Howerton(p. 403)  Clinical Examination  Image Examination

8. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 8 Detection of Caries  Clinical examination and dental images are necessary to detect dental caries.  Dental images enable the dental professional to identify carious lesions that are not visible clinically.  They also allow the dental professional to evaluate the extent and severity of carious lesions.

9. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 9 Clinical Examination  Some carious lesions can be detected simply by looking in the mouth, and others cannot.  The mirror can be used to reflect light, allow for indirect vision, and retract the tongue.  The explorer can be used to detect changes in consistency in pits, grooves, and fissures of teeth.

10. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 10 Clinical Examination  Color changes may be observed.  Occlusal surfaces may show dark staining in fissures, pits, and grooves.  Smooth surfaces may exhibit a chalky white spot or opacity.  An interproximal ridge may appear discolored.

11. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 11 Clinical Examination  Iannucci & Howerton(pp. 403) (Fig. 33-2)  Some teeth may exhibit a discolored area. cavitation, or have no visible changes.  Caries that occur between teeth may be difficult or impossible to detect clinically.  Dental images play an important role in these situations.

12. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 12 Image Examination  A carious area appears radiolucent because decreased density allows for greater penetration in the carious area.  The bite-wing image provides the dental professional with the greatest amount of diagnostic information.  A periapical exposure taken with paralleling technique may also be used.

13. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 13 Interpretation of Caries  Iannucci & Howerton(p. 403)  Interpretation Tips  Factors Influencing Caries Interpretation

14. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 14 Interpretation Tips  Proper mounting  Viewing in a room with subdued light that is free of distractions  An illuminator or viewbox  Masking light around the mounted films  A pocket sized magnifying glass

15. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 15 Factors Influencing Caries Interpretation  Dental images must be of diagnostic quality.  Examples may include: Improper horizontal angulation on a bite-wing image Improper horizontal angulation on a bite-wing image Errors in exposure with improper contrast and density Errors in exposure with improper contrast and density

16. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 16 Classification of Caries on Dental Images  Iannucci & Howerton(p. 404)  Interproximal Caries  Occlusal Caries  Buccal and Lingual Caries  Root Surface Caries  Recurrent Caries  Rampant Caries

17. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 17 Interproximal Caries  Iannucci & Howerton(pp. 404-405) (Figs. 33-3 through 33-6)  Interproximal  Between two adjacent surfaces  Interproximal caries typically seen on dental images at or just below the contact point.  As caries progresses through the enamel, it typically assumes a triangular configuration.  When it reaches the DEJ, it spreads laterally and progresses through dentin.  These are classified as incipient, moderate, advanced, and severe.

18. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 18 Incipient Interproximal Caries  Iannucci & Howerton(p. 405) (Figs. 33-7, 33-8)  Incipient interproximal caries extends less than halfway through the thickness of enamel.  An incipient or Class I lesion is seen only in enamel.

19. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 19 Moderate Interproximal Caries  Iannucci & Howerton(p. 405) (Figs. 33-9, 33-10)  Moderate interproximal caries extends more than halfway through enamel but does not involve the DEJ.  A moderate or Class II lesion is seen only in enamel.

20. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 20 Advanced Interproximal Caries  Iannucci & Howerton(pp. 405-406) (Figs. 33-11, 33-12)  Advanced interproximal caries extends to or through the DEJ and into dentin, but does not extend into dentin more than half the distance toward the pulp.  An advanced or Class III lesion affects both enamel or dentin.

21. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 21 Severe Interproximal Caries  Iannucci & Howerton(p. 406) (Figs. 33-13, 33-14)  Severe interproximal caries extends through enamel and dentin more than half the distance toward the pulp.  A severe or Class IV lesion involves both enamel and dentin and may appear clinically as a cavitation in the tooth.

22. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 22 Occlusal Caries  Occlusal caries are caries that involve the chewing surface of posterior teeth.  A thorough clinical exam is the method of choice for the detection of occlusal caries.  Early occlusal caries is difficult to see on a dental image.

23. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 23 Incipient Occlusal Caries  Incipient occlusal caries cannot be seen on a dental image.  It must be detected with an explorer.

24. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 24 Moderate Occlusal Caries  Iannucci & Howerton(pp. 406-407) (Figs. 33-15, 33-16)  Moderate occlusal caries extends into dentin.  It appears as a thin, radiolucent line.

25. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 25 Severe Occlusal Caries  Iannucci & Howerton(pp. 406-407) (Figs. 33-17, 33-18)  Severe occlusal caries extends into dentin and appears as a radiolucency.  The radiolucency extends under the enamel of the occlusal surface of the tooth.

26. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 26 Buccal and Lingual Caries  Iannucci & Howerton(pp. 407-408) (Figs. 33-19, 33-20)  These are difficult to detect on a dental image because they are superimposed on tooth structure.  If seen on a dental image, they appear as a circular radiolucent area.

27. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 27 Root Surface Caries  Iannucci & Howerton(pp. 407-408) (Figs. 33-21, 33-22)  Root surface caries involves only the roots of teeth.  On a dental image, it appears as a cupped-out or crater-shaped radiolucency below the CEJ.  Early lesions may be difficult to detect on a dental image.

28. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 28 Recurrent Caries  Iannucci & Howerton(p. 408) (Fig. 33-23)  Recurrent caries occurs adjacent to an existing restoration.  It appears as a radiolucent area just beneath a restoration.  It is most often located beneath the interproximal margins of a restoration.

29. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 29 Rampant Caries  Iannucci & Howerton(pp. 408-409) (Fig. 33-24)  Rampant caries are advanced and severe caries affecting a number of teeth.  This is associated with children with poor diets and adults with decreased salivary flow.