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Radiographic interpretation of Dental caries

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Dental caries

  • Microbial disease of the calcified tissues of the teeth, characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth.

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Diagnosing Caries !

  • Direct vision of clean, dry teeth
  • Gentle probing
  • Transillumination
  • Radiographs

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How does dental caries appear in a radiograph?

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  • Radiolucent (dark)

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Why dental caries appears Radiolucent in radiograph ?

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  • Carious process causes tooth demineralization, which allows greater passage of x-rays in these areas.

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Limitations of radiographs in dental caries diagnosis

  • Approx 40% demineralization is required for radiographic detection of a lesion.

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  • The actual depth of the carious lesion is deeper than may be detected by the radiograph.

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  • Radiograph is a two-dimensional image
  • Active V/s Arrested lesions

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Methods

  • IOPAR
  • BITEWING
  • OPG
  • DIGITAL

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Radiographic appearance of dental caries�

Incipient Occlusal caries

  • usually begins in the pits and fissures. The carious lesion starts at the side of the fissure than at the base and it tend to penetrate nearly perpendicular towards the DEJ.

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  • Radiographs are not very effective for the detection of occlusal carious lesion until it reaches the dentine.

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Moderate occlusal caries

  • observing the long thin radiolucency that first appears at the DEJ
  • Broad based thin radiolucent zone in the dentine with little or no changes apparent in the enamel can be seen in radiograph.

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Severe Occlusal Caries�

  • Observed both clinically and radiographically.
  • The underlying dentine is carious and cannot support the enamel, masticatory forces cause a collapse of the occlusal surface.
  • Radiographically severe occlusal caries appears as a large radiolucency.

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Incipient Proximal caries�

  • Develops slowly, takes 3-4 years to become clinically apparent and seen as opaque chalky region.
  • Incipient lesions may not be visible on the radiograph.
  • The radiographic appearance of an incipient lesion is of radiolucent “notch” on the outer surface of the tooth.

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Moderate Proximal caries�

  • Involve more than the outer half of the enamel
  • A triangle with its broad base at the surface of the tooth.
  • A diffuse radiolucent image.
  • Combination of these.

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Advanced Proximal caries�

  • Carious lesion had invaded the DEJ.
  • There is spreading of the demineralization process at the DEJ and subsequently extending into the dentine.
  • Radiograph shows radiolucent penetration through out the enamel.

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Facial, Buccal and Lingual caries

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  • Occurs in enamel pits and fissures.
  • When small, these radiolucencies are usually round, as they enlarge they become elliptical or semilunar in shape.
  • Clinical examination is more useful than radiographic examination because of the superimposition of the structures

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  •   In radiograph it appears as small circular radiolucent area surrounded by dense area of normal tooth structure.
  • Some times mistaken as occlusal caries if superimposed on the DEJ.
  • It is difficult to differentiate between buccal and lingual caries on the radiograph.
  • Occlusal caries are usually more extensive than buccal or lingual caries
  • Out line of the caries lesion is not well defined in case of occlusal caries.

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Root caries�

  • Usually affects older people because of gingival recession, and bone loss.

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  • It involves cementum and dentine. It does not involve the enamel.

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  • Radiographic appearance is usually a saucer like or a notched radiolucency.

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Recurrent caries

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Recurrent caries or secondary caries occurs adjacent to a restoration. It may result from

  • Poor marginal adaptation of a restoration, which allows marginal leakage.
  • Inadequate extension of a restoration.
  • Incomplete excavation
  • Fractured restoration

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  • Radiographs show radiolucent areas adjacent to a restoration.

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  • Restorative materials can resemble recurrent caries. Composite, silicate, acrylic resemble dental caries.

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  • Radiolucent restorative materials can be differentiated from recurrent caries by

Well-defined and smooth outline.

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Rampant Caries

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  • Rampant caries usually occurs in children. There will be extensive smooth surface caries involving many teeth.

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  • Radiographs demonstrate severe dental caries.

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Radiation Caries

  • Type of rampant caries seen in patients who received radiation therapy for head and neck tumors.
  • Xerostomia.
  • Caries begins at the cervical region and may aggressively encircle the tooth causing entire crown to be lost with only root fragments remaining in the jaws.
  • Radiograph shows dark radiolucent shadows appearing at the necks of teeth. 

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Radiographic Differential Diagnosis of caries�

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  • Cervical burnout
  • Abrasion and attrition
  • Proximal wear
  • Restorative materials

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Cervical burnout

  • Intact root surface may appear carious as a result of a phenomenon called cervical burn out.
  • True caries lesions may be distinguished from the cervical burn out by
    • Absence of an image of the root edge
    • Appearance of a diffuse rounded inner border where tooth substance has been lost.
    • Clinical evaluation and probing of root surface.

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Treatment consideration

  • Enamel caries- interceptive treatment
  • Just into dentine- stop microbiological activity, reverse demineralization process.
    • Reduction in sugar intake
    • Proper oral hygiene
    • Topical flourides
  • cavitated lesion- restoration.