RADIOGRAPHIC

INTERPRETATION OF DENTAL
CARIES

1
 CONTENTS
1. INTRODUCTION
2. METHODS
– Clinical Examination
– Radiographic Examination
3. RADIOGRAPHIC EXAMINATION TO DETECT DENTAL CARIES
4. RADIOGRAPHIC APPEARANCE OF DENTAL CARIES
5. RADIOGRAPHIC DETECTION OF LESION
– Proximal Surface
– Occlusal Surface
– Buccal and Lingual Surface
– Root Surface
– Associated with Dental Restoration
6. DIFFERENTIAL DIAGNOSIS
7. ALTERNATIVE DIAGNOSTIC TOOLS
8. LIMITATION OF RADIOGRAPHIC DIAGNOSIS OF CARIES

2
 INTRODUCTION

Dental Caries is an infectious microbial disease of the calcified tissue of

the teeth characterized by demineralization of inorganic portion and
destruction of organic substance of tooth.

3
 METHODS

1. CLINICAL EXAMINATION
– Direct vision of clean and dry mouth
– Gentle probing
– Transillumination
2. RADIOGRAPHIC EXAMINATION
– Bitewing radiography in adults and children
– Periapical Paralleling Technique in adults

RADIOLOGIC EXAMINATION TO DETECT CARIES

Caries process cause due to demineralization of enamel and dentin.
Lesion is seen as radiolucent (darker) zone because
demineralization area of tooth does not absorb as many X-Ray
photon as compared to unaffected portion.

4
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
 Amalgam Restoration - BDS Lecture Notes PDF Download
 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
Other Popular Links for Law Study Material:
 BDS Lecture Notes, eBooks, Guides, Projects and Case Papers FREE PDF Download
 BDS Lecture Notes, eBooks, Guides & Handouts FREE PDF Download
 BDS University Previous Year Exam Question Papers & Solutions FREE PDF Download
 VARIOUS RADIOGRAPHIC TECHNIQUE FOR CARIES
DETECTION

1. BITEWING RADIOGRAPHIC TECHNIQUE

– Aids in detecting proximal caries
– Distal ends of premolar and molar
– Caries at CEJ
2. PERIAPICAL RADIOGRAPHIC TECHNIQUE
– Gross carious lesion
– Changes in apical and interradicular bone
3. OPG
– Multiple carious teeth
– Rampant caries

5
 RADIOGRAPHIC APPEARANCE OF CARIES

• ACCORDING TO LOCATION OF CARIES ON TOOTH :-

1. Pit and fissure Caries
• Occlusal
• Buccal and lingual
2. Smooth Surface Caries
• Proximal
• Buccal and lingual
• Root surface caries

6
 PROXIMAL SURFACE
• TYPICAL RADIOGRAPHIC APPEARANCE
– Shape of lesion is triangular with broad base at tooth surface spreading along enamel
rods.
– They are most commonly found in area between contact point and free gingival margin.
• FALSE INTERPRETATION
– Failure to recognize caries of proximal surface because of false-positive outcome
– Cervical burnout, enamel hypoplasia, wear
– When demineralization is not radiographically visible, its c/as false negative outcome
– Overlapping contact points.
• TREATMENT CONSIDERATION
– If lesion is present, then no operative t/t. arrest lesion progression by conservative
intervention.
– For cavitated lesion, operative t/t
– Dentinal lesion, either monitor the lesion or operative t/t

7
 OCCLUSAL SURFACE
• TYPICAL RADIOGRAPH APPEARANCE
– Occurs often on occlusal surface of posterior teeth.
– Demineralization process occurs on enamel pits and fissures where plaque
accumulates.
– Broad based radiolucent zone, often beneath the fissure.
– Little or no apparent change in enamel.
• FALSE INERPRETATION
– Superimposition of enamel over fissured areas
– Failure to observe thin radiolucency
– Failure to distinguish between occlusal and buccal caries.
– Mach band- when there is sharply defined density difference, such as enamel
and dentin, there may appear more radiolucent region adjacent to enamel.This is
an optical illusion referred to as “mach band”
• TREATMENT COSIDERATION
– An occlusal lesion spreads through dentin, it undermines enamel and eventually
masticatory forces cause cavitation.
– Operative treatment is required when cavitation is visible.

8
 BUCCAL AND LINGUAL SURFACE

• They often occur in enamel pits and fissures

• When small, these lesion are round
• As they enlarge, they become semilunar.
• they demonstrate sharp and well defined border.
• It is difficult to differentiate between buccal and lingual lesion
through a radiograph.
• The clinician should look for a uniform non-carious region of enamel
surrounding the radiolucency. This area represents parallel non-
carious enamel rods surrounding lesion.

9
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
 Amalgam Restoration - BDS Lecture Notes PDF Download
 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
Other Popular Links for Law Study Material:
 BDS Lecture Notes, eBooks, Guides, Projects and Case Papers FREE PDF Download
 BDS Lecture Notes, eBooks, Guides & Handouts FREE PDF Download
 BDS University Previous Year Exam Question Papers & Solutions FREE PDF Download
 ROOT SURFACE

• Involves both cementum and dentin and are associated with gingival
recession.
• Exposed cementum is relatively soft and so it rapidly damage
degrades by attrition, abrasion, erosion.
• Root surface caries should be detected clinically.
• True carious lesions radiographically will have:-
– Absence of an image of root edge
– Appearance of diffused, rounded inner border where tooth substance
has been lost.

10
 PULPAL CARIES

• The extent of caries to the pulp chamber can be evaluated with a

limited degree of reliability from radiograph.
• If on radiograph, a carious lesion appears to have progressed right
to the edge of pulp chamber, and not in pulp, a dentist should be
forewarned of a possible pulp exposure

11
 ARRESTED CARIES

• Incipient or advanced carious lesion may become arrested if there’s

a shift in oral environment.

• TYPICAL RADIOGRAPHIC APPEARANCE

- May appear as small radiolucent area
- Appearance of arrested occlusal caries is an open cavity
revealing yellow, brown or black exposed lesion that has
polished surface.

12
 ASSOCIATED WITH DENTAL RESTORATION

• Carious lesion developing at the margin of an existing restoration

may be termed as SECONDARY OR RECURRENT CARIES.
• Lesion next to restoration can be obscured by radioopaque image.
• Two radioopaque views are made at different horizontal or vertical
angulation in case of multiple restoration.
• Restorative material vary in their radiographic appearance
depending upon the thickness, density etc.

13
Studynama’s BDS Community is one of India’s Largest Community of Dental Students. About
19,232 Indian Dental Course students are members of this community and share FREE study
material, cases, projects, exam papers etc. to enable each other to do well in their semester exams.

Links to Popular Study Material for BDS (Dental) students:

 Orthodontic Fixed Appliances - BDS Lecture Notes PDF Download
 Amalgam Restoration - BDS Lecture Notes PDF Download
 COMPLEX NON-SKELETAL PROBLEMS IN PREADOLESCENT CHILDREN - BDS Lecture Notes
 Anatomy of Scalp - BDS Lecture Notes PDF Download
 Cerebrospinal Fluid (CSF) - BDS Lecture Notes PDF Download
 Cementum - BDS Lecture Notes PDF Download
 Recent Advances in Instrumentation Techniques - BDS Lecture Notes PDF Download
 Ameloblastoma - BDS Lecture Notes PDF Download
 Prevention of Odontogenic Infection - Principles of Management - BDS Lecture Notes
 Therapeutic Dentistry Histology of Teeth Dental Charting - BDS Lecture Notes PDF Download
 Maxillofacial Trauma and Management - BDS Lecture Notes PDF
 Technical Endodontics - BDS Lecture Notes PDF Download
And 698 more free downloads for Dental Students.
Other Popular Links for Law Study Material:
 BDS Lecture Notes, eBooks, Guides, Projects and Case Papers FREE PDF Download
 BDS Lecture Notes, eBooks, Guides & Handouts FREE PDF Download
 BDS University Previous Year Exam Question Papers & Solutions FREE PDF Download
 DIFFERENTIAL DIAGNOSIS

• EROSION CAVITY
– Saucer shaped and have sloping margins.
• NON OPAQUE FILLINGS
– Distinguished by sharpness and uniformity of the margins
• CARVICAL BURNOUT
– Located at the neck of teeth demarcated above by enamel cap and
below by alveolar bone level.
• INTERNAL RESORPTION
– Margins are well defined and normal margins of pulp chamber are
effaced.
• EXTERNAL RESORPTION
– Line of demarcation between adjacent tooth and defective area is sharp.
• HYPOPLASIA
– Several small dark spots are seen.

14
 CERVICAL BURNOUT

• Constricted cervical neck of the tooth, the area between the crown
and root absorbs less x-ray energy than the areas above and below
it.
• This is because of the presence of enamel above the cervical neck
and alveolar bone covering root of this tooth below cervical neck.
• Radiolucent band running across cervical neck of teeth (anterior)
and triangular wedge shaped radiolucency at interproximal cervical
neck of posterior teeth

15
 ALTERNATIVE DIAGNOSTIC TOOLS

• LIGHT FLUROSCENCE
– Helps to quantify mineral loss on smooth surface
• DIAGODENT LASER
– Helps to quantify mineral loss on occlusal surface
• FIBEROPTIC TRANSILLUMINATION
– Helps to quantify mineral loss on proximal surface, but cannot detect
small lesion.
• ULTRASOUND
• DIGITAL FOTI
– Combines fiberoptic transillumination with digital camera
• FLUOROSCENCE

16
 LIMITATION

• Carious lesion are larger clinically than they appear radiographically,

• Technique variation in film and X-ray beam position can effect the
image.
• Exposure factors can have a marked effect on overall radiographic
contrast, i.e size or appearance of caries.
• Exact site of carious lesion – buccal or lingual cannot be
determined.
• Distance between pulp horn and carious lesion can not be
determined.
• Recurrent carious lesion at the base of interproximal box cannot be
determined.

17
 REFERENCE

• White and Pharoah – Radiographic Interpretation of Dental Caries

• Eric Whaites – Radiographic Features Of Dental Caries
• Freny Karjodkar – Radiographic Diagnosis Of Pathology Affecting
Jaw

18