Dental Caries

 Dental caries, or tooth decay, is a pathological

process consisting of localized destruction of
dental hard tissues by organic acids produced
by microorganisms.
 The caries process is one of demineralization
of tooth structure (enamel, dentin, cementum).
 This demineralization of tooth density allows
more x-rays to pass through the tooth and
darken the image.
 Therefore, caries appear radiolucent on the
radiograph
Radiograph for Dental Caries
 Radiographs can be used to confirm a
clinical suspicion of caries, detect early
lesions and for monitoring disease
activity.
 Radiographs are really useful to detect
caries in occlusal which the surface is
clinically intact or in proximal tooth
surfaces which has limited access
clinically
 The radiograph only mirrors the current
extent of demineralization, one radiograph
alone cannot distinguish between an active
and an arrested lesion.
 Only a second radiograph taken at a later
time can reveal whether the disease is
active.
 When a decision is made to monitor a
lesion, factors (oral hygiene, diet, age,etc)
should be considered in determining the
time interval between the radiologic
examinations
 Examination With Conventional
Intraoral Film
1. Bitewing radiographs
 The most useful radiologic examination for
detecting caries , especially for diagnosis of
occlusal and proximal caries in posterior teeth
 Diagnostic problems may arise because of
superimposition of the cuspal pattern and contact
point overlap.
2. Periapical radiographs are required for
anterior teeth.
 Extraoral radiographs such as dental
panoramic radiographs should not be used for
the diagnosis of dental caries owing to their
lack of sensitivity
 Examination With Conventional
Intraoral Film
1. Bitewing radiographs
 The most useful radiologic examination for
detecting caries , especially for diagnosis of
occlusal and proximal caries in posterior teeth
 Diagnostic problems may arise because of
superimposition of the cuspal pattern and
contact point overlap.
2. Periapical radiographs
 Useful primarily for detecting changes in the
periapical bone
 Are required for anterior teeth.
Examination With Digital Imaging
 Digital image receptors may replace film for
intraoral radiography.
 There are two different methods available:
(1) solid-state sensors
(2) storage phosphors (PSP plates)
 The disadvantage of solid state sensor,
when use for bitewing examination
 The surface area of the sensor is smaller than
the surface area of a size-2 film showed fewer
interproximal tooth surfaces per bitewing image
 The stiffness and increased thickness of these
sensors may result in more projection errors and
retakes.
Bite Wing Examination
 Size-2 “ adult ” films are used for patient which
the age of approximately 7 to 8 years onward.
 For child under 7 years, size-0 can be used
 When it is necessary to examine all the contact
surfaces from the cuspid to the most distal molar,
one or two bitewing films per side are required,
depending on the number of teeth that are present
Examination With Conventional
Extraoral Film
 Extraoral radiographs such as dental
panoramic radiographs should not be used
for the diagnosis of dental caries owing to
their lack of sensitivity
Quality Of Radiograph For
Detecting Caries
 To be a useful diagnostic aid, the
radiographs must be precisely exposed
and meticulously processed
 For best imaging caries, it’s sugessted to
use lower kVp (such as 60 kVp)  high
contrast, because caries appear
radiolucent against a radiopaque enamel
(or lesser radiopaque dentin)
 Improper angulation can render a
radiograph worthless for caries detection
 improper vertical or horizontal
angulation
Angulation and Caries
Interpreting Dental Caries
 Dental caries is a process of decalcification
and requires 30- 50 % loss of mineral (Ca,
P) before the decreased density can be
seen on a radiograph.
 So, the depth of penetration of a carious
lesion is deeper clinically than it appears
on the radiograph.
 The proximal surfaces of posterior teeth
are broad, the loss of small amounts of
mineral from incipient lesions may be
difficult to see on the radiograph