Transcript Slide 1

Essentials of Dental Radiography
for Dental Assistants and Hygienists
NINTH EDITION
CHAPTER
24
The Use of
Radiographs in the
Detection of Dental
Caries
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Objectives
• Define the key words.
• Explain why caries appear radiolucent on
radiographs.
• Define the role radiographs play in
detecting caries.
• Identify the ideal type of projection,
technique and exposure factors that
enhance a radiograph’s ability to image
caries.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Objectives
• List and describe the four categories of the
caries depth grading system.
• List the four locations of dental caries and
identify their radiographic appearance.
• Define and identify the radiographic
appearance of recurrent dental caries.
• List three conditions that resemble dental
caries radiographically and discuss how to
distinguish these from caries.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Key Words
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Advanced caries
Arrested caries
Buccal caries
Caries
Cemental (root) caries
Cementoenamel junction (CEJ)
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Key Words
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Cervical burnout
Dentinoenamel junction (DEJ)
Incipient (enamel) caries
Interproximal
Interproximal caries
Lingual caries
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Key Words
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Mach band effect
Moderate caries
Nonmetalic restoration
Occlusal caries
Proximal caries
Rampant caries
Recurrent (secondary) caries
Severe caries
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Introduction
• The detection of caries (tooth decay) is
probably the most common reason for
exposing dental radiographs.
• The dental hygienist and dental assistant
who is skilled in identifying normal
radiographic anatomy, should be able to
differentiate between the appearance of
normal tooth structures and dental caries
on a radiograph.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
PROCEDURE 24-1 Radiographic interpretation for caries
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Dental Caries
• Description
• Detection
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-1 Proximal surface caries found just apical to the contact area between two adjacent teeth.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
TABLE 24-1 Radiographic Appearance of Caries
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-2 Vertical angulation. (1) Excessive vertical angulation prevents viewing this proximal surface carious
lesion. (2) Proper vertical angulation shows the proximal surface caries. Note the difference in alveolar bone crest
heights between the two radiographs indicating a change in the vertical angulation.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-3 Horizontal angulation. (1) Incorrect horizontal angulation causes overlapping between adjacent teeth,
which prevents viewing for interproximal caries. (2) Improved horizontal angulation, but caries difficult to view. (3)
Correct horizontal angulation clearly images caries.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-4 Periapical radiograph records proximal surface caries.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-5 Drawing showing ratio of caries to enamel. X-ray A passing through a small ratio of caries to enamel,
resulting in the caries being difficult to view. X-ray B passing through a large ratio of caries to enamel, results in the
caries being easier to view.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-6 Diagram of classification of dental caries recommended by Haugejorden and Slack. (1) C-1 caries.
Less than halfway through the enamel (incipient caries). (2) C-2 caries. Penetrate over halfway through the enamel
(moderate caries). (3) C-3 caries. At or through the dentinoenamel junction (DEJ), but less than halfway through the
dentin toward the pulp (advanced caries). (4) C-4 caries. Penetrate over halfway through the dentin toward the pulp
(severe caries).
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-7 Drawing indicating the area to examine for interproximal caries. View the area where two adjacent
teeth contact, and apical down to where the gingival margin would most likely be (boxed area). Avoid mistaking caries
in the region apical to the gingival margin, where the optical illusion cervical burnout is most likely to be appear.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Classification of the Radiographic
Appearance of Caries
• There are four locations on the tooth
where caries occur:
– Proximal (mesial and distal)
– Occlusal
– Buccal/lingual
– Cemental (root surface)
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-8 Drawing of occlusal caries, early stage. Early occlusal caries (C-1 and C-2) extend along the
dentinoenamel junction (DEJ) and may not be seen on the radiograph, even though the lesion may be detected
clinically.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-9 Drawing of advanced occlusal caries. Advanced (up to halfway toward the pulp) or severe occlusal
caries (more than halfway toward the pulp) will most likely be imaged radiographically.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-10 Radiograph of occlusal caries. (1) Severe occlusal caries appearing as a large radiolucent lesion in
the first molar.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-11 Drawing of buccal or lingual caries. Advanced buccal or lingual caries have well-defined borders.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-12 Radiograph of buccal or lingual caries on this mandibular second premolar appears as a round
radiolucency (superimposed over the pulp chamber).
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-13 Drawing of cemental (root) caries illustrates involvement of only the roots of teeth. Gingival recession
and bone loss precede the demineraliztion process to expose the root surfaces.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-14 Radiograph of cemental (root) caries. The large radiolucency on the distal surface of the distal root of
the first mandibular molar is cemental caries. Note the bone loss exposing the root surface.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-15 Radiograph of recurrent caries. (1) Radiolucent caries under the metallic restoration.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-16 Radiographs of rampant caries. Multiple teeth affected by severe cemental caries.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-17 Radiograph of nonmetalic restorations and carious lesions in anterior teeth. (1) Radiolucent
nonmetallic restorations on the mesial surface of the lateral incisor and distal surface of the central incisor. Note that
under both restorations is a base of radiopaque material. (2) The radiolucencies on the mesial surfaces of both central
incisors are carious lesions.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Conditions Resembling Caries
• Nonmetallic restorations
• Cervical burnout
• Mach band effect
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-18 Drawing of cervical burnout. (1) Thin cervical root surface between dense crown and alveolar bone
crest allows more x-rays to pass and reach the image receptor. This cervical area of the teeth will most likely be imaged
at an increased radiolucency.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-19 Radiograph demonstrating cervical burnout. Note the radiolucent optical illusion of cervical burnout
on the mesials and distals between the enamel and restorations and the alveolar crest of bone.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Figure 24-20 Caries and optical illusions that mimic decay. (1) Severe occlusal caries. (2) Radiolucent lines
creating a mach band effect caused by overlapped enamel. (3) Incipient distal surface caries. (4) Cervical burnout.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Review: Chapter Summary
• The detection of caries is probably the
most common reason for taking dental
radiographs.
• Caries appear radiolucent because the
demineralization of the tooth allows more
x-rays to pass through to reach the image
receptor.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Recall: Study Questions
• General
• Chapter Review
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
• You are interpreting a full mouth series of
radiographs on a patient who had dental
hygiene services at your facility this
morning. The completed patient’s dental
examination chart is available, but the
patient has been dismissed. As you
examine the radiographs, you notice the
following:
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
1. Incipient proximal caries on the distal of
the maxillary right first molar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
incipient.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
2. Moderate proximal caries on the mesial of
the maxillary left first premolar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
moderate.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
3. Advanced proximal caries on the mesial
of the mandibular left second premolar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
advanced.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
4. Severe proximal caries on the distal of
the mandibular right first molar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
severe.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
5. Advanced occlusal caries on the
maxillary right second molar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
advanced.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
6. Cemental caries on the mesial of the
mandibular right first premolar.
a. Describe the radiographic appearance of this
lesion.
b. Indicate why you classified this lesion as
cemental.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
7. The patient’s chart indicates incipient
occlusal caries detected clinically on the
maxillary left first and second molars.
However, these do not seem to be
evident radiographically.
a. Explain why these caries are not observed
on the radiographs.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
8. The patient’s chart indicates incipient
buccal caries detected clinically on the
mandibular left first molar. However, this
lesion does not seem to be evident
radiographically.
a. Explain why the buccal caries is not
observed on the radiographs.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
9. The radiographs reveal two
radiolucencies resembling cemental (root)
caries around the cervical of the
mandibular right first and second
premolars. However, the patient’s chart
does not indicate that cemental caries
were detected clinically.
a. Explain the possible cause of these
radiolucencies.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Reflect: Case Study
10.The periapical radiograph of the maxillary
left molar region is overlapped between
the maxillary first and second molars.
a. Explain why detecting caries in this area will
be compromised.
b. What optical illusion will most likely present
in this area?
c. Describe the appearance of this optical
illusion.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.
Relate: Laboratory Application
• Proceed to Chapter 24, Laboratory
Application, to complete this activity.
Essentials of Dental Radiography for Dental Assistants and Hygienists, Ninth Edition
Evelyn M. Thomson • Orlen N. Johnson
Copyright ©2012 by Pearson Education, Inc.
All rights reserved.