Descriptive Terminology Chapter 31 Descriptive Terminology

Dental Radiography Questions What is the difference between a radiograph and an x-ray? What is the difference between radiolucent and radiopaque? What terms may be used to describe radiolucent and radiopaque lesions?

Dental Radiography Chapter 31 Reading Iannucci & Howerton (pp. 372-382)

Dental Radiography Chapter 31 Outline Descriptive Terminology Definition and uses Review of basic terms

What is Descriptive Terminology? Descriptive terminology is terms used to describe the appearance, location, and size of a lesion. This information should be documented for all lesions viewed on dental images. This information can be used to describe the appearance, location, and size of a lesion.

Why Use Descriptive Terminology? Descriptive terminology allows dental professionals to describe and discuss what is seen on a dental image intelligently and to communicate using a common language. It eliminates the chance for miscommunication. It allows for documentation that images were reviewed. Allows the dental professional to document what is seen on an image in the patient record in terms of appearance, location, and size. Documentation is essential for legal purposes. A written description indicates that the images were interpreted. If no interpretation is included in the patient record, there is not documentation that the images were reviewed.

Descriptive Terminology versus Diagnosis Descriptive terminology allows the dental hygienist to describe what is seen on an image without implying a diagnosis. The patient’s medical and dental history, clinical findings, signs and symptoms, laboratory tests, and biopsy results are necessary for the dentist to make a definitive diagnosis. It is extremely difficult, if not impossible, to make a diagnosis from a dental image alone.

Review of Basic Terms Radiograph/dental image versus x-ray Radiolucent versus radiopaque Terms used to describe radiolucent lesions Terms used to describe radiopaque lesions It is very important that the dental radiographer have a good understanding of these four terms.

Radiograph/Dental Image versus X-ray An image that is produced on photosensitive film by exposing the film to x-rays and then processing the film so that a negative is produced Not applicable with digital radiography, in which term digital image used instead X-ray A beam of energy that has the power to penetrate substances and to record shadow images on photographic film These terms are often used interchangeably, it is important to know that they do have distinct and different meanings. A radiograph is the actual film exposed. An x-ray refers to the beam of energy, or radiation.

Radiolucent versus Radiopaque Iannucci & Howerton (pp. 373-374) (Figs. 31-1, 31-2, 31-3) Radiolucent This that portion of a processed image that is dark or black. Caries appears radiolucent because the area of tooth with caries is less dense than surrounding structures. Radiopaque This is that portion of a processed image that appears light or white. A metallic restoration appears radiopaque because it is very dense and absorbs the radiation. Radiolucent structures are soft or thin, lack density, and permit the passage of the x-ray beam with little or not resistance. Radiopaque structures are thick or hard, dense, and absorb or resist the passage of the x-ray beam. What are some other examples of radiolucent and radiopaque structures in the oral cavity?

Terms Used to Describe Radiolucent Lesions Appearance Location Size

Appearance Unilocular radiolucent lesions Iannucci & Howerton (pp. 374-375) (Box 31-1) Unilocular radiolucent lesions One compartment Tend to be small and nonexpansile Have borders that may appear corticated or noncorticated on image The word part “uni” means “one” and the word part “loculus” means “small space” or “compartment.”

Appearance Unilocular lesion, corticated borders Iannucci & Howerton (pp. 374-375) (Figs. 31-4, 31-5) Unilocular lesion, corticated borders The lesion exhibits a thin, well-demarcated radiopaque rim of bone at the periphery. Usually indicative of a benign, slow-growing process. Unilocular lesion, noncorticated borders The lesion does not exhibit a thin radiopaque rim of bone at the periphery. The periphery appears fuzzy or poorly defined. May represent either a benign or a malignant process.

Appearance Multilocular radiolucent lesions Iannucci & Howerton (pp. 374-375) (Fig. 31-6) Multilocular radiolucent lesions A lesion that exhibits multiple radiolucent compartments Frequently expansile Typically benign lesions with aggressive growth potential Tend to displace the buccal and lingual plates of bone. Most represent a reactive or neoplastic process.

Location Iannucci & Howerton (pp. 375-376) (Box 31-2) May appear in a periapical, inter-radicular, edentulous, or pericoronal location. May appear as alveolar bone loss. Important for communication and documentation purposes.

Periapical Location A lesion located around the apex of a tooth Iannucci & Howerton (pp. 375-376) (Fig. 31-7) A lesion located around the apex of a tooth Example Periapical cyst secondary to pulpal necrosis What are some examples of periapical radiolucencies?

Inter-radicular Location Iannucci & Howerton (p. 376) (Fig. 31-8) A lesion located between the roots of adjacent teeth Example Lateral periodontal cyst The prefix “inter” means “between.” The combining form “radicular” means “pertaining to a root.”

Edentulous Zone A lesion located in an area without teeth Iannucci & Howerton (pp. 376-377) (Fig. 31-9) A lesion located in an area without teeth What are some examples of radiolucent lesions found in the edentulous zone?

Pericoronal Location Iannucci & Howerton (p. 377) (Fig. 31-10) A radiolucent lesion located around the crown of an impacted tooth Example Dentigerous cyst The Greek term “peri” means “around.” The term “coronal” refers to the “crown” of the tooth.

Alveolar Bone Loss Iannucci & Howerton (p. 377) (Fig. 31-11) Loss of bone in the maxilla or mandible that surrounds and supports the teeth Appears radiolucent Not only seen with periodontal disease but also with systemic illnesses, such as diabetes, histiocytosis X, and leukemia.

Size Iannucci & Howerton (p. 377) (Fig. 31-12) Can vary in size from several millimeters in diameter to several centimeters in diameter Can be measured on an image with a millimeter ruler The size often dictates the type of treatment necessary. Documentation of the size of a lesion is important for future comparisons.

Terms Used to Describe Radiopaque Lesions Appearance Location Size

Appearance Iannucci & Howerton (pp. 377-378) (Box 31-3) Can be described as focal opacity, target lesion, multifocal confluent, irregular, ground glass, or mixed lucent-opaque. Radiopaque lesions occur not only in bone but in soft tissue as well. A radiopaque lesion located in soft tissue can be described as a “soft tissue radiopacity.”

Focal Opacity A well-defined, localized radiopaque lesion on an image Iannucci & Howerton (pp. 377-378) (Fig. 31-13) A well-defined, localized radiopaque lesion on an image Example Condensing osteitis What are some other examples of focal opacities?

Target Lesion Iannucci & Howerton (p. 378) (Fig. 31-14) A well-defined, localized radiopaque area surrounded by a uniform radiolucent halo Example Benign cementoblastoma

Multifocal Confluent Iannucci & Howerton (p. 378) (Fig. 31-15) Multiple radiopacities that appear to overlap or flow together Example Osteitis deformans, florid osseous dysplasia Multifocal confluent radiopacities involving multiple quadrants of the jaws usually represent benign fibro-osseous disorders.

Irregular Ill-Defined Iannucci & Howerton (pp. 378-379) (Fig. 31-16) A radiopacity may exhibit an irregular, poorly defined pattern. It may represent a malignant condition. Examples Osteosarcoma and chondrosarcoma

Ground Glass Iannucci & Howerton (p. 379) (Fig. 31-17) A granular or pebbled radiopacity that resembles pulverized glass Often said to resemble the appearance or texture of an orange peel Examples Fibrous dysplasia, osteitis deformans, and osteopetrosis

Mixed Lucent-Opaque Iannucci & Howerton (p. 379) (Fig. 31-18) Exhibits both a radiopaque and a radiolucent component Often represent calcifying tumors Example Compound odontoma Often appear as a radiolucent are with central opaque flecks of calcifications. The mineralization progresses with time, a predominantly radiolucent lesion with radiopaque flecks becomes more radiopaque.

Soft Tissue Opacity Iannucci & Howerton (p. 379) (Fig. 31-19) Appears as a well-defined, radiopaque area located in soft tissue Examples Sialolith Calcified lymph node A sialolith is a salivary stone.

Location Iannucci & Howerton (pp. 379-380) (Box 31-4) Radiopaque lesions may appear in the same places as radiolucent lesions: in a periapical, inter-radicular, edentulous, or pericoronal location. The location of a lesion is important for communication and documentation.

Periapical Location Iannucci & Howerton (p. 380) (Fig. 31-20) Periapical refers to a radiopaque lesion located around the apex of a tooth. Example Benign cementoblastoma

Inter-radicular Location Iannucci & Howerton (p. 380) (Fig. 31-21) A radiopaque lesion located between the roots of adjacent teeth Example Sclerotic bone What are some additional examples of inter-radicular radiopacities?

Edentulous Zone A radiopaque lesion located in an area without teeth Iannucci & Howerton (p. 380) (Fig. 31-22) A radiopaque lesion located in an area without teeth Example Complex odontoma

Pericoronal Location Iannucci & Howerton (p. 380) (Fig. 31-23) A radiopaque lesion located around the crown of an impacted tooth Example Adenomatoid odontogenic tumor is a mixed lucent-opaque lesion.

Size Radiopaque lesions can vary from several millimeters to several centimeters in diameter. They can be measured on an image with a ruler. Documentation of the size of a lesion is important for treatment decisions as well as for comparative purposes.