The epidemiology of common dental diseases in children. Epidemiological studies in dentistry, accounting methods and forms.

Bitewing Film primarily used. Periapical film also used There is a lot of discussion on which film speed (D or F) should be used. Many dentists use D-speed film because they feel it provides better diagnostic images as a result of the smaller grain size. Most educators, on the other hand, recommend the F-speed film (Insight) because of the significant reduction in x-ray exposure to the patient (approximately 60% less). Radiographs

Approximately 50 % demineralization is required for radiographic detection of a lesion. As seen in the occlusal view, above right, the thickness of the tooth buccolingually masks the carious lesion when it is small. The actual depth of penetration of a carious lesion is deeper clinically than radiographically. Proximal caries susceptible zone caries

Buccolingual thickness of tooth. The thicker the tooth, the more difficult it is to see the extent of the caries. Two-dimensional film. Cannot see the extent of carious involvement in a buccolingual direction. Factors affecting appearance of caries:

X-ray beam angle (horizontal or vertical). This is especially important when trying to identify recurrent caries, since changes in angulation may cause the superimposition of the existing restoration with the carious lesion. Exposure factors. Caries detection is improved with a lower kVp setting, which provides a higher contrast. If the density of the film is too light or too dark, the diagnostic potential of the film is limited. Factors affecting appearance of caries:

I M = Moderate (Stage II) I = Incipient (Stage I) A = Advanced (Stage III) S = Severe (Stage IV) Caries Classification S A M A

Unless fairly large, interproximal caries in the posterior region usually requires radiographs to make a diagnosis. In the anterior region, interproximal caries can often be diagnosed using transillumination, which involves directing a bright light through the contact areas.

Interproximal Caries (Incipient) I Up to half the thickness of enamel Usually not restored unless patient has high level of caries activity (high risk). Treat with fluoride.

The arrow points to incipient lesions on the mesial of # 19 and the distal of # 20.

Incipient Moderate Advanced

M Interproximal Caries (Moderate) More than halfway through the enamel (up to DEJ)

The bottom arrow points to a moderate lesion on the distal of # 20. The upper arrow points to one of several incipient lesions on the molar and premolars.

Moderate lesion seen on previous film

Class III moderate lesion seen in the anterior region

A A Interproximal Caries (Advanced)

Advanced lesion identified by arrows.

Advanced lesions seen on previous film

Advanced lesion

More than halfway through the dentin S Interproximal Caries (Severe)

Severe lesion

Must have penetrated into dentin Diagnosed from clinical exam May be seen as thin radiolucent line or cup-shaped zone underlying occlusal enamel, but difficult to see on radiographs unless lesion is large. Some feel that a sharp explorer used too forcefully may contribute to spread of caries by opening up pit or fissure Occlusal Caries

Occlusal caries

Should be identified from clinical exam. Sometimes seen as well- defined circular area in middle of tooth, although it is not very radiolucent. Depth can not be determined radiographically. Buccal/Lingual Caries

Lingual caries (Can’t tell whether it’s buccal or lingual from one radiograph

Buccal caries with severe interproximal caries on # 12

Saucer-like cratering on the roots of the teeth, involving the cementum. Usually found on older individuals with prominent recession and/or periodontitis. May have xerostomia due to medications. May be confused with cervical burnout (discussed on later slide). Root Caries

Root caries

Cervical Burnout Cervical burnout is an apparent radiolucency found just below the CE junction on the root due to anatomical variation (concave root formation posteriorly) or a gap between the enamel and bone covering the root (anteriorly). Mimica root caries. Posteriorly, this radiolucency usually disappears when another film of the region is examined. Caries does not occur on the root of the tooth unless there is loss of alveolar bone and gingival tissue due to recession or periodontitis.

Posterior cervical burnout. The invagination of the proximal root surfaces allow more x- rays to pass through this area, resulting in a more radiolucent appearance on the radiograph. X-rays directed at a different angle usually pass through more tooth structure and the radiolucency disappears.

Radiolucency seen at left (arrow) disappears on periapical film of same tooth. This is cervical burnout.

bone level Anterior cervical burnout. The space between the enamel and the bone overlying the tooth will appear more radiolucent than either the enamel or the bone-tooth combination.

Cervical burnout in the anterior region due to gap between enamel (red arrows) and alveolar bone over root (blue arrows).

Found around the margins of existing restorations. May be due to unusual susceptibility to caries, poor oral hygiene, failure to remove all of the caries during cavity preparation, a defective restoration or a combination of the above. Recurrent Caries

Recurrent caries

Rampant Caries Extensive and rapidly progressing caries usually found in children and teens with poor diet and inadequate oral hygiene

Found in head/neck radiation therapy patients with xerostomia Fluoride used for control Radiation Caries

Before radiation

1 year after radiation

Mach Band Optical illusion giving appearance of increased radiolucency at the junction of differing tissue densities, such as enamel and dentin. If you block off the enamel with a fingernail, the radiolucency will disappear if due to the mach band effect. If the radiolucency persists, it may be caries.