This document discusses dental caries diagnosis using radiographs. It describes how bitewing and periapical films are used and factors that can affect detection. Stages of caries are defined from incipient to severe based on depth of lesion. Occlusal, root, and recurrent caries diagnosis methods are also outlined. Cervical burnout is distinguished from root caries based on location and appearance on radiographs. Rampant and radiation-induced caries are also briefly mentioned.

1. Dental carries
Islam Kassem
Consultant oral & maxillofacial surgeon
ikassem@dr.com

2. Caries
Bitewing Film primarily
Periapical film also used
Low kVp, high contrast
(short scale)

3. Proximal caries susceptible zone
caries
Approximately 50 % demineralization is required for
radiographic detection of a lesion.
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.

4. Factors affecting caries diagnosis:
Buccolingual thickness of tooth
Two-dimensional film
X-ray beam angle
Exposure factors

5. Radiographic Caries
I M A
A
I = Incipient
M = Moderate
A = Advanced S
S = Severe

6. Incipient
Interproximal
Caries I
Cone-shaped radiolucent area
Up to half the thickness of
enamel
Treat or no treat ?

7. Incipient
Interproximal
I
Caries
Usually not restored:
* Unless patient has high caries activity

8. Incipient

9. Moderate
Interproximal
M
Caries
More than half-way through the
enamel (up to DEJ)

14. Moderate

15. Advanced
Interproximal
Caries A A
From DEJ to half-way through the
dentin

16. Advanced

17. Advanced

18. Advanced

19. Advanced

20. Incipient
Moderate
Advanced

21. Severe
Interproximal
Caries S
More than halfway through the
dentin

22. Severe

23. Transillumination
Anterior interproximal caries can
usually be diagnosed by directing
bright light through the contact
areas.

24. Occlusal Caries
Must have penetrated into dentin
Diagnosed from clinical exam
Radiographs are not a reliable
diagnostic aid for the detection of
occlusal caries.

25. Occlusal Caries
The apex of the triangle is toward the
outer surface of the tooth and the
base is at the dentino-enamel
juncition.

26. Occlusal

27. Occlusal

28. Buccal/Lingual
Caries
Use clinical exam
Can’t determine depth
Appears as round dots

29. Buccal/lingual

30. Root Caries
Older patients with recession or
periodontitis

31. Root caries

32. Root caries

33. Root caries may be confused with
cervical burnout
Cervical burnout appears as a collar or wedge-shaped radiolucency on the
mesial and distal root surfaces near the CEJ of a tooth.
The tissue density at the cervical region of the tooth is less than the regions
above and below it. (variable penetration of X-ray)
Burn-Out:
*Mainly located at the neck of the tooth (Demarcated above
by enamel cap or restoration and below by the alveolar
bone)
**Usually all teeth are affected esp. smaller premolars.
***it is more obvious when the exposure factors are
increased!

34. Anterior Cervical Burnout
bone level
cervical burnout area

35. Cervical burnout
Radiolucency seen above left (arrow) disappears on
periapical film of same tooth (above right).

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

37. Recurrent Caries
May be due to high caries rate, poor
oral hygiene, failure to remove all the
caries, defective restoration or a
combination.

38. Recurrent Caries
Is not always easy to detect
radiographically:
1. Location of caries lesion relative to
restoration.
2. Angulation of X-ray beam.

39. Recurrent caries
(red arrows)

40. Recurrent caries

41. Recurrent caries

42. Rampant Caries
* Usually found in children and teens with
poor diet and inadequate oral hygiene.
* Patients with xerostomia

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

45. Before radiation

46. 1 year after radiation

47. Thank you
ikassem@dr.com