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Oral Radiographic Interpretation
Dental Caries
By Neil L. Frederiksen, D.D.S., Ph.D.
Department of Oral Diagnosis
Baylor College of Dentistry
The Texas A&M University System
Web Presentation by
Continuing Education Foundation
Copyright CEF 1997 All Rights Reserved
Radiographic Interpretation
Dental Caries
On completion of this program you will be able to:
recognize caries by radiographic appearance
identify the type of lesion by its location
differentiate caries from normal tooth anatomy and
artifacts which may appear in the radiograph
Radiographically there are five types of
carious lesions
Proximal
Root
Occlusal
Facial-Lingual
Recurrent
These five kinds of lesions are
differentiated from one another
on the basis of the location of
their point of origin on the tooth
Proximal Caries
Early proximal
caries - small
radiolucent notch
in enamel just
apical to contact
area.
Arrows point to early proximal lesions on distal 28 (mandubularright first premolar) and on mesial 29 (the mandibular right
second premolar).
Proximal Caries
Lesion becomes
triangular with
apex toward
dentoenamel
junction.
Arrow: lesion on the distal 29 (mandibular right second premolar).
Note lesion at this stage on mesial 30 (mandibular right first
molar) Also, early carious lesion on mesial 3 (maxillary right first molar).
Proximal Caries
After penetrating
dentinoenamel
junction, lesion
spreads
laterally in dentin.
Arrow: lesion on mesial 8 (maxillary right central incisor).
Note similar lesion on mesial 9 (maxillary left central incisor).
Proximal Caries
Lesion extends
in dentin, again
triangulates, apex
to pulp.
Arrow: lesion on mesial 13 (maxillary left second premolar).
Note second such lesion on 18 (mandibular left second molar).
Root Caries
Caries in the dentin of the root, also
called Root, Cervical, or Cemental
caries, may occur in patients with
exposed root surfaces resulting
from alveolar bone loss.
Root Caries
Root lesions appear on
proximal surfaces in
cervical areas as
radiolucent, saucer-
shaped defects.
Left arrow: lesion on distal root surface of 23 (mandibular leftlateral incisor).
Right arrow: lesion on mesial 22 (mandibular left canine).
Root Caries
Proximal carious
lesions and carious
lesions of the root
are differentiated by
location.
Recall: proximal lesions (left arrow) occur apical to contact area,
while root lesions (right arrow) occur apical to cementoenamel
junction in the cervical area of the tooth.
Root Caries
The image of
cervical burn-out is
often mistaken for
root caries because
of their location.
Arrows: Cervical burn-out (adumbration) - area of relative
radiolucency - an artifact appearing in dentin between part of root covered by alveolar bone and enamel part of crown.
Root Caries
To distinguish between
cervical burn-out (arrows)
and caries of the rootremember that
First:Cervical burn-out appears
as a radiolucent zone with
ill-defined margins incervical area of teeth,
while root caries is imaged
as a more definite, saucer-shaped radiolucency on
root surfaces exposed by
alveolar bone loss andgingival recession. (Next->)
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Root Caries
Second:
While good alveolar boneheight will enhance
cervical burn-out, root
caries is usually precededby bone loss.
Arrow: cervical burn-out on mesial 32, mandibular right
third molar. Note: no cervical burn-out on either proximal 30,
mandibular right first molar, involved with severe bone loss.
Facial-Lingual Caries
Facial and lingual cariesusually occurs in the
cervical area of teeth.Because of this location, it
is also known as cervicalcaries.
These lesions (arrows) usually present a distinct, punched-out
radiolucent appearance.
Occlusal Caries
Beginning occlusal
caries is usually
detected earlier
clinically than
radiographically.
Earliest evidence (arrow) of occlusal caries usually that of a thin, radiolucent line beneath the more radiopaque enamel. Observed
when process has penetrated enamel and begun to spread along
dentinoenamel junction.
Occlusal Caries
Occasionally beginningocclusal caries seen as an
ill-defined radiolucency inenamel. Not frequently
observed because
superimposition of slightlyradiolucent lesion with
unaffected enamel tendsto obscure the image of
the lesion.
Occlusal Caries
The ill-defined margins of
occlusal caries distinguishit from the image of
cervical caries whichusually presents a distinct,
punched-out radiolucentappearance.
As the occlusal lesion progresses into the dentin, its image
expands as a diffuse, radiolucent shadow (arrow).
Recurrent Caries
Recurrent or residual
caries appears as a
radiolucent area with
diffuse margins
beneath or adjacent to
a restoration.
The detection of recurrent caries depends not only on its location,
but also on the angulation of the central ray when the radiograph was made.
The latter may cause the radiolucent caries to be superimposed with the veryradiopaque restorative material.
Review Questions - 1
Test Your Skill.
Study this slide carefully
andidentify all carious lesions
by the surface of the toothinvolved.
Answers on Next Slide.
Answers to
Previous Slide
Review Answers - 1
Review Questions - 2
Test Your Skill.
Study this slide carefully
andidentify all carious lesions
by the surface of the toothinvolved.
Answers on Next Slide.
Review Answers - 2
Answers to
Previous Slide
Review Questions - 3
Test Your Skill.
Study this slide carefully
andidentify all carious lesions
by surface of the toothinvolved.
Answers on Next Slide.
Review Answers - 3
Answers to
Previous Slide
You have completed the
Oral Radiographic Interpretation
Dental Caries Presentation.
Thank you.
Center for Professional Development
Baylor College of Dentistry