Dental Caries Disease

Dental Caries

• Dental caries results from a net mineral loss from the teeth, developing in the crowns and roots of teeth.
• Classification of dental caries has evolved from the traditional Black classification to newer systems like ICDAS and ADA CCS.

International Caries Detection and Assessment System (ICDAS)

• A newer classification system for dental carious lesions.

Imaging Modality to Diagnose Caries

• 2D imaging techniques:
  • Intra oral Periapical radiograph
  • Intra oral Bitewing radiograph
  • Extra oral bitewing radiograph
• 3D imaging techniques:
  • CBCT (limited use in caries detection due to metal artifact)

Radiographic Classification of Caries

• 1. Interproximal caries:
  • 4 classifications: RA1, RA2, RB4, RC5
  • RA1: Incipient interproximal caries
  • RA2: Initial interproximal caries
  • RB4: Moderate interproximal caries
  • RC5: Extensive interproximal caries
• 2. Occlusal caries:
  • Incipient occlusal caries: must be detected clinically
  • Moderate occlusal caries: may be seen as thin radiolucent line or cup-shaped zone
  • Severe occlusal caries: appears clinically as cavitation and radiographically as a large radiolucency
• 3. Buccal/Lingual caries:
  • Use clinical examination
  • May be seen as well-defined circular area in the middle of the tooth
  • Depth cannot be determined radiographically
• 4. Root caries:
  • Saucer-like cratering on the roots of teeth, involving the cementum
  • Often found in older patients with recession or periodontitis
  • May be confused with cervical burnout
• 5. Recurrent caries:
  • Found around the margins of existing restorations
  • May be due to high caries rate, poor oral hygiene, failure to remove all caries, defective restoration, or a combination
• 6. Rampant caries:
  • Rapidly progressing caries usually found in children and teens with poor diet and inadequate oral hygiene
• 7. Radiation caries:
  • Found in head/neck radiation therapy patients with xerostomia
  • Fluoride used for control

Extraoral Bitewing

• Can play a vital role in dental caries assessment, especially in cases where intra-oral bitewing views are not possible or appropriate.

Limitations of Radiography

• Carious regions are usually larger clinically
• Exposure factors affect overall contrast (kVp & mA)
• Superimposition in 2-D image cannot determine:
  • Buccolingual extent of lesion
  • Distance between carious lesion and pulp horn
  • Presence of recurrent caries
• Technique variations in film and x-ray beam position affect the image of carious lesion

Test your knowledge of dental caries, its classification and treatment. Learn about the classification methods and systems used to diagnose and assess carious lesions.