Dental Caries

Dental Caries

• Results from a net mineral loss from the teeth
• Develops in the crowns and roots of teeth

Classification of Dental Caries

• Various classification methods have been developed, each with advantages and limitations
• Newer classification systems include the International Caries Detection and Assessment System (ICDAS) and the American Dental Association Caries Classification System (ADA CCS)
• Traditional Black classification is an older method

Imaging Modality to Diagnose Caries

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

Radiographic Classification of Caries

• 1. Interproximal Caries
  • Classification:
    • RA1: Incipient interproximal caries
    • RA2: Initial interproximal caries
    • RB4: Moderate interproximal caries
    • RC5: Extensive interproximal caries
• 2. Occlusal Caries
  • Difficulty in radiographic detection due to superimposition of dense buccal and lingual enamel cusps
  • Classification:
    • Incipient Occlusal caries: must be detected clinically
    • Moderate Occlusal caries: may be seen as thin radiolucent line or cup-shaped zone underlying occlusal enamel
    • Severe Occlusal caries: appears clinically as cavitation, extends into dentin and appears as a large radiolucency underlying occlusal enamel
• 3. Buccal/Lingual Caries
  • Use clinical examination
  • May be seen as well-defined circular area in the middle of the tooth, although it is not very radiolucent
  • Depth cannot be determined radiographically
• 4. Root Caries
  • Saucer-like cratering on the roots of the teeth, involving the cementum
  • Older patients with recession or periodontitis, xerostomia may be present due to medications
  • 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 the 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

Important Points to Note

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

Learn about dental caries, a condition that results in a net mineral loss from teeth, and its classification methods, including ICDAS, ADA CCS, and traditional Black classification.