Dental caries, or tooth decay, is a pathological
process consisting of localized destruction of dental hard tissues by organic acids produced by microorganisms. The caries process is one of demineralization of tooth structure (enamel, dentin, cementum). This demineralization of tooth density allows more x-rays to pass through the tooth and darken the image. Therefore, caries appear radiolucent on the radiograph Radiograph for Dental Caries Radiographs can be used to confirm a clinical suspicion of caries, detect early lesions and for monitoring disease activity. Radiographs are really useful to detect caries in occlusal which the surface is clinically intact or in proximal tooth surfaces which has limited access clinically The radiograph only mirrors the current extent of demineralization, one radiograph alone cannot distinguish between an active and an arrested lesion. Only a second radiograph taken at a later time can reveal whether the disease is active. When a decision is made to monitor a lesion, factors (oral hygiene, diet, age,etc) should be considered in determining the time interval between the radiologic examinations Examination With Conventional Intraoral Film 1. Bitewing radiographs The most useful radiologic examination for detecting caries , especially for diagnosis of occlusal and proximal caries in posterior teeth Diagnostic problems may arise because of superimposition of the cuspal pattern and contact point overlap. 2. Periapical radiographs are required for anterior teeth. Extraoral radiographs such as dental panoramic radiographs should not be used for the diagnosis of dental caries owing to their lack of sensitivity Examination With Conventional Intraoral Film 1. Bitewing radiographs The most useful radiologic examination for detecting caries , especially for diagnosis of occlusal and proximal caries in posterior teeth Diagnostic problems may arise because of superimposition of the cuspal pattern and contact point overlap. 2. Periapical radiographs Useful primarily for detecting changes in the periapical bone Are required for anterior teeth. Examination With Digital Imaging Digital image receptors may replace film for intraoral radiography. There are two different methods available: (1) solid-state sensors (2) storage phosphors (PSP plates) The disadvantage of solid state sensor, when use for bitewing examination The surface area of the sensor is smaller than the surface area of a size-2 film showed fewer interproximal tooth surfaces per bitewing image The stiffness and increased thickness of these sensors may result in more projection errors and retakes. Bite Wing Examination Size-2 “ adult ” films are used for patient which the age of approximately 7 to 8 years onward. For child under 7 years, size-0 can be used When it is necessary to examine all the contact surfaces from the cuspid to the most distal molar, one or two bitewing films per side are required, depending on the number of teeth that are present Examination With Conventional Extraoral Film Extraoral radiographs such as dental panoramic radiographs should not be used for the diagnosis of dental caries owing to their lack of sensitivity Quality Of Radiograph For Detecting Caries To be a useful diagnostic aid, the radiographs must be precisely exposed and meticulously processed For best imaging caries, it’s sugessted to use lower kVp (such as 60 kVp) high contrast, because caries appear radiolucent against a radiopaque enamel (or lesser radiopaque dentin) Improper angulation can render a radiograph worthless for caries detection improper vertical or horizontal angulation Angulation and Caries Interpreting Dental Caries Dental caries is a process of decalcification and requires 30- 50 % loss of mineral (Ca, P) before the decreased density can be seen on a radiograph. So, the depth of penetration of a carious lesion is deeper clinically than it appears on the radiograph. The proximal surfaces of posterior teeth are broad, the loss of small amounts of mineral from incipient lesions may be difficult to see on the radiograph