Lecture 4:

Radiographic Interpretation of
Dental Caries

ODRP 755 Radiology II Theory &

Interpretation
Heidi L. Christensen, DDS, MS

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 Dental Caries
• A process of decalcification
• 50% of calcium and phosphorus in a
particular area must be destroyed before
decreased density can be seen on
radiographs

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 Radiographic Criteria
• Description of Depth of Lesion
– E0 = Sound, no caries
– E1 = Caries in the outer 1/2 of enamel
– E2 = Caries into the inner 1/2 of enamel to DEJ
– D1 = Caries through DEJ, into the outer 1/3 of dentin
– D2 = Caries into the middle 1/3 of the dentin
– D3 = Caries into the inner 1/3 of the dentin

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Occlusal Caries

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Occlusal Caries

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 Interproximal Caries
• Most difficult to detect clinically
• Interproximal caries usually begin just
below the contact point

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Caries Progression –
Interproximal Caries

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Interproximal Caries

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Incipient Caries

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Interproximal Caries

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Interproximal Caries

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Interproximal Caries

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Interproximal Caries

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Interproximal Caries

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Facial or Lingual Caries

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Facial or Lingual Caries

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Facial or Lingual Caries

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 Recurrent Caries
• Caries immediately next to a restoration
• Inadequate margins or excavation
• Pulpal necrosis
• Metallic restorations often hide
• Clinical examination

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Recurrent Caries

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Recurrent Caries

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Recurrent Caries

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Recurrent Caries

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Root or Cemental Caries

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Root or Cemental Caries

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Cervical Burnout
• Often mistaken for
root caries

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Cervical Burnout
• Caused by
– The great density
difference between the
cervical neck of the
tooth and the tissues
above and below it
– Shape of CE contour
– Root configurations
– Poor horizontal
angulation of the beam
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 Cervical Burnout
• Found between CEJ and alveolar crest
• Diffuse radiolucency generally viewed on
periapical but not on bitewing
• Clinical evaluation important – lesion looks
BIG, if it is decay, you would be able to
find it!

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Cervical Burnout

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Cervical Burnout vs. Root Caries

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 Radiation Caries
• A result of therapeutic radiation
• Caused by xerostomia, a common side
effect
• Caries begins at cervical region
• Extensive decay very quickly
• Pre-therapy dental evaluation and treatment
is very important
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Radiation Caries

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 Rampant Caries
• Children
• Poor dietary habits
• Extensive caries
• Proximal and smooth surface
• Socio-economic factors

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Rampant Caries

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Regressive and Traumatic
Alterations of Teeth

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 Regressive Alterations
• Attrition
• Abrasion
• Erosion

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 Attrition
• Physiologic wearing away
• Incisal, occlusal and interproximal surfaces
• Part of aging process
• Bruxism – pathologic attrition

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 Attrition – Radiologic Features
• Change in normal outline
• Flat occlusal plane
• Loss of mamelon
• Pulp chamber, canal size
• Hypercementosis

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Attrition

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Attrition

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Attrition

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 Abrasion
• Non-physiologic wearing away
• Habits
• Toothbrush trauma
• Dental floss injury
• Occupational hazards

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 Abrasion – Radiologic Features
• Radiolucent defects at the cervical region
• Well-defined semilunar defects
• Pulp chambers sclerosed
• In case of dental floss injury, distal surfaces
more involved

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Abrasion

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Abrasion

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Abrasion

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 Erosion
• Chemical cause
• No bacteria involved
• Diet
• Regurgitation
• Occupational hazards

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 Erosion - Radiologic Features
• Radiolucent defects
• Dietary acids – labial surface
• Regurgitation – mandibular lingual surface
• Occupational – all surfaces

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Acid Erosion
Soft Drinks

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Erosion

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Erosion

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Questions?

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