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From J
Phenomenon or Landmark: Dental caries: proximal surfaces
Notes:
• Shape typical of early lesion is triangular with base at tooth surface
• Other shapes include a notch, dot, band, or thin line
• Spread along enamel rods
• When reaches DEJ, spreads along DEJ and may form new triangular with a wider base, advancing to pulp along dentinal tubules.
• Commonly found between contact point and free gingival margin. Above margin helps distinguish from cervical burnout.
• Proximal surfaces of posterior teeth are broad, therefore, enamel lesions may not present radiographically until 30-40 demineralization has taken place.
• False positive: Dental anomalies, hypoplastic pits, concavities from wear
• False negative: demineralization not seen radiographically
• The deeper the radiographic lesion, the greater the likelihood of cavitation. More than half-way to pulp always cavitated.
• Cavitated lesions need treatment.
Phenomenon or Landmark: Dental caries: occlusal surfaces
Notes:
• Most common site of carious lesions in adults and children.
• Originate in pits and fissures (walls not base) where bacteria gather. Penetrate DEJ and can be seen thin radiolucent line between enamel and dentin.
• Early lesions appear clinically as white, yellow, or brown discolorations of occlusal fissures. Indicates a radiographic examination
• Clinical cavity indicates lesion already into dentin
• False positive: mach band: illusion of a more radiolucent region adjacent to DEJ. Superimposition of buccal pit can simulate occlusal lesion.
• Occlusal spread through dentin undermines the enamel and masticatory forces cause cavitation.
• Rampant caries: severe, rapidly progressing carious destruction of teeth. Seen in children with poor diet and hygiene or patients with xerostomia.
Phenomenon or Landmark: Dental caries: buccal and lingual surfaces
Notes:
• Occur in enamel pits and fissures.
• Round when small and become elliptic and semilunar when they enlarge. Sharp, well-defined borders.
• Can’t always differentiate between buccal and lingual. DEJ may be superimposed (take another radiograph and look for surrounding noncarious region).
• Not as extensive and occlusal, but more well defined.
Phenomenon or Landmark: Dental caries: root surfaces
Notes:
• Involve cementum and dentin and are associated with gingival recession
• Cementum at CEJ is soft and 20-50microns, so it rapidly degrades by attrition, abrasion, and erosion.
• Usually can be detected clinically.
• Cervical burnout can mimic root lesions.
• Lesion: absence of root edge and diffuse rounded inner border where tooth substance has been lost. Not-lesion, in tact surface.
Phenomenon or Landmark: Dental caries: associated with dental restorations
Notes:
• Secondary or recurrent carries: carious lesion developing in the margin of existing restoration.
• Usually new lesion, not residual caries.
• Most common at mesiogingival or distogingival margins.
• May be obscured by radio-opaque restoration.
• Radiolucent lesion may simulate carious lesion.
Phenomenon or Landmark: Dental caries: after radiation therapy
Notes:
• Decreased salivary gland function => xerostomia => rampant caries
• Typically, destruction begins at cervical region and may encircle tooth.
• Radiolucent shadows appearing at the neck of teeth, most obvious on mesial and distal aspects.
• Variation in depth of destruction may be present but usually uniform in given region of mouth.
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