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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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