33.1

Detection of Caries

Clinical examination and dental images are necessary to detect dental caries. A clinical exam is not complete without images. Dental images enable the dental professional to identify carious lesions that are not visible clinically. They also allow the dental professional to evaluate the extent and severity of carious lesions.

To detect dental caries, both a careful clinical examination and interpretation are necessary.

Clinical Examination

Some carious lesions can be detected simply by looking in the mouth, and others cannot.

• • The mirror is an instrument than can be used by the dentist to reflect light, allow for indirect vision, and retract the tongue
  • The explorer is an instrument by the dentist that can be used to detect changes in consistency in pits, grooves, and fissures of teeth

Knowledge of dental anatomy is very important for interpretation.

Color changes may be observed during a clinical examination. Occlusal surfaces may show dark staining in fissures, pits, and grooves. Smooth surfaces may exhibit a chalky white spot or opacity. An interproximal ridge may appear discolored. Some teeth may exhibit a discolored area, cavitation, or have no visible changes.

Caries that occur between teeth may be difficult or impossible to detect clinically. Dental images play an important role in these situations.

Dental Image Examination

A carious area appears radiolucent (dark) because decreased density allows for greater penetration in the carious area.

• • The bite-wing image provides the dental professional with the greatest amount of diagnostic information
  • A periapical exposure taken with paralleling technique may also be used

Dental caries is the most frequently encountered radiolucent lesion on dental images.

Interpretation of Caries on Dental Images

The dental radiographer must be confident in the use of interpretation methods and must be able to identify factors that influence the radiographic interpretation of caries. Remember interpretation is NOT making a diagnosis.

Just as with mounting, knowledge of dental anatomy is very important when interpreting radiographs.

Dental images must be of diagnostic quality. Some examples of images failing to meet diagnostic quality would be improper horizontal angulation on a bite-wing image or errors in exposure with improper contrast and density.