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157 Cards in this Set

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What is a pathological process consisting o localized destruction of hard dental tissues by organic acids produced by the microbial deposits adhering to teeth
Dental Caries
Conventional Radiography is processed how
With film, using a dark room.
Digital radigraphy is processed how
Using sensors and plates, it saves time and is lower dosage.
A type of x-ray based diagnostic method that takes slices and eliminates super position
Tuned Aperture Computed Tomography (TACT)
Name three kinds of Diagnostic Methods based on X-rays
Conventional Radiography, Digital Radiography, and Tuned Aperture Computed Tomography (TACT)
X-ray energy creates an ___ ___ that is stored on the ___, which is measured and assigned a number from 0 (black) - 256 (white) according to the ___
electronic charge, sensor, intensity
The digital immage is viewed where ___ ___ within a few ____ of exposure
Computer monitor seconds
In what ways can digital images be enhanced thereby imporving diagnostic ability
1. Variation in contrast and density, 2 Variation in brightness, 3. zoom magnification, digital subtraction radiography
What is a technique that allows us to determine Quantitatie Changes in Radiographs. ie succeve series of images is taken over time and compared for differences
Digital Subtraction Radiography
In Digital Subtraction Radiography, Two images are digitazed and compared on a pixel by pixel basis. the resultant image shows ony teh changes that have occured and "___" thoses components of the image that are ___
Subtracts, Unchanged
Tuned-aperature computed tomography (TACT) is a method that constructs radigrapic ___ or ___ ___ through teeth
Radiographic Slices or cross sections
TACT slices allow us to detect ____
Radiolucencies
TACT slices can also be used to generated a 3D computer model of the teeth called a
Pseudohologram
What kind of radiograph enables dection of lesion that are clinically hidden (interporximal liesion) from a careful clinical visual examination?
Bitewing Radiograph (BW)
Bitewing Radiographs help estimate the ___ of the lesion, Note a lesion that is radiographtically confined to the inner enamel has progressed to the dentin
Depth
What kind of carries should one always look for in a BW radiograph?
Occlusal and Interproximal carries.
Dental carries can spread through what 3 parts of the tooth?
Enamel, Dentin , and Cementum
Radiographs show loss of sound tooth structure as ____ areas
Radiolucent (dark) areas
No Radiolucency =
R-0
radiolucency onfined to the outer half of the enamel =
R-1
Radiolucency extending into dentin; lesions spread less than half way through dentin
R-3
Radiolucency extending more than 1/2 way through denting to the pulp =
R-4
R-1 carries are also called
Incipient carries
A matt/chalky surface indicates an ___ ___
Active lesion
A brown shiny hard surface indicates an ___ ___
Arested Lesion
Lesions can become reactivated in which case part of it will be ___
Soft
What is the most prominent location for caries?
Occlusal surface
Occulsal Caries are more common in what 2 age groups and what location in their dentition?
Childen and adolescents in posterior teeth
What type of anatomy makes occlusal surfaces inherently more prone to caries?
Irregular pits and fissures
Occlusal caries form in the shape of an upside down triangle with the apex towards the ___ ____ of the tooth and the base toward the ___ ___ ___
Outer Surface, Dentin-Enamal Junction (DEJ)
Occlusal caries can not be seen radiographically until it reaches the ___
DEJ
Is a radiograph a reliable diagnostic tool for occlusal caries?
NO
Why can't early occlusal carries be dected radiographically?
In most cases not early radiographic evidence of enamel involvement exists because the lesion is in a pit or fissure surrounded by dense sound enamel.
Where do carious occlusal lesions spread
alsong the DEJ
Occlusal Caries may be seen as a ______ line along the DEJ
Radiolucent line
With advancement, Occlusal radiolucency spreads below the enamel and extends pulpally in a ____ Pattern
Spherical pattern
The margin between carious and non-carious dentin may be ___
Diffused
Lesions spread through dentin and can undermine enamel leading to
Cavitation upon masticatory forces. ie small lesion and then "over night" a massive crater
Occlusal radiographs are not effective untl incipient caries reach the ___
Dentin
In occlusal caries that have not reached the dentin, the only detectable radiographic change may be a __ __ __ under teh DEJ
fine gray shadow under the DEJ
What stage of occlusal caries is the first to induce detectable radiographic changes?
R-3, moderate occlusal caries, less than 1/2 way through the dentin.
A band of increased opacity between lesion and the pulp champer in dentin indicates
Reparative Secondary Dentin
What stage of occlusal caries is readioy oberved both clinically and radiographically?
R-4 Severe Occlusal Caries
Severe Occlusal Caries is characterized by what 3 features
1. Large holes or cavities in crowns, 2. Underlying dentin is carious, 3. Masticatory forces cause a collapse of occlusal surface
Incipient proximal Caries develops quickly or slowly
slowly
Incipient Proximal Caries takes how long to become clinically apparent
3-4 years
Incipient Proximal Caries occures where
On the outer surface of enamel between the contact point and the height of free ginginval margin
In what 3 ways is Incipient Proximal Caries Detactable
1. Loss of enamel ransparency, 2. Chalky-white apperance, 3. may be roughened or stained due to demineralization
Are early incipiet lesions visible on radiographs?
Incipient lesions may not be visible on radiographs because of small volume of tooth mineral lost
Early Incipient proximal caries are radiolucent and do not penetrate more than ___ of the enamel thickness
1/2
Incipient proximal caries that are RL are seen as what
a V-shaped RL area on the outer surface of the enamel with the base facing the outer surface and the apex pointing toward the DEJ
What does the radiographic dection of Proximal Caries depend on
It depends on the loss of enough mineralization to result in detectable change in radiographic density
What % demineralization must occur before proximal caries can be dected on a radiograph
30-40% demineralization
Can Incipient Caries (R-1) be arrested or reversed by remineralization?
yes
Restoration of Incipient Caries (R-1) is generally ____ ____
not recommended
What classification of caries involves more than half of the thickness of the enamel
Moderate Interproximal caries (R-2)
Moderate Interproximal caries (R-2) is seen radiographically as
a RL triangle or diffused RL or combination
Moderate Interproximal caries that 1. Invades the DEJ, 2. RL penetration through enamel, 3. Demineralization spreads at DEJ undermining enamel and extinds in dentin, 4. Does not spread more than 1/2 thickness of dentin would be classified as
R-3
R-4 Severe Proximal Caries would have what 3 characteristics
1. RL penetrates more than 1/2 the dentin and may reach pulp chamber, 2. Pulp exposure may not be identified froum radiographs alson, 3. masticatory forcs may cause a collapse
When can Occlusal enamel careis be detected from Radiographs
Only when into dentin, R-3 or R-4
Are Incipient Proximal Caries Slow or Fast to Develop
Slow
How long does it take for Incipient Proximal Caries to become apparent
3-4 years
Where do Incipient Proximal Caries occur
On the outer surfaceof enamel between teh contact point and the height of free gingival margin
What 3 findings charaterize Incipient Proximal Caries
1. Loss of enamel transparency, 2. Chalky-white appearance, 3. may be roughened or stained due to early demineralization
Are Incipient Proximal Caries always visible on radiographs?
No, Incipient Proximal Caries may not be visible on radiographs because of small volume of tooth mineral lost
Early Incipient Proximal Caries lesions are RL and do not penetrate more than ___ of the enamel thickness
1/2
Incipient Proximal Caries can be seen radiographically as a what shaped area on the outer surface of enamel with the base at eh tooth surface and the apex pointed towards the DEJ
V-shaped
What does the radiographic detection of proximal caries depend on?
Loss of enough mineralization to result in detectabl change in radiographic density
What % demineralization is required for Proximal caries to be detected on a radiograph
30-40% demineralization
Incipient Caries (R-1) can be arested or reversed by?
Remineralization
Restoration is generally not recommended for what type/stage of carries,
Incipient Caries (R-1)
Moderate Interproximal caries can be either ___ or ___ stage of caries
R-2 or R-3
What are 2 characteristics of R-2 Moderate Interproximal Caries
1. Involves more than 1/2 of the thickness of the enamel, 2. RL triange or diffused RL or combination
What are 3 characteristics of R-3 Moderate Interproximal Caries
1. Invades DEJ, 2. RL penetration through enamel, 3. Demineralization spreads at DEJ, undermining enamel and extends in dentin, 4. Does not spread more than 1/2 the thickness of dentin
What are 3 characteristics of R-4 Severe Interproximal Caries
1. Radiolucency penetrates more than 1/2 the dentin and may reach the pulp cahmber, 2. Pulp exposure may not be identified from radiographs alone, 3. Masticatory forces may cause a collapse
When can R-3 or R-4 Occlusal enamel caries be detected Radiographically?
Only when it extends into the dentin
When is it impossible to detect raiographically R-1 or R-2 interproximal enamel caries
If over 1/2 of the enamel is overlappied by adjacent surface
Facial/Lingual caries is radiographically distinguished by what 3 features?
1. Radiographically: "black hole" or dots, 2. Periphery of lesion is usually well demarcated, 3. Cerical caries is crescent shaped
Where does Cemental/Root/Radicular caries start
Near CEJ
The base of a Root caries lesion on the surface is determine by what
recession of the gingiva
A radiograph of a root caries lesion has what appearance
ill defined, saucer-shaped or scooped-out, discolored
Cemental Caries have what appearance and are located where
Active lesionns are soft or leathery, located along the cemento-enamel junction or next to gingival margins
Cemental Caries can be what color
brown or black and covered by plaque
Cemental Caries that have been arrested have what appearance
Arrested Lesions are hard, shiny, sometimes dark brown and often located at some distance from teh gingival marign.
Misdiagnosed root caries is termed ___ ___ ___
Cervical Burn Out
Cervical Burn Out is caused by what
The Area between the neck of the tooth and the root absorbs less x-rays
On a radiograph, Cervical Burn Out is seen where
It is seen as a RL at the neck of the tooth below the CEJ
Cervical Burn Out on posterior teeth appears how
RL triangular or wedge-shaped area on proximal cerival neck of teh tooth
Cervical Burn Out on Anterior teeth appears how
RL band across the cervical neck of teeth
Cervical Burn Out can be caused by what 2 factors
1. Greater density difference between the cervical neck of the tooth and the tissues below and above it. 2. Anatomical differences like CEJ, root configurations, and poor horizontal angulation
What steps need taken if Cervical Burn Out is observed on a radiograph?
No treatment is required, Often RL disappears if radiograph is retaken with an improved horizontal angulation
A New Lesion is also called a
Primary Lesion
A Recurrent Lession is also called a
Secondary Lesion
Secondary: recurrent Lesion develops where, indicated what, and is radiographically how easy to see
1. Develops at margins of/or in the vicinity ofo an existing restoration, 2. may indicated susceptibility to caries, poor oral hygine, deficient cavity preparation, a defective restoration, 3 .is Radiographically difficult to see in some situations ddue to existing restoration
Is the actual lesion depth greater or lesser than shown radiographcally
Lesser
How much demineralization is required before a lesion is radiographically detectible
30-40%
What 2 film properties affect the radiograph quality
1. density 2. contrast
Define desity and contrast
1. density - amount of blackness 2. contrast - differences in density
A Child new patient should posterior ___ radiographs if proxima contacts cannot be visualized or probed
BW
An Adolescent New Patient should have what radiographs
Combination of BW, PA, and Panoramic film
A New Patient Adult should have what radiographs
Combination fo BW, PA, and Panoramic film
A High risk caries child should have BW every ___ months or until no carious lesions are evident
6
A High risk caries Adolecent should have BW every ___ months or until no carious lesions are evident
6-12 months
A High risk caries Adult should have BW every ___ months or until no carious lesions are evident
12-18 months
A No risk caries child should have BW every ___ monthsif proximal contacts cannot be visualized or probed
12-24 months
A No risk caries adolecent should have BW every ___ months
18-36 months
A No risk caries adult should have BW every ___ months
24-36 months
Teeth must be ___ for clinical detection
Clean
What 2 functions does drying a tooth have?
1. Removes saliva that can obscure a lesion, 2. Can reveal a white spot (demineralization).
BW radiographs are used to detect what kinds of lesions?
INterproximal, occlusal, recurrent carious lesions.
Immediate past caries experience means?
Development of new lesions within a certain period of time
Progression of lesions means?
Continues progression or arrestion of know lesions.
Appearance of lesions can be described how - has 3 characteristics
1. Structure - shiny, matte, smooth, cavitatted, Consistancy - hard or soft tooth surface, 3. Color - white, yellow, brown, black
Locations of lesions (where can one have a lesion)-
Surfaces prone ot caries formation or sites not normally affected by caries
Presence of plaque/gingivitis (does a lesion always have to be covered by plaque and does there have to be gingivitis)-
1. A lesion can be covered or not covered by plaque. 2. There can be gingival inflamation near teh carious lesion or not.
What dental surfaces are most at risk for caries?
Occlusal fissures and exposed CEJ and root structure due to ression
If a tooth has a white spot, what can this indicate?
Initial evidence of a carious lesion
A zone of demineralization can _____ beyond an intact surface layer
extend
What surfaces can be affected by remineralization/deminerialization?
Enamel pits, fissures, smooth surfaces
In 5 progressive steps, what visual signs can be detected indicating caries
1. No or slight change in enamel translucency after drying for at least 5 sec, 2. On wet surface opacity is slighty visible and distictly visible after air drying, 3. Opacity or discoloration distinctly visible without air drying, 4. Localized enamel demineralization in opaque or discolored enamel. 5. Cavitation in enamel exposing the dentin
In 5 progressive steps, what are the histological steps for pit and fissure caries ie progressive depth stages
1. No enamel demineralization 2. Enamel demineralization limited to the outer half of the enamel layer 3. Demineralization involving between half of the enamel and the outer third of the dentin 4. Demineralization involving the middle third of the dentin 5. Demineralization involving the pulpal third of the dentin
Smooth surface lesions are the most ___ lesions
Visible
Smooth surface lesions are the most ___ to become ___ due to preventive treatment
likely, Arrested
Smooth surface lesions is visually indicated by what 2 things
1. White spot lesions close to gingival margin that has a matte appearance and plaque covered. 2. Cavitated, plaque covered lesions with/without exposed dentin. Soft dentin indicated infected dentin and active lesion
What does Soft dentin indicate?
Infected dentin and active lesion
If a tooth is covered in plaque and has gingival bleeding, can remineralization occur?
NO, must have clean tooth with healthy gingiva
Arrested Smooth Surface Lesions are what color, exposed and ___ plaque covered
Are Shiny white or brown lesions and NOT plaque covered
Arrested Smooth Surface Lesions may be ____ lesions that may be ___ ___ in color with ___ dentin and ___ plauqe covered
Caviated, dark brown, Hard dentin, not plaque covered
Arrested Smooth Surface Lesions - may be ___ from the gingival marigin
Away
Proximal lesions may be Arrested if there is no ____ seen on subsequent radiographs
Progression
Arrested Lesion are ___ caries risk following preventive treatment
Low
Multiple carious anterior and posterior teeth seen in a child is called
Early Childhood Caries and is caused by sleeping with a bottle filled with sugary substance or breast feeding at night without wiping off teeth
By age 50 ___ of the population will have at least one surface of root caries
Half will have root caries
The Initial Phase of Root Caries is categorized by
Ression, Abrasion, Aging, Periodontal conditions
Phase II Root Caries Begins where and has what clinical symptoms
Begins apical to the CEJ, and has few Clinical symptoms
Active Root Caries will be where and have what texture
1. Close to gingival margin and plaque covered 2. Soft or leathery lesion
Arrested Root Caries 1. will be where, 2. have what texture and 3. what color
1. Distance from gingival margin and not covered in plaque, 2. Hard consistency as surrounding tooth, 3. Color of lesion is not reliable in differentiating between active and arrested lesion
DIAGNOdent is what
A device for detecting caries using laser fluorescence
DIAGNOdent has a ___ wavelength that penetrates the tooth ___ mm
Fixed wavelength, Penetrated 1-2 mm
What property of teeth alow a DIAGNOdent to work and what does the DIAGNOdent measure
Teeth have fluorescence characteristics that change when caries is present. The laser measures the change in fluorescence qualities of the tooth
Is a DIAGNOdent 100 % accurate
No, it can give false positives and at present should be used as a supplementary method of caries detection/confirmation
Class 1 caries are found where 3 locations
In pits or Fissures 1. Occlusal surfaces of Premolars and molars, 2. Facial and lingual surfaces of molars, 3. Lingual surfaces of maxillary incisors
Class I caries should be examined how
1. Direct or indirect visual exploration 2. Radiographs are not useful
Class II Cavities are found where
In proximal surfacs of premolars
Class II caries can be examined early on by
Radiographs only
Class II moderate caries not broken through from porximal to occlusal can be examined
1. visual by color changes in tooth and loss of translucency, 2. Exploration from proximal
Class II extensive caries can be examined
By direct visual
Class III caries are found where
In proximal surfaces of incisors and canines that do not involve the incisal angle
Class III caries early examination can be dected how
By Radiographs or transillumination
Class III Moderate caries not broken through to the lingual or facial can be dected how
1. by visual tooth color change 2. Exploration 3. Radiograph
Class III Extensive caries can be dected how
Direct Visual
Class IV caries are found where
In Proximal surfaces of incisors or canines that involve the incisal angle
Class IV caries can be examined how
Visual or transillumination
Class V Caries occure where
In the cerical 1/3 of facial or lingual surfaces (not pit or fissure)
Class V Caries can be examined how
1. Direct visual: need dry surface, 2. Exploration to distinguish demineralization: whether rough or hare and unbroken (areas may be sensitive to touch)
Class VI caries are found where
On incisal edges or anterior teeth and cusp tips of posterior teeth
Class VI Caries can be examined how
Direct visual (may be discolored)