'Selection criteria for dental radiography'.
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Biomedical subjects
Publications and source records attributed to E A Kidd.
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This 'personal view' makes recommendations on the use of the bitewing radiograph in the diagnosis of dental caries on the basis of published evidence about the disease and available diagnostic methods. It suggests that posterior bitewing radiographs are required for all new patients if the approximal surfaces of the teeth cannot be examined directly. At this initial visit, an assessment of the caries risk of the individual patient should be made. Subsequent radiographic recall intervals are suggested, which are determined on the basis of this risk assessment. It should be appreciated that risk status may change over time and that, in the future, an individual's radiographic recall interval may have to be changed.
This article describes some of the factors to be considered by the practitioner when prescribing bitewing radiographs in the diagnosis and management of dental caries and draws on the literature of a number of disciplines including restorative dentistry, cariology, epidemiology and oral radiology. It seems appropriate to re-assess current practice in the light of information on changes in the disease of dental caries, its behaviour and the way this behaviour may vary in high and low caries risk groups. The diagnostic potential of the bitewing examination appears, at present, to be unrivalled, but other diagnostic methods, such as fibreoptic transillumination and tooth separation, must also be considered. Some methods to minimize radiation doses and increase diagnostic yield are discussed. Current knowledge of prescribing patterns is reviewed and areas of ignorance are mentioned as findings from future research in these areas may influence decisions about when to use and re-use bitewing radiographs.
Many clinicians take for granted that occlusal caries which is just visible as a cavity is extended (deep) into the dentine. This study was aimed at quantifying this opinion. The study was carried out with 60 molars containing small but visible occlusal cavities. After taking bite-wing radiographs the crowns were separated from the roots and embedded. 700-microns sections were cut and glued on plastic sheets. X-ray pictures were taken of the sections which were scored by independent examiners. The bite-wings provided inaccurate estimates of the extent of caries. Radiographs of the sections revealed that about 25% of the molars had caries which reached just to the dentino-enamel junction, while the remaining 75% showed caries extending far into the dentine.
The prevalence of clinically undetected occlusal dentine caries was determined in a group of adolescents living on the Isle of Wight by comparing data from clinical and radiographic examinations carried out in 1987. 6.3% of maxillary molars and 12.9% of mandibular molars which had been designated as clinically sound showed dentine caries on radiographs. Comparison of the radiographic data from 1975 and 1987 showed that there were more sound and fewer filled occlusal surfaces in 1987, but more primary occlusal caries. Approximately 50% of subjects examined in both 1975 and 1987 had at least one molar tooth with primary and/or secondary caries in dentine on radiograph.
This paper reviews secondary caries which is the major reason for failure of restorations and therefore worthy of attention if operative dentistry is to be cost effective. The basic premise of the review is that the secondary caries process is difficult to diagnose and cannot be permanently treated away by operative management. Preventive therapy, dependent on the patients' self-care, is essential. However, the quality of the restorative material and the skill with which it is handled are also relevant to the prevention of further failure.
The purpose of this study was to examine histologically teeth containing 27 tooth-coloured restorations with both stained and unstained margins for comparison of their caries status. Histological examination of 56 cavity margins showed that early caries lesions were present adjacent to many stained and unstained margins, but were more likely to be present in the outer enamel and the enamel of the cavity wall where the margin was stained. Thus, the development of staining at the margin of the restoration is likely to indicate caries and the appropriate preventive measures should be instituted.
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Chlorhexidine has a role in the management of patients with a high level of disease, but it is not a universal panacea for caries control. This paper reviews the antibacterial activity and mode of action of this antiseptic and presents the evidence supporting its use in caries control. Current clinical applications are suggested and the methods of application described.
The aim of this paper was to re-assess the available literature examining the value of the bitewing radiograph in the diagnosis of approximal caries and to compare the relative values of radiographic and clinical examinations. To this end, results from 29 research studies have been re-presented and tabulated. These results show that the use of the bitewing radiograph is essential if much approximal caries is not to be missed. It is particularly important in the detection of the small lesion which may be managed preventively rather than operatively. Although there is a proper need to ensure that radiographic exposures are minimised, the evidence suggests that both clinicians and epidemiologists must balance this need with the ethical issues associated with failing to employ an established diagnostic aid.
The purpose of this study was to examine histologically occlusal amalgam restorations with both defective and sound margins for comparison of their caries status. Thirty extracted teeth with occlusal amalgam restorations were sectioned so that a ditched and a clinically sound margin could be examined on the same tooth in the mouth. Histological examination showed a low prevalence of caries lesions in the outer enamel. However, lesions were present in the enamel of the cavity wall in 54% of specimens, whether the margin was defective or sound. If the results of this study are applicable to all occlusal amalgams with defective margins, it would appear that a defective margin alone is not an indication that a restoration needs to be replaced.
Secondary caries is the most common reason given by dentists for the replacement of restorations, and yet this is a diagnosis that is difficult to make with confidence. This paper attempts to define some of the problems in the diagnosis of caries in restored teeth. The histology of the secondary carious lesion shows that it may be considered in two parts: an outer lesion adjacent to the filling, and a wall lesion which will occur only if there is leakage between the filling and the tooth. The specific diagnostic difficulties addressed are the difficulty of seeing this wall lesion, whether a defective margin indicates secondary caries, and the difficulties of differentiating secondary from residual caries and active from arrested disease. Since further research is needed to solve many of these problems, the paper ends by discussing the consequences of these difficulties for clinicians, epidemiologists, teachers, and research workers.
Discoloration around restorations may lead practitioners to suspect recurrent caries. Dentists, using conventional optical and tactile criteria, often fail to render the enamel-dentine junction completely caries-free during cavity preparation. The aim of the present laboratory study was to test the hypothesis that such residual caries could take up stain from tea and hence affect clinical judgement on the presence of recurrent disease. Cavities were prepared in freshly extracted carious teeth and restored with amalgam. Specimens were then temperature cycled in tea and chlorhexidine or in tea alone to encourage leakage. Subsequent removal of restorations showed staining of parts of the enamel-dentine junctions and histological examination showed these stained areas to correspond to areas of demineralization. Similarly prepared caries-free teeth showed no such staining. Thus residual caries in teeth with leaking restorations can, in the laboratory, take up stain. If this were to happen in vivo, stained residual caries could subsequently be misdiagnosed as recurrent caries.
The aim of this study was to compare the conventional visual and tactile method of detecting carious dentine during cavity preparation using a mirror, probe and excavator with a visual method enhanced by a dye. The dye, 1% acid red in propylene glycol, was used on 100 cavities prepared by dental students and passed as clinically satisfactory by their teachers. Results showed dye stain at the enamel-dentine junction in 57 cavities (57%) which had been assessed as caries-free in this area using conventional visual and tactile means. Subsequent laboratory work on extracted carious teeth confirmed histologically that the dye stains demineralised dentine. If clinicians consider it important to render the enamel-dentine junction caries-free, it might be prudent to use the dye as an aid to diagnosis in this area.
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