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Proper film mounting and viewing techniques are essential in the interpretation of dental radiographs, especially in the evaluation of dental caries. . All films must be properly mounted in opaque film mounts prior to interpretation. Mounted films should be viewed in a room with subdued lighting that is free of distractions.

An illuminator or viewbox is required to accurately view radiographs and assist in the interpretation of images.

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If the screen of the viewbox is not completely covered by the mounted radiographs, the harsh light around the mounted films must be masked to reduce glare and intensify the detail and contrast of the radiographic images.

The use of a pocket-sized magnifying glass is helpful in evaluating the radiographic appearance of dental caries and can be used to detect slight changes in density and contrast present in radiographic images.

Dental radiographs should be viewed with the patient present.

F A C TO RS INF L UE NC ING C A RIE S INTE RPRE TA TIO N There are a number of factors that can influence the radiographic interpretation of dental caries. Radiographs must be of diagnostic quality in order to evaluate dental
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caries. . Errors in technique may result in non-diagnostic films. For example, a bite-wing film that is used to detect dental caries must be free of overlapped contacts. Improper horizontal angulation causes overlapped contact areas (see red arrows) and makes it impossible to interpret the interproximal regions for dental caries. Errors in exposure may also result in non-diagnostic films. For example, a dental radiograph used to detect dental caries must exhibit proper contrast and density. Incorrect exposure factors result in films that are too dark or too light and are useless in the detection of caries.

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A number of radiolucencies that involve the crown and roots of teeth are seen on a dental radiograph and may be confused with dental caries. Restorative materials, abrasion, attrition and cervical burnout may all resemble dental caries on a radiograph. The dental professional must remember that the final diagnosis of caries is made only after the clinical and radiographic findings are corroborated. Both the clinical examination and interpretation of radiographs are mutually contributory aids in making
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the diagnosis of dental caries. RESTORATIVE MATERIALS

Restorative materials, such as composites, silicates and acrylics, may appear radiolucent and resemble dental caries on a radiograph. The appearance of an anterior cavity preparation restored with these materials differs from the appearance of interproximal caries and can be identified by the well-defined, smooth outline (see red arows). In addition, a careful clinical exam helps the dental professional determine the difference between a restorative material and dental caries.

ABRASION

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Abrasion refers to the wearing away of tooth structure from the friction of a foreign object. The surface of the tooth affected depends on the causative factor. The most frequent type of abrasion is caused by tooth brushing and is seen at the cervical margin of the teeth. Tooth brush abrasion affects the root surface of a tooth and may be confused with root surface caries. On a dental radiograph, tooth brush abrasion appears as a well-defined horizontal radiolucency along the cervical region of a tooth (see red arrows). Clinically, the areas affected by abrasion appear as hard, highly polished defects in dentin and should not be confused with root caries that appears brown and leathery. ATTRITION

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Attrition, or the mechanical wearing down of teeth, may be mistaken for dental caries on a radiograph. Attrition may be seen on the incisal or occlusal surfaces of deciduous or permanent teeth. When the incisal or occlusal enamel is worn away, the underlying dentin wears away rapidly, and shallow concavities may form (see red arrows). These concavities may resemble occlusal or incisal caries on a dental radiograph. Clinical examination enables the dental professional to distinguish attrition from caries.

CERVICAL BURNOUT Cervical burnout, a radiolucent artifact seen on dental radiographs, may also be confused with dental caries. Cervical burnout appears as a collar or wedge-shaped radiolucency on the mesial and distal root surfaces near the CEJ of a tooth (see red arrows). When seen as a radiolucent collar, cervical burnout may be confused with root caries. This radiolucent artifact is seen because of the difference in densities of adjacent
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tissues. . The tissue density at the cervical region of the tooth is less dense than the regions above and below it; above the neck of the tooth, enamel covers the crown, and below the neck of the tooth, bone covers the roots. Cervical burnout can also appear as an ill-defined wedge-shaped radiolucency on the mesial or distal root surfaces near the CEJ of posterior teeth. This wedge-shaped radiolucency is seen because of the anatomic root concavities found in this area. Next Page

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