6- Bitewing Radiography

Question 1

Name 3 diagnostic methods for assessing the teeth and restorations?

Answer 1

1. History
2. Clinical examinations
3. Special tests

Question 2

Name 4 different types of radiographs?

Answer 2

1. bitewing
2. periapical
3. panoramic
4. cephalogram

Question 3

What is a bitewing radiograph?

Answer 3

A radiograph of the crowns of posterior teeth and their immediate supporting tissues

Question 4

What 3 things are bitewings used for?

Answer 4

1. Detection and diagnosis of dental caries
2. Assessment of current restorations
3. Assessment of periodontal attachment and bone loss
4. Assessment of calculus levels

Question 5

2 techniques of bitewings?

Answer 5

1. Freehand - very inaccurate, poor results

2. Film holder - more accurate positioning, fewer rejects (guides x-rays directly onto receptor)

Question 6

Radiograph intervals relative to risk?

Answer 6

High caries risk: every 6 months
Moderate: 12 months
Low: (kids: 12-18 months) adults 24 months

Question 7

What is the caries susceptible zone?

Answer 7

at/just below the contact point, stagnation area for plaque as hardest to clean

Question 8

How do caries look on radiograph?

Answer 8

Grey zones due to demineralisation

Question 9

How much demineralisation is needed for caries to show up?

Answer 9

Approximately 40%

Question 10

Approximal caries depth classification?

Answer 10

D1: Outer enamel
D2: Inner enamel
D3: Outer dentine
D4: Inner dentine 
D5: Pulpal Involvement

Question 11

Why in D1 and D2 just fluoride and OHI?

Answer 11

Enamel can remineralise

Question 12

What is the primary diagnostic method of occlusal caries?

Answer 12

Clinical examination

Question 13

At what stage can you usually see occlusal?

Answer 13

D3

Question 14

What is root surface caries?

Answer 14

Caries where the centre of lesion is below the enamel and well below the contact point

Question 15

What can root surface caries be misinterpreted as?

Answer 15

“cervical burnout”

Question 16

What can cause cervical burn out?

Answer 16

caused by natural radiolucency in the anatomy of the tooth as below the enamel there is less material for the x-rays to be absorbed

Question 17

How can you tell the difference between cervical burnout and caries?

Answer 17

Flat and uniform in colour, only present between bone surface and enamel

Question 18

Periodontal bone attachment?

Answer 18

0.5 - 1.9mm

Question 19

Why can we see restorations on radiographs?

Answer 19

due to their radiopacity?

Question 20

What does radiopacity depend on?

Answer 20

material: atomic number, density and thickness

Question 21

Highly radiopaque materials?

Answer 21

Gold, Amalgam

Question 22

Lower radiopaque materials?

Answer 22

Composites, glass ionomer

Question 23

What is recurrent caries?

Answer 23

Caries around the base of the restoration

Question 24

Process of recurrent caries

Answer 24

marginal seal around restoration broken -> plaque retention -> demineralisation of enamel

Question 25

Sequence of examining bitewing radiograph?

Answer 25

1. Check periodontal bone levels and calculus
2. Check proximal surfaces for caries (specifically at contact points)
   3, Check occlusal surfaces for caries -> D3