Evaluation of the Depth of Non-Cavitated Carious Lesions by Radiographs
Aims: To evaluate and compare the depths of white and brown spot, non-cavitated, carious lesions by radiographs.
Methods: Thirty white spot and 25 brown spot, non-cavitated carious lesions from proximal surfaces of extracted premolar and molar teeth were selected. The bucco-lingual dimension (size) of all lesions was measured using a vernier caliper. The teeth were radiographed. Three observers scored the lesions’ depths from the radiographs. The lesions’ depths in ground sections were used as the gold standard. The depths of the white and brown spot lesions were compared. The relationship between the depth and the sizes of both types of lesion were evaluated. The depths measured on the radiographs were compared to those of the gold standard.
Results: The white lesions were significantly deeper than the brown lesions. Radiographically, most of the brown lesions (72%) showed no radiolucency. Of the white lesions, 50% had lesion depths limited to enamel and 36.7% showed no radiolucency. The remainder had lesions reaching at least to the DEJ. However, the ground sections showed that 60% of the white lesions reached at least to the DEJ. There was a significant correlation between the radiographic depth and the lesions’ sizes in only the white lesions. Compared to the gold standard, the radiographic measurement underestimated the lesions’ depths, equally for both white and brown spot lesions.
Conclusions: For both radiographic and ground section examinations, white spot lesions were deeper than brown spot lesions. Therefore, they should be given more attention in disease prevention and treatment. Radiographs should be used as one of the aids for treatment planning of non-cavitated, carious, especially white, lesions.
1. Stahl J, Zandona AF. Rational and protocol for the treatment of non-cavitated smooth surface carious lesion. Gen Dent 2007; 55: 105-111.
2. Young DA. Managing caries in the 21st century: today’s terminology to treat yesterday’s disease. J Calif Dent Assoc 2006; 34: 367-370.
3. Wenzel A. Dental caries. In: White SC, Pharoah MJ eds: Oral Radiology Principles and Interpretaiton. 5ed., St. Louis: Mosby; 2004: 297-313.
4. Anusavice KJ. Treatment regimens in preventive and restorative dentistry. JADA 1995; 126: 727-740.
5. Pitts NB, Rimmer PA. An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. Caries Res 1992; 26: 146-152.
6. Christensen GJ. Initial carious lesions: When should they be restored? JADA 2000; 131: 1760-1762.
7. Gustafsson BE, Quensel CE, Lanke LS, et al. The Vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand 1954; 11: 232- 264.
8. Clark DC, Hann HJ, Williamson MF, Berkowitz J. Effects of lifelong consumption of fluoridated water or use of fluoride supplements on dental caries prevalence. Community Dent Oral Epidemiol 1995; 23: 20-24.
9. Ismail AI, Brodeur JM, Gagnon P, et al. Prevalence of non-cavitated and cavitated carious lesions in a random sample of 7-9 year-old schoolchildren in Montreal, Quebec. Community Dent Oral Epidemiol 1992; 20: 250-255.
10. Roeters FJ, Verdonschot EH, Bronkhorst EM, vanít Hof MA. Prediction of the need for bitewing radiography in detecting caries in the primary dentition. Community Dent Oral Epidemiol 1994; 22: 456-460.
11. Thylstrup A, Billie J, Qvist V. Radiographic and observed tissue changes in approximal carious lesions at the time of operative intervention. Caries Res 1986; 20: 75-84.
12. Bille J, Thylstrup A. Radiographic diagnosis of clinical tissue changes in relation to treatment of approximal carious lesions. Caries 1982; 16: 1-6.
13. Mejare I, Grondahl HG, Carlstedt K, Grever AC, Ottosson E. Accuracy at radiography and probing for the diagnosis of proximal caries. Scand J Dent Res 1985; 93: 178-184.
14. Kidd EA, Joyston-Bechal S, Smith MM. Staining of residual caries under freshly packed amalgam restorations exposed to tea/ chlorhexidine in vitro. Int Dent J 1990; 40: 219-224.
15. Verochana K, Prapayasatok S, Pramojanee S, Janhom A. White and brown spot carious lesions: how do they look in radiographs? The 5th Asian Congress of Oral and Maxillo-Facial Radiology. December 15-17, 2004, Bangkok, Thailand.
16. Kidd EAM, Mejare I, Nyvad B. Clinical and radiographic diagnosis. In: Fejerskov O and Kidd E, eds: Dental caries. The disease and its clinical management. Oxford: Munksgaard Blackwell; 2003: 118-128.
17. Lagerlof F, Oliveby A. Clinical implications: new strategies for caries prevention. In: Stookey GK., ed. Early detection of dental caries: Proceedings of the 1st Annual Indiana Conference, Indiana University School of Dentistry. Cincinnati: Sidney Printing Works; 1996: 297-322.
18. Janhom A, van Ginkel FC, van Amerongen JP, van der Stelt PF. Scanning resolution and the detection of approximal caries. Dentomaxillofac Radiol 2001; 30: 166-171.
19. Prapayasatok S, Janhom A, Verochana K, Pramojanee S. Digital camera resolution and proximal caries detection. Dentomaxillofac Radiol 2006; 35: 253-257.
20. Grondahl HG. Radiographic assessment of caries and caries progression. In: Anusavice KJ, ed. Quality evaluation of fental restorations: Criteria for placement and replacement: Proceedings of the International Symposium on Criteria for Place. Chicago: Quintessence Publishing; 1989: 151-167.
21. Shwartz M, Grondahl HG, Pliskin JS, Boffa J. A longitudinal analysis from bite-wing radiographs of the rate of progression of approximal carious lesions through human dental enamel. Arch Oral Biol 1984; 29: 529- 536.
22. Mejare I, Kallestal C, Stenlund H, Johansson H. Caries development from 11 to 22 years of age. A prospective radiographic study. Prevalence and distribution. Caries Res 1998; 32: 10-16.
23. Mejare I, Kallestal C, Stenlund H. Incidence and progression of approximal caries from 11 to 22 years of age in Sweden: a prospective radiographic study. Caries Res 1999; 33: 93- 100.
24. อรุณี ลายธีรพงษ์, สุภาภรณ์ จงวิศาล. การหยุดยั้งการลุกลามของรอยผุเริ่มแรกของฟลูออไรด์วานิชในเด็กก่อนวัยเรียน. ว. ทันต จุฬา 2543; 23: 101-110.
25. จิราภรณ์ แต้วีระพิชัย. สถานการณ์การใช้ฟลูออไรด์วานิชของทันตบุคลากรในสถานบริการทัตกรรมของรัฐระดับภูมิภาค. ว. ทันต 2551; 58: 1-8.