of the enamel and dentine carious lesions present, the clinician needs to be helped by
diagnostic aids. The most commonly used of these are radiographs. The views which
are of value for caries diagnosis are:
- bitewings,
- orthopantomogram (OPT),
- bimolars,
- periapicals.
Bitewings are the first choice view for caries diagnosis. These provide information on
both occlusal dentine caries and approximal enamel and dentine caries. OPTs can
detect the presence of an occlusal dentine carious lesion with a high degree of
accuracy. OPTs have much less value in the detection of approximal lesions.
Bimolars are not as useful a view as bitewings because there is often overlap of
structures. However, they are of use in the pre-cooperative child who will not cope
with bitewings or an OPT. Periapicals are as accurate as bitewings for caries diagnosis
but obviously less information is available on any one film.
As with the visual examination it is vital that the radiographs are viewed in a
systematic way with appropriate illumination and ideal magnification.
Although not all children will tolerate them, bitewing radiographs should be
considered for all children from the age of 4 years and above who are at risk of caries.
The clinician should ask the question 'Why not take bitewings?' rather than 'Why take
bitewings?'
The decision to take and the frequency of further radiographic examinations needs to
be based on a thorough carious-risk assessment, the dentist having to balance the
benefits of the additional diagnostic yield with the risks of exposure to ionizing
radiation. Current guidelines from the Faculty of General Dental Practitioners UK
(1998) suggest annually for the carious-active child and biennially for the child with
controlled caries.
An interesting clinical phenomenon which may help the clinician decide if
radiographs are warranted is the presence of a bleeding papilla, this suggesting the
presence of an approximal cavity. This occurs because the cavity will be full of
plaque, which together with driving the carious process on will cause gingivitis and
thus the bleeding papilla.
Other diagnostic aids which may assist with approximal caries diagnosis include
fibre-optic transillumination (FOTI) and temporary tooth separation (235HFig. 6.10). FOTI
consists of the placement of a 0.5 mm light source in the embrasure. If a carious
lesion is present it will show as a dark shadow. Some studies have suggested that
FOTI is as accurate as radiographs but the situation is confused by other studies which
question the benefit of FOTI. Certainly if it is used FOTI provides the clinician with
more information to base a decision on.
Temporary tooth separation consists of the placement of an orthodontic elastameric
separator between the teeth (236HFig. 6.11 (a) and b)). The patient returns after 3-4 days,