Dental X-rays - How to Read and Report | Easy Acronym - CREPS

Summary

In this video, Zoh, a foundation dentist in London, provides a detailed guide on how to interpret dental radiographs, focusing on bitewings and periapicals. He explains the key steps for analyzing radiographs, including assessing enamel, detecting cavities, and evaluating existing restorations. Zoh emphasizes the importance of understanding peripheral tissues like the periodontal ligament and lamina dura when interpreting periapicals. The video also offers tips on how to report and present radiographs clearly and effectively, introducing the acronym CREPS (Caries, Restorative, Endodontics, Periapical, and Structures) to aid in structured reporting.

Takeaways

• 😀 Bitewing radiographs are primarily used to detect cavities, monitor their progression, and assess existing restorations like overhangs or secondary caries.
• 😀 Radiographs like bitewings are not ideal for diagnosing periodontal disease due to the inability to visualize the full root length and bone loss percentage.
• 😀 The frequency of bitewing radiographs should depend on the patient's risk level, with higher-risk patients requiring shorter intervals between x-rays.
• 😀 When analyzing bitewing radiographs, start from the distal of the last standing tooth, working through to the canine on both upper and lower arches to ensure no teeth are overlooked.
• 😀 Key steps in analyzing a bitewing include tracing the enamel outline, checking for radiolucencies (like cavities), and differentiating between true caries and artifacts like cervical burnout.
• 😀 Cervical burnout is a common artifact at the cervical margin of the teeth and can be mistaken for cavities. Features like triangular shape and location help distinguish burnout from true caries.
• 😀 It's important to differentiate between various types of caries, including root, dentin, and occlusal caries, and to adjust radiograph contrast for clearer visualization.
• 😀 Existing restorations, such as overcontoured fillings, marginal fits, and overhangs, should be checked for problems, as these can trap plaque and lead to secondary caries.
• 😀 Pulp analysis involves checking for changes in pulp chamber size or the presence of pulp stones, which could affect endodontic treatment decisions.
• 😀 Periapical (PA) radiographs are more suitable for assessing peripheral tissues like the periodontal ligament (PDL), lamina dura, and surrounding bone for conditions such as bone resorption and inflammatory responses.
• 😀 When reporting radiographs, use precise terminology. Refer to them as radiographs, not x-rays, and avoid diagnosing conditions directly from radiographs; instead, describe radiolucencies and their implications.

Q & A

Why are bitewings taken in dental radiography?

Bitewings are primarily taken to detect caries, monitor the progression of caries, and assess existing restorations, such as overhangs on amalgams or secondary caries.

What is the limitation of using bitewings to assess bone levels?

While bitewings can give some indication of bone levels, they are not sufficient for a full periodontal diagnosis, as they do not show the full length of the roots, which are necessary for assessing bone loss percentage.

How often should bitewings be taken according to FGDP guidelines?

The frequency of taking bitewings depends on the patient's risk level. The higher the risk, the shorter the interval between radiographs. Bitewings should be repeated until no new or active lesions are present, and the patient has entered a different risk category.

What is the correct order for analyzing a bitewing radiograph?

The recommended order is to start at the distal aspect of the last standing tooth on the upper side, work through to the canine, then analyze the lower teeth in the same manner, ensuring that no part of the radiograph is missed.

What is cervical burnout, and how can it be differentiated from caries?

Cervical burnout is a radiolucency at the cervical margin of teeth caused by less tissue for the X-ray beam to pass through. It can be mistaken for caries, but cervical burnout is demarcated between the enamel cap and alveolar bone, while caries usually extend above and under the enamel.

What are the key things to check when analyzing root and dentin caries on a radiograph?

When analyzing root and dentin caries, look for radiolucency indicating root caries, especially in areas like the lower right seven and upper right five. Adjusting the contrast in digital X-rays can enhance visibility of occlusal caries.

How can overhanging restorations affect a patient's oral health?

Overhanging restorations, like those seen in amalgams, can trap plaque, potentially leading to secondary caries and other oral health issues.

What should you look for when checking the pulp on a radiograph?

When checking the pulp, observe the size of the pulp chamber and look for any pulp stones, which could affect endodontic treatment. Pulp stones are common in patients who grind their teeth (bruxism).

What is the primary purpose of periapical radiographs?

Periapical radiographs are used to detect apical pathologies, assess bone levels for periodontal disease, evaluate root morphology before extractions or root canal treatments, and assess heavily restored teeth or implants.

What are the three key features to focus on when analyzing periapical radiographs?

When analyzing periapical radiographs, focus on the periodontal ligament (PDL) space, the lamina dura, and the surrounding bone. Changes in these features can indicate disease or inflammation.

What is the CREPS acronym, and how is it used in radiographic reporting?

The CREPS acronym is a systematic approach to reporting radiographs: C for caries, R for restorations, E for endodontics, P for periapical, and S for structures. This helps ensure that all important aspects of a radiograph are covered during reporting and presentation.