Radiology 101

The senior clerkship program at UMSOD allows D4 students to delve further into a specialty of their choice. Students devote a portion of their clinic time to this specialized program (the remaining clinic time is spent in the comprehensive treatment of patients in the regular program). The UMSOD radiology clerkship builds upon basic knowledge of intraoral and panoramic radiology, and develops proficiency in Cone Beam CT capture and interpretation. To help you answer the age-old question, “caries or burnout?,” I interviewed former radiology clerk, Dr. Brian Calhoon. A 2020 graduate, Brian now takes perfect radiographs (😜) in his General Practice Residency at Christiana Care Health System in Wilmington, DE.

1. What did your radiology clerkship entail?

The radiology clerkship is a great opportunity for those interested in learning more about CBCT’s and how to read them. The more you put into the clerkship, the more you’ll get out of it. Ultimately you would be able to write up a radiology report to identify any significant radiographic findings and interpretations.

2. How can dental students differentiate between caries and “burn out?”

Radiographic burnout occurs at the CEJ and can often get confused for caries. In order to improve your diagnostic abilities, you have to take into consideration a few factors. Typically, interproximal caries originate right below the contact point. Unless the person has periodontal disease that has caused bone loss/recession allowing for decay to form more apical, a radiolucency at the CEJ typically represents burnout. You could also take the overall oral health of the patient into consideration. A person with very good oral hygiene and no other signs of decay is unlikely to have a large lesion at the CEJ. Lastly, make sure to look at any other radiographs of the tooth in question at different angles to see if the radiolucency is still apparent.

3. What are the top radiographic pathologies that dental students should be able to diagnose?

I know this is going to be pretty obvious but…caries! Get really good at catching cavities early so they can be treated appropriately. It’s one of the most common issues we deal with every day and proficiency in your diagnostic abilities will benefit your patients greatly. Don’t forget to use a combination of both radiographic and clinical examination to help with your diagnosis.

4. How can students take better radiographs (prevent overlap, cone cuts, etc.)?

One of the things that always helped me take better radiographs was mentally drawing a straight line coming out of the x-ray unit. Ideally this line would intersect the sensor perfectly perpendicular angle and pass through the area that you are trying to capture. Always assess your patient clinically first before going straight for that capture button. Sometimes you need to get a bit creative in order to keep the sensor in the correct orientation. Don’t be afraid to have the patient help you by having them adjust their bite, moving their head, or helping to hold the XCP in place. Also, recognize that sometimes the “perfect” radiograph is impossible whether it be because of a patient’s anatomy, gag reflex, or other extenuating circumstance.

5. What are the pros and cons of CBCT?

One of the greatest things about CBCT’s are the fact that you get an accurate 3D representation of someone’s anatomy. This is very useful in areas where knowing all three dimensions are important such as implant placement. I am of the option that CBCT’s should be standard of care before any implants. However, with more power comes more responsibility. If you are exposing someone to a CBCT you better be proficient in your diagnostic capabilities as you are responsible for reading the whole scan. If you don’t feel confident or have some doubts, it is always a good idea to have the CBCT sent to a specialist for interpretation.

6. Any other radiology tips?

Make sure to know your anatomy! Maybe that is a PARL on #28 or maybe its just the mental foramen . Knowing your anatomy can help you be more accurate in diagnosing any abnormalities by recognizing structures that should and shouldn’t be there. Keep an eye out for any asymmetries too! You might make the difference in a patient’s life by catching a malignancy before its too late.

To brush up on anatomy, take a peek at this PPT from UMSOD:

How do you distinguish between caries and burnout? Any tips for taking the perfect PA? Comment below!


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