Occlusal caries lesions (which develop on surfaces that contact an opposing surface of a tooth in the opposing jaw) are difficult to diagnose by visual examination only. Using bitewing radiography raises the sensitivity of the diagnosis if obvious dentin caries activity is to be detected, but can be inaccurate if diagnosing enamel occlusal caries activity. Visual–tactile examination alone also fails to detect a number of occlusal and approximal caries lesions in deciduous teeth in children. Complementing the clinical examination with bitewing radiography has also been found to increase the sensitivity of detecting caries lesions in these teeth. Another way in which bitewing radiography complements the visual–tactile examination is in the diagnosis of recurrent caries lesions. A radiolucent area typically indicates that residual carious tissue was left behind when the restoration was placed.2
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