What is the first-line imaging modality for the initial assessment of suspected caries at the occlusal surface in a patient with good radiographic exposure?

• A. Periapical radiographs
• B. Bitewing radiographs
• C. Occlusal radiographs
• D. Panoramic radiographs

Answer: (B)

Focusing on the crowns of the posterior teeth to detect early demineralization at the chewing surfaces is most effectively done with bitewing radiographs. When radiographic exposure is good, bitewings provide a high-resolution view of the enamel-dentin interface at pits and fissures across multiple teeth in one image, making it the most reliable first check for occlusal caries and early lesions that could extend beneath the occlusal enamel.

Periapical views target the tooth apex and surrounding bone, so they don’t efficiently screen multiple posterior teeth for early occlusal caries. Occlusal radiographs can show surface details of the chewing surface but have limited sensitivity for small caries and aren’t ideal for screening across an arch. Panoramic images cover a broad area but sacrifice resolution and accuracy for detecting subtle occlusal caries.

So, bitewing radiographs are the best initial imaging choice for suspected occlusal caries when exposure is good.