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PubMed1992

The prescription and timing of bitewing radiography in the diagnosis and management of dental caries: contemporary recommendations.

This 'personal view' makes recommendations on the use of the bitewing radiograph in the diagnosis of dental caries on the basis of published evidence about the disease and available diagnostic methods. It suggests that posterior bitewing radiographs are required for all new patients if the approximal surfaces of the teeth cannot be examined directly. At this initial visit, an assessment of the caries risk of the individual patient should be made. Subsequent radiographic recall intervals are suggested, which are determined on the basis of this risk assessment. It should be appreciated that risk status may change over time and that, in the future, an individual's radiographic recall interval may have to be changed.

Adolescent↗
PubMedDate not supplied

The sensitivity and specificity of clinical assessment compared with bitewing radiography for detection of occlusal dentin caries.

PURPOSE: This prospective, cross-sectional study examined the sensitivity and specificity of clinical assessment compared to bitewing radiographs in the detection of occlusal dentin caries in permanent molars. METHODS: Subjects were 481 children aged 5-12 years from a school-based dental clinic. Occlusal surfaces of 1929, sealed and unsealed first and second permanent molars were examined clinically and scored using specific criteria. Teeth with any type of restorations or proximal caries, including preventive resin restorations, were excluded from the study. Bitewing radiographs were exposed within 4 weeks of clinical examination and were assessed for dentin radiolucencies beneath the occlusal surface. The results of the clinical examinations were correlated with those of bitewing radiographs. Information provided by the parents on history forms, including systemic fluoride exposure, was also noted. RESULTS: Of the 1833 teeth scored as clinically sound in the study, only 72 (4%) demonstrated a dentin radiolucency on bitewings, and 1761 (96%) were scored as sound. The sensitivity of the clinical examination was determined to be 0.96. In the teeth clinically scored as showing dentin caries, only 56/96 (58%) were found to have dentin radiolucencies on the radiographs. The specificity of the technique was determined to be 0.58. A positive history of a medical condition, or fluoride exposure, in the forms of toothpaste use, or water fluoridation did not affect the examination results. CONCLUSIONS: Clinical examination of cleaned and dried, sealed, and unsealed teeth has a sensitivity of 0.96 and a specificity of 0.58 in the detection of dentin radiolucencies in bitewing radiographs. Dentin radiolucencies beneath clinically sound occlusal surfaces are not significantly associated with gender, medical conditions or fluoride.

Cariostatic Agents↗
PubMed1989

Comparison between panoramic and posterior bitewing radiography in the diagnosis of periodontal bone loss.

A study is reported comparing the diagnostic yield of panoramic and posterior bitewing radiographs when used to image periodontal bone disease. It is concluded that there is a high concordance between the findings from the two types of radiographs but that the concordance varies with the degree of bone loss and tooth type. Consequently when panoramic radiography is used in clinical practice, the examination should be supplemented by intraoral radiographs in regions when image quality is poor in the panoramic image and where there are structures of special interest.

Adult↗
PubMed1983

Monitoring of caries progression in permanent and primary posterior approximal enamel by bitewing radiography.

The work which has monitored caries progression in posterior approximal enamel surfaces by reference to the size of radiolucency seen on bitewing radiographs is reviewed. There are wide variations in the degree of standardisation achieved, in the composition of the study groups and in the duration of the studies. There is a paucity of information relating to adults, the elderly, groups with low caries prevalence, and fluoridated communities. The results indicate that for the majority approximal caries progresses slowly, and large numbers of lesions remain unchanged for long periods. The available results are compared using the mathematical model of a negative exponential. The 'mean' time during which a lesion remains radiographically confined to the enamel is of the order of 3-4 yr, although in caries active individuals much shorter times are reported. Some clinical implications are suggested and the need for further research using comparable methods is stressed.

Adolescent↗
PubMedDate not supplied

In vitro study of laser diode 655 nm diagnosis of occlusal caries.

The aim of this in vitro study was to evaluate the performance of a new laser method (DIAGNOdent, KaVo) by comparing it to the visual inspection, conventional bitewing radiography and digital bitewing radiography. Fifty fresh permanent teeth with clinically sound or suspicious fissures were selected. The teeth were submitted to the diagnostic tests by 2 examiners independently after calibration. The laser examination was repeated to assess the reproducibility. The teeth were sectioned right in the spot that showed the highest value by the laser device. Histological examination of sections (40x magnification) served as gold standard. The results showed that: 1) the intra and interobserver agreement for the DIAGNOdent was excellent (values over 0.87); 2) the sensitivity, specificity and predictive values were very high; 3) and the Spearman correlation coefficient of DIAGNOdent was the best one (R = 0.81), followed by visual inspection (R = 0.68).

Dental Caries↗
PubMed1998

Occlusal caries diagnosis: an in vitro histological validation of the Electronic Caries Monitor (ECM) and other methods.

OBJECTIVES: The aim of this in vitro study was to validate the use of the Electronic Caries Monitor (ECM) for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and to compare it with visual examination, fibre-optic transillumination, conventional and digital bitewing radiography. METHODS: One-hundred and three extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Thirty teeth were re-examined with each system to assess repeatability. Each tooth was then serially sectioned and examined histologically for occlusal caries. RESULTS: The occlusal surfaces of 25 teeth had caries in enamel and 37 had dentinal carious lesions. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions (cut-off = 0.391) and 0.65 and 0.73 for enamel lesions (cut-off = 0.501). The weighted kappa value for repeatability of the ECM was 0.68. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively. CONCLUSION: The ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth.

Bicuspid↗
PubMed1998

A logistic regression model for analyzing the relation between dentists' attitudes, behavior, and knowledge in oral radiology.

The aim was to study the relation between risk attitude and knowledge in technical, patient-oriented, and organizationally related behavior within oral radiology. A questionnaire was mailed to 2000 randomly selected dentists listed in the register of the Swedish Dental Society, with a response rate of 69.3%. Regression analysis was used for analyzing the effects of the independent variables knowledge, risk attitude, continuing education in oral radiology, counties with specialists in oral radiology, type of practice, work experience, and sex on three categories of dependent variables: 1) technical behaviors: type of film, type of collimator, dose level, frequency of change of chemicals; 2) patient-oriented behaviors: use of patient protection barriers, strict indications for performing full-mouth X-ray examinations and bitewing radiography on new patients and recall patients; and 3) organizationally related behaviors: delegation of X-ray examinations to dental auxiliaries, influence on choice of collimator, influence on choice of film. Knowledge and education had strong direct effects for most of the dependent variables. The technical behaviors were mainly influenced by knowledge, education, and risk attitude, while organizationally related behaviors were influenced by type of practice and sex. The patient-oriented behaviors were influenced by a number of independent variables, such as education, type of practice, work experience, and sex. The present results indicate that both knowledge and the organizational context of dentists influence work.

Adult↗
PubMedDate not supplied

Computer-automated caries detection in digital bitewings: consistency of a program and its influence on observer agreement.

The aim of this study was to evaluate a decision-support, caries detection program and its influence on observer agreement in caries diagnosis. 130 patients were examined by digital bitewing radiography (RVG XL sensor, Trophy Radiologie Inc.). Fifty-four approximal surfaces (27 in premolars and 27 in molars) were selected by the author: 24 surfaces (9 in molars and 15 in premolars) scored as sound, 16 surfaces (9 in molars and 7 in premolars) scored as carious in enamel, and 14 surfaces (9 in molars and 5 in premolars) scored as carious in dentine. The Logicon Caries Detector (LCD) program (Logicon Inc., USA) was assessed by repeating the automated analysis ten times for each surface. The two most varying outcomes for lesion probability (Lp(min) and Lp(max)) were saved. Five observers scored the 54 surfaces independently as sound, caries in enamel or caries in dentine before and after the use of LCD. In more than one third of all surfaces the program indicated different lesion probability, from sound at Lp(min) to the presence of a carious lesion at Lp(max). The 5 observers changed their caries score after the use of LCD in a total of 31 surfaces (only 2 of these were in the same surface). Mean kappa value for inter-observer agreement for caries scores before the use of LCD was 0.47 (range 0. 39-0.61) and after LCD 0.48 (range 0.37-0.69). It was concluded that the automated caries detection program was not very consistent and provided different opinions on the caries status in a surface. Inter-observer agreement in caries diagnosis did not improve using the program.

Decision Support Systems, Clinical↗
PubMed1999

Causes of excessive bitewing exposure: results of a survey regarding radiographic equipment in New York.

OBJECTIVE: The purpose of this study was to identify the causes of excessive exposure in those dental practices that were found to use exceptionably high levels of radiation in bitewing radiography. STUDY DESIGN: Using the parameters of the Dental Exposure Normalization Technique survey, certified radiation equipment safety officers conducted on-site inspections of 186 intraoral x-ray machines in 77 dental facilities. RESULTS: In 23 facilities, the safety officers identified 43 units (23.1%) that delivered entrance exposures greater than 10% in excess of the upper limit of recommended exposures. For each of 27 (63%) of these units, the cause of the elevated exposure was clearly identifiable. CONCLUSIONS: The factors contributing to increased exposure, listed from most frequent to least frequent, were as follows: improper processing, kilovoltage miscalibration, use of D-speed techniques with E-speed film, use of newly installed units with default timer settings that were too high, exposure timer failure, and insufficient half-value layer. Only 18% of the facilities surveyed reported using E-speed film.

Child↗
PubMed1993

Visual and radiographic diagnosis of occlusal caries in first permanent molars and in second primary molars.

Diagnosis of early occlusal caries has proved more difficult than that affecting smooth or approximal surfaces. With time, this type of lesion has come to form a greater proportion of caries as a whole and its accurate diagnosis is consequently becoming more important. The most widely used methods of diagnosis are visual inspection and bitewing radiography but the value of both of these for occlusal caries has been questioned. The aim of this study was to investigate the validity of diagnosis using each of these two methods in extracted teeth. A total of 100 first permanent molars and 100 second primary molars were used and teeth and sites with questionable or borderline caries were selected for examination. The condition of the tooth on section was used to validate. In these samples sensitivity of radiographic diagnosis was greater than that of visual diagnosis. Both methods showed good specificity. When radiographs were used together with visual examination the status of 82% of first permanent molars and 91% of second primary molars were correctly classified.

Child↗
PubMed1995

Operative and microbiological validation of visual, radiographic and electronic diagnosis of occlusal caries in non-cavitated teeth judged to be in need of operative care.

The diagnosis of occlusal caries depends upon the correct identification of demineralised enamel and dentine. However, tissue demineralisation precedes bacterial infection so that dentine may be demineralised but uninfected. The presence of a bacterial infection of dentine may be a more relevant factor to be considered when planning to restore a carious lesion. The aim of this clinical study was to validate three techniques for the diagnosis of occlusal caries as demineralised tissue and as infected demineralised tissue during cavity preparation. The study sample was 82 non-cavitated occlusal lesions, judged by various dentists to be in need of operative care. The diagnostic techniques used by the single operator were vision, bitewing radiography and electronic caries diagnosis. The validating techniques were a caries detector dye to stain demineralised tissue, microbiological sampling to determine the level of infection of the dentine and clinical assessment of the dentine at operation. The caries detector dye showed demineralised dentine in 96% of the referred lesions. This demineralisation was reliably predicted by the electronic readings. However, the dentine samples from many teeth yielded only small numbers of bacteria indicating no, or only a very low level of bacterial infection. Neither vision nor electronic readings reliably predict heavily infected dentine. Radiographic evidence of dentine demineralisation was significantly associated with heavily infected dentine and this dentine was soft and wet at operation.

Adolescent↗