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PubMed1979

Doses to patients from pantomographic and conventional dental radiography.

The increasing popularity of pantographic dental radiography and particularly its recent use for routine screening of asymptomatic patients have prompted the NRPB to compare the risks to patients from this technique with those from more conventional dental diagnostic procedures. Pantographic equipment from seven manufacturers have been investigated along with five procedures for obtaining similar information using conventional dental X-ray sets. Lithium borate thermoluminescent dosimeters located at 141 sites in the head and neck of a Rando phantom have been used to measure the mean absorbed dose to organs of interest as well as the total energy imparted to the phantom. Relative values of the energy imparted by the various techniques provide an estimate of their relative somatic risk to the patient. Pantomographic techniques were generally found to impart less than half the energy to the phantom than that given by a conventional full-mouth periapical series conducted at 45 kV, and a similar amount of energy to four bitewing intra-oral films. The restriction of the frequency of pantomographic examinations to no more than once per year during adolescence and once per three to five years during adulthood has been shown to involve only a minimal increase in the risk of somatic injury to the patient.

Absorption↗

PubMed1982

Endodontic therapy associated with a case of cuspid gigantism.

A case of cuspid gigantism is reported. A technique used to diagnose and complete the root canal therapy is discussed. Modifications of conventional techniques and materials are shown to be effective in managing this case. Routine use of the bitewing film on long cuspids is not recommended. It is suggested only in extreme cases of unusual anatomic features that lend themselves specifically to this technique. It should be kept in mind that such circumstances are uncommon.

Adult↗

PubMed1976

Alveolar bone loss in the permanent first molars of Norwegian schoolchildren receiving systematic dental care.

A distance exceeding 2 mm from the cementoenamel junction (CEJ) to the alveolar bone was observed on the proximal surfaces of the first molars of proportionally more 15-year-olds (101 subjects) than 13-year-olds (99 subjects). The measurements were performed on bitewing radiographs, and the methodologic error amounted to 3%. Recordings in excess of 2 mm were most frequent (0.27 and 0.23) for the distal surfaces of the maxillary molars.

Adolescent↗

PubMed1989

Image analysis of radiolucencies in approximal enamel: a comparison of xeroradiographic and conventional film images.

Xeroradiographic and conventional film bitewing images of radiolucencies in approximal enamel were compared using a computer-aided image analysis system. Densitometric analysis of the conventional film types used in the study showed that the "lead foil free" film exhibited lower overall density when compared with conventional D-speed film. Computer-aided image analysis of radiolucencies in approximal enamel found that xeroradiographs depicted a higher degree of demineralization and a larger area than conventional radiography with the "lead foil free" film.

Adolescent↗

PubMed1983

A survey of radiographs obtained at the initial dental examination and patient selection criteria for bitewings at recall.

This paper reports the results of a 1980 survey of a 27% simple random sample of all practicing dentists in North Carolina. The objective of the survey was to establish current practice standards regarding panoramic, full-mouth series, and bitewing radiographs. A total of 414 dentists (76.2% of those surveyed) responded. A questionnaire recorded demographic data on the dentists, age-specific prevalence data on the type of radiograph most often done at a patient's initial visit, and prevalence of radiographs based on need as perceived by the dentist and assessed separately for a variety of patient characteristics (age, oral hygiene, caries activity, fluoride treatment, and systemic medical problems). Results of the survey of a subset of 338 dentists in general practice showed the median age to be 40 with a median length of experience of 13 years. At an initial visit, for patients younger than 12, bitewing radiographs only were most commonly taken; for patients older than 12, bitewings plus a panoramic radiograph were taken. Full-mouth series plus bitewings were rarely performed among patients younger than 6 years (2.1% of the time), but were more commonly performed as patients aged (29.0% for patients aged 40 and older). A variety of patient characteristics were considered for their impact on the need for bitewing radiographs on recall. Caries activity was ranked most important by the general dentist, followed by oral hygiene and periodontal activity.

Adolescent↗

PubMed1984

The effectiveness of the thyroid shield in dental radiology.

The effectiveness of the thyroid shield in reducing patient exposure during routine dental radiographic examinations was studied. A nonscreen film and two film-screen combinations were used as dosimeters and to show the spatial distribution of x-ray exposure. The error in the absolute accuracy of the film dosimeter and the error in the reproducibility of the film-screen combinations were less than +/- 10%. Measurements of thyroid exposure and exposure distribution, with and without the shield, were made on a Rando phantom and on patients. In the phantom study, the reduction by the shield of exposure to the thyroid from primary beam and from scatter was found to be highly dependent on the position of the primary beam relative to the thyroid gland but independent of kVp. Exposure reduction by the shield varied from 5% to 56% for a complete-mouth survey, 2% to 18% for a bitewing survey, and 10% to 79% for a panoramic survey. In the patient study, thyroid skin exposures measured on adults were 33% to 84% lower in offices in which the shield was used as compared to offices in which it was not used. Thyroid skin exposures measured on children were 63% to 92% lower. In accordance with the ALARA principle, these results support the routine use of the thyroid shield for all dental radiography.

Adolescent↗

PubMed1997

The radiographic investigation of the visibility of secondary caries adjacent to the gingiva in Class II amalgam restorations.

The aim of this study was to investigate the visibility of secondary caries in the gingivobuccal and gingivolingual corners of teeth restored with amalgam restorations. Standard Class II cavities were created in 15 orthodontically extracted mandibular premolar teeth, and the teeth were randomly divided into five groups of three teeth each. In four of the groups, a 1.0- or 1.5-mm cavity was prepared in the gingivolingual or gingivobuccal corner of the restoration. No lesions were created in group 5, the control group. The teeth were restored with amalgam. The teeth were adapted in the actual tooth space of 15 volunteers with one mandibular premolar missing. Radiographs of each patient were taken with the bisecting-angle technique and the bite wing technique. The radiographs were sorted at random and given to 15 members of the professoriate who were often involved in detecting caries and to 17 members who were not normally involved in detecting caries. The bitewing technique was found to be more reliable than the bisecting-angle technique in detecting secondary caries in gingivobuccal approximal corners (P < .05). It was also found that, in group 1, the bisecting-angle technique was more reliable than the bitewing technique in detecting caries in gingivolingual corners (P < .05). No significant differences were found in the correct evaluation of radiographs between the faculty who were normally involved in the detection of caries and those who were not.

Bicuspid↗

PubMedDate not supplied

Orthodontic radiographic usage by pediatric dentists.

Pediatric educators and practitioners were surveyed to determine the composition of the radiographic examination used to diagnose patient malocclusion; pediatric dentists provide the initial diagnosis for much of the orthodontic service provided to children and adolescents. The initial diagnosis of malocclusion is based on information obtained from a clinical and radiographic examination. Results of the study are based on the 111 pediatric dentists who report providing comprehensive orthodontic treatment. For those who reported providing comprehensive orthodontic therapy, the frequency of ordering each of ten radiographs and the importance of the radiographs to the dentists' diagnosis and treatment plans were measured. The bitewing, lateral cephalometric and panoramic radiographs were the most frequently ordered radiographs for both young and older patients. Radiographic and clinical examinations were judged to be of equal importance to more than fifty percent of the dentists.

Female↗

PubMed2003

Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales.

OBJECTIVES: The aims of this study were to determine the self-reported use of panoramic radiography, D- and E-speed film, rectangular collimation, film holders, equipment fitted with a long spacer cone (>200 mm) and the bisecting angle and paralleling techniques by general dental practitioners and to see if use was related to the dentists' age and postgraduate qualifications. METHODS: Three mailings of a self-completion questionnaire were circulated to 800 general dental practitioners working in the National Health General Dental Service in England and Wales. RESULTS: A response rate of 74% was achieved. Sixty-one percent of general dental practitioners reported use of panoramic equipment. Fifty percent of dentists always used E-speed film and 18% always used rectangular collimation. Sixty-eight percent of dentists always used bitewing film holders though fewer (37%) used periapical film holders. Sixty-three percent of dentists always used a long cone. The bisecting angle technique was used by 70% of dentists with 22% always using this technique for periapical radiographs. Thirty-one percent always used the paralleling technique. Use of panoramic equipment, periapical film holders, bisecting angle and paralleling techniques were associated with the dentists' age. Use of periapical film holders, bisecting angle and paralleling techniques and rectangular collimation were associated with dentists' postgraduate qualifications. CONCLUSIONS: There are several features of radiographic equipment and techniques that can aid high quality imaging and reduce patient dose. Although a number of these are being used in general dental practice in England and Wales they have yet to achieve universal adoption.

Adult↗

PubMed1988

Dutch dentists' decisions to take bitewing radiographs.

A postal questionnaire was sent to a 10% (n = 444) national random sample of Dutch dental practitioners. The response was 77% (n = 344). The practitioners prescribed bitewings on average for 57% of "new" 25-yr-old patients. Five significant (P less than 0.05) variables explained 24% of the variation in bitewing prescribing for these "new" patients. These were, in declining level of importance: the initial dental condition of the patient, the proportion of restorative treatment decisions based solely on radiographs, the level of urbanization of the practice location, the technical level of the practice equipment and the importance attached by dentists to the diagnostic use of dental floss for interproximal caries diagnosis. The low power of the regression model in explaining variation in the decision to take bitewings indicates an idiosyncratic use of bitewing radiographs for caries diagnosis. A weak tendency to adopt different diagnostic sets of procedures was demonstrated.

Adolescent↗

PubMed2001

Case challenge: the case of the post-extraction bone lesion.

A 28-year old male patient presented for his routine dental health visit which included the above bitewing radiograph. The radiograph was taken as a follow-up nine months after the extraction of the mandibular second molar by the oral surgeon. The patient had no discomfort and was unaware of any dental problem.

Adult↗

PubMedDate not supplied

Pre-eruptive intracoronal resorption as an entity of occult caries.

"Occult" or "hidden" caries refers to occlusal caries which is not diagnosed clinically because the occlusal surface appears ostensibly intact, and radiographs show radiolucencies in dentin. The prevalence of occult caries has been reported to range from 2.2% to over 50% of permanent molars. In spite of its relatively high prevalence, the etiology and pathogenesis of occult caries remain unclear. The author hypothesizes that occult lesions could have resulted from processes which are pre-eruptive or post-eruptive. Pre-eruptive processes include intracoronal resorption of unerupted teeth, and the post-eruptive process is occlusal fissure caries. Although the prevalence of intracoronal resorption has been shown to be around 3-6% by subject and 0.5-2% by teeth, the percentage contribution of this process to the overall prevalence of occult caries is unclear. When affected teeth are fully erupted, it is difficult to determine if pre-eruptive resorption had been present previously. The prevalence of occult lesions does not appear to be affected by fluoride exposure. Radiographs are useful adjuncts to aid in the diagnosis of occult lesions. Bitewing radiographs are useful for detecting early occlusal fissure caries while panorex radiographs of unerupted developing teeth aid in the diagnosis of pre-eruptive intracoronal lesions. It is suggested that all unerupted, developing teeth on radiographs be examined for pre-eruptive resorptive lesions.

Adolescent↗

PubMedDate not supplied

A radiographic study of interproximal alveolar bone crest between the primary molars in children.

This study establishes baseline data regarding the normal relationship between the cementoenamel junction and the alveolar crest in the primary dentition, using bitewing radiographs. Measurements greater than those presented in this study may indicate an early stage of periodontal disease in the primary dentition, a tendency of the patient to develop the disease, or a combination of these.

Age Factors↗

PubMed2004

Dental X-rays and the risk of intracranial meningioma: a population-based case-control study.

BACKGROUND: Ionizing radiation is a likely cause of intracranial meningioma. The authors determined whether the risk of intracranial meningioma was associated with past dental X-rays-specifically, posterior bitewings, full-mouth series, and lateral cephalometric and panoramic radiographs. METHODS: The authors conducted a population-based case-control study of residents of King, Pierce, and Snohomish counties in western Washington State. Case patients (n = 200) had an incident intracranial meningioma that was confirmed histologically during life between January 1995 and June 1998. The authors used random-digit dialing and Medicare eligibility lists to identify two control subjects to be matched to each case patient based on age and gender. Exposures were determined during an in-person interview. The authors compared self-report and dental records in a subset of study participants. RESULTS: Of the 4 dental X-ray procedures evaluated, only the full-mouth series (specifically, > or = 6 over a lifetime) was associated with a significantly increased risk of meningioma (odds ratio, 2.06; 95% confidence limits, 1.03-4.17). However, evidence for a dose-response relation was lacking (P for trend = 0.33). The risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15-40 years before diagnosis, with significant elevations in the 10-year periods beginning 22-30 years before diagnosis. The risks in these analyses were even greater when only women were considered. CONCLUSIONS: Dental X-rays involving full-mouth series performed 15-40 years ago, when radiation exposure from full-mouth series was much greater than it is now, were associated with an increased risk of meningioma. The authors did not observe an increased risk with bitewings, lateral cephalometric, and panoramic radiographs.

Adult↗

PubMedDate not supplied

An evaluation of pit and fissure caries and caries experience as selection criteria in bitewing examinations for children.

One area of particular concern, on behalf of the pediatric dental patient, is the routine use of low doses of ionizing radiation in the form of bitewing radiographs at semi-annual examinations. Patients at high-risk for interproximal caries should receive bitewing examinations at the first clinical evidence of caries. The use of pit and fissure caries as a criterion for determining relative interproximal caries risk may not be reliable in fluoridated communities.

Age Factors↗

PubMed1983

Radiation shielding in dental radiography.

The protective effect in the thyroid region from different types of radiation shielding at intraoral radiography has been studied as well as the reduction of the absorbed dose to the sternal and the gonadal regions. The shielding tested were the different types of leaded aprons, of which three had an attached leaded collar and the other two were used in combination with separate soft leaded collars. Furthermore one of the soft leaded collars and an unflexible horizontal leaded shield were tested separately. Two dental x-ray machines of 60 and 65 kVp with rectangular and circular tube collimators were used. The exposure times corresponded to speed group E film. The absorbed doses were measured with two ionization chambers. No significant difference in the protective effect in the thyroid gland could be found between the different types of radiation shieldings. There was a dose reduction by approximately a factor of 2 to the thyroid region down to 0.08 mGy per full survey using parallelling technique, and below 0.001 mGy per single bitewing exposure. The shielding reduced the thyroid dose using bisecting-angle technique by a factor of 5 down to 0.15 mGy per full survey (20 exposures). In the sternal region the combinations of apron and collar reduced the absorbed dose from a full survey to below 2 microGy compared with 18 microGy (parallelling) and 31 microGy (bisecting-angle) without any shielding. With the horizontal leaded shield a reduction by a factor of 6 was obtained, but no significant sternal dose reduction could be detected from the soft collar alone. The gonadal dose could be reduced by a factor of 10 with the horizontal leaded shield, parallelling technique and circular collimator. Using leaded aprons the gonadal was approximately one per cent of the dose without any shielding, i.e. below 0.01 microGy per single intraoral exposure.

Humans↗

PubMed1986

The frequency of bitewing radiographs.

A model for use in analyzing the implications of different rates of caries incidence and progression for the timing of bitewing radiographs was developed. Estimates of progression rates and incidence patterns were derived from an analysis of serial bitewing radiographs. A time schedule for taking the next radiographs was determined so that carious lesions would be detected before radiolucencies reach the inner half of the dentin. For asymptomatic persons with extensive exposure to fluorides and no unrestored enamel lesions on the last radiographs, bitewing films could be scheduled every 2.5 to 3 years. For persons with little exposure to fluorides or with many early enamel lesions or at least one deep enamel lesion that has not been restored, radiographs should be performed every 6 months to 1 year.

Adolescent↗

PubMed1989

Effect of a decrease of interproximal overexposure of bitewing radiographs on the diagnosis of approximal caries.

In bitewing radiographs the approximal enamel is always overexposed because of the short X-ray beam path in this area. This expectedly leads to a deteriorated detectability of lesions. Abrogation of this overexposure by application of X-absorbing paste in the interproximal space will presumably relieve the deterioration of lesion detection. This principle is demonstrated with aluminum cylinders in which a groove simulates a lesion. The principle is also applied to a phantom head with 0.1- to 0.7-mm lesions in the bicuspids. The resulting bitewing radiographs were scored by dentists, and a lesion detection score as used before was calculated. No score improvement resulted from the relieving of overexposure. This is ascribed to the predominant role of recognition processes in the ability to detect a lesion.

Absorption↗