464 - Detecting Caries With and Without the Use of Bitewing Radiographs

Abstract:

Purpose: The aims of this study are: (1) to determine the number of carious lesions diagnosed from clinical examination alone compared to the number of carious lesions diagnosed from the combination of clinical examination and radiographic examination, and (2) illustrate the need for evidence-based radiographic protocols to aid in diagnostic techniques and treatment planning decisions for patients with special health care needs.

Methods: This study consisted of new or existing patients presenting to the Department of Pediatric Dentistry at RSDM for either comprehensive or periodic dental examinations. The sample population included 172 children ages 6 – 12. For this study, only posterior teeth (primary or permanent) were examined for caries. For each tooth, five surfaces (occlusal, mesial, distal, buccal, and lingual) were inspected for the presence or absence of decay. Surfaces with decay found during a clinical examination were documented by examiners. Only after completion of the clinical examination, bitewing radiographs were exposed utilizing either an XCP-DS or Snap-A-Ray-DS. Surfaces with decay found radiographically were documented by examiners. A Pearson Correlation Coefficient, Paired Sample T-Test, and One-Sample Statistics were utilized to assess the data.

Results: A Pearson correlation coefficient (r) of 0.897 indicated a strong positive correlation between variables (P < 0.001). As the number of decayed surfaces found clinically increases, an even greater number of decayed surfaces found through both clinical and radiographic examinations is expected. A Paired Sample T-Test was used to compare the mean number of decayed surfaces detected between clinical examination and radiographic examination in addition to clinical examination. The difference between the means for each variable (2.16 for clinical, 3.72 for clinical and radiographic) was statistically significant (P < 0.001). In terms of the magnitude of the difference, One-Sample Statistics revealed the difference between the means of each variable to be 1.6. For the average patient involved in this study, an additional 1.6 surfaces of decay could be identified after radiographic examination. Of the 172 patients involved in this study, 89 patients had no signs of decay following clinical examination alone. Out of these 89 patients, 29 had carious lesions detected after radiographic examination. Without bitewing radiographs, 32.5% of patients would be misdiagnosed as being caries free.

Conclusions: Bitewing radiographs proved to be critical in diagnosing interproximal decay. Without radiographs, a high percentage of patients can be misdiagnosed as being caries free. As a result, appropriate and timely treatment may be delayed leading to future pain, infection, and higher costs of treatment. Evidence-based radiographic guidelines must be established to appropriately treat patients with special health care needs. In certain cases, a lack of clinically detectable caries should not deter dental providers from recommending treatment in the hospital setting under general anesthesia. Providers must explain the importance of obtaining radiographs to detect and treat carious lesions while discussing the risks and benefits of receiving treatment in the hospital setting.

Identify Supporting Agency and Grant Number: Research supported by The Rutgers Institutional Review Board