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

Comparison of periapical radiography, panoramic radiography, and CBCT in the evaluation of trabecular bone structure using fractal analysis

OBJECTIVES

The aim of this study is to compare imaging techniques to evaluate trabecular bone structure using Fractal Analysis (FA).

METHODS

Fifteen sheep hemimandibles were used for this study. Digital images were obtained using periapical radiography, panoramic radiography, and cone-beam computed tomography (CBCT). CBCT imaging was performed in standard (STD) and high-resolution (HR) modes. FA was conducted using ImageJ 1.3 software with the box-counting method on the images. The fractal dimension (FD) values were analyzed by the statistical software Jamovi 1.6.23. Statistical significance was accepted as p < 0.05.

RESULTS

The highest mean FD value was the FD on digital periapical radiographs (PaFD) (1.28 ± 0.04), and the lowest mean FD value was the FD on standard resolution cone-beam computed tomography images (STD-CBCTFD) (1.12 ± 0.10). Although there was no statistically significant difference between the PaFD and the FD on digital panoramic radiographs (PanFD) (p = 0.485), the PaFD was found to be significantly higher than STD-CBCTFD (p < 0.001), and the FD on high-resolution cone-beam computed tomography images (HR-CBCTFD) (p = 0.007). The PanFD was found to be significantly higher than the STD-CBCTFD (p = 0.004).

CONCLUSION

According to our results, in the evaluation of trabecular bone structure using FA, periapical radiographs and panoramic radiographs have similar image quality for assessment of the FD. On the other hand, CBCT results did not correlate with results from any of the other techniques in this study.

Exposure and protection protocols of dentomaxillofacial imaging applied by paediatric dentists in Europe

OBJECTIVES

Evaluate exposure and protection practices regarding dentomaxillofacial imaging among pediatric dentists in Europe and determine the effect of different clinician specific characteristics on their implementation.

METHODS

A cross-sectional study involving an electronic questionnaire addressed to paediatric dentists, participating in a seminar on dental radiology organized by the European Academy of Paediatric Dentistry. Participants were asked to respond to questions regarding dentomaxillofacial imaging in terms of applied radiation dose, adoption of radiation protection techniques, and different patterns of radiographic studying and exchange between patients and colleagues. Data analysis was performed and distribution of responses was tested using chi-square and Fisher's exact tests.

RESULTS

A total of 151 paediatric dentists, 119 females and 32 males, with a mean chronological age of 42.8 years (s.e. 11.3 years), successfully completed the questionnaire (response rate = 82%). Regardless of the type of radiograph, majority of respondents (68%), reported that they perform the radiographs themselves, while 21% reported that they refer the patients. Half of the respondents (51%), indicated requesting a small (localized) field of view (FOV) when referring for a cone beam computed tomography (CBCT) with only a small proportion (11%) reporting a large (maxillofacial) FOV. Thyroid collars and optimizing exposure settings were the most commonly reported patient protection measures used. Lastly, paediatric dentists have adopted the latest technological capacities for the study of dental images.

CONCLUSIONS

Dentomaxillofacial imaging protection and exposure protocols used are common among paediatric dentists with none of their specific characteristics having a significant effect.

Robust automated teeth identification from dental radiographs using deep learning

OBJECTIVES

This study developed and validated a deep learning-based method to automatically segment and number teeth in panoramic radiographs across primary, mixed, and permanent dentitions.

METHODS

A total of 6,046 panoramic radiographs were collected and annotated. The dataset encompassed primary, mixed and permanent dentitions and dental abnormalities such as tooth number anomalies, dental diseases, dental prostheses, and orthodontic appliances. A deep learning-based algorithm consisting of a U-Net-based region of interest extraction model, a Hybrid Task Cascade-based teeth segmentation and numbering model, and a post-processing procedure was trained on 4,232 images, validated on 605 images, and tested on 1,209 images. Precision, recall and Intersection-over-Union (IoU) were used to evaluate its performance.

RESULTS

The deep learning-based teeth identification algorithm achieved good performance on panoramic radiographs, with precision and recall for teeth segmentation and numbering exceeding 97%, and the IoU between predictions and ground truths reaching 92%. It generalized well across all three dentition stages and complex real-world cases.

CONCLUSIONS

By utilizing a two-stage training framework with a large-scale heterogeneous dataset, the automatic teeth identification algorithm achieved a performance level comparable to that of dental experts.

CLINICAL SIGNIFICANCE

Deep learning can be leveraged to aid clinical interpretation of panoramic radiographs across primary, mixed, and permanent dentitions, even in the presence of real-world complexities. This robust teeth identification algorithm could contribute to the future development of more advanced, diagnosis- or treatment-oriented dental automation systems.

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry

OBJECTIVES

Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics.

METHODS

An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05.

RESULTS

More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%).

CONCLUSIONS

The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

The Performance of Paralleling Technique and Bisecting Angle Technique for Taking Periapical Radiographs: A Systematic Review

Periapical radiography is a routine radiographic procedure performed by dentists on a daily basis. It can be taken with two techniques, the paralleling technique (P tech) and the bisecting angle technique (B tech). This systematic review aimed to identify the relevant literature, compare the use of P and B techs across various dental specialties, and determine the most appropriate technique to be used for different purposes in taking periapical radiographs. In January 2023, we searched PubMed, Web of Science, Scopus, and Google Scholar to identify the studies that compared the two radiographic techniques. The search string was: (paralleling AND ("bisecting angle" OR "bisected angle")). Manual reference tracing was also performed to identify the studies potentially missed. After screening, 26 studies were included for the qualitative review. The 26 included studies were published between 1976 and 2021. Ten of the studies were about general dentistry (dental radiology in general applications), whereas another ten studies were related to endodontics, such as working length estimation. Most studies advocated the use of the P tech for general, endodontics, implantology, and other indications. B tech was advocated for patients with a low palatal height. More future studies are needed to evaluate their performance in different scenarios with standardized equipment and radiographic positioning.

Detection and diagnosis of cleidocranial dysplasia by panoramic radiography: a retrospective study

BACKGROUND

Cleidocranial dysplasia (CCD) is a rare and underdiagnosed congenital disorder in dentistry. The purpose of this study was to illustrate and quantify the maxillofacial bone abnormalities detected on panoramic radiographs from a relatively large retrospective case series and to provide a series of diagnostic references for dentists to indicate the presence of disease and help in making an early and accurate diagnosis.

METHODS

The dental panoramic radiographs of thirty CCD patients aged 11 to 45 years (18 males and 12 females) were examined retrospectively. The dentition states, including supernumerary teeth and impacted teeth, were recorded. Twelve quantified measurements were adopted to determine the abnormalities of maxillofacial bones, including the degree of the zygomatic arch downward bend, bicondylar breadth, ramal height, mandibular height, mandibular aspect ratio, mandibular body height, condylar height, coronoid height, distance between the coronoid process and the condyle, bigonial width, gonial angle and best-fit gonial circle diameter. The Wilcoxon rank-sum test was used to compare the findings of the CCD patients with those of their matched controls (n = 300).

RESULTS

Supernumerary teeth were detected in 27 patients (90.0%), and all 30 patients presented impacted teeth. Compared to the matched controls, the CCD patients had a significantly larger degree of zygomatic arch downward bend (ZAD), a larger diameter of the best-fit gonial circle (BGC), and a shorter distance between the coronoid process and the condyle (DCC) in panoramic radiographs (P < 0.001). According to the reference cutoff values established from the 5th or 95th percentile of the measurements in the control group, ZAD higher than 6.90 mm, DDC less than 22.37 mm and BGC higher than 52.41 mm were significantly associated with the CCD features identified. Other panoramic measurements were not significantly different between the two groups.

CONCLUSIONS

Panoramic radiographs had great value in the diagnosis of CCD. In this study, we identified some dental and maxillofacial features on panoramic radiographs from a relatively large retrospective case series of CCD. A series of reliable quantitative indicators were provided for dentists that can indicate the presence of disease and improve the diagnostic specificity.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety

OBJECTIVES

Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures.

METHODS

Dentists from two major dental health centres in İzmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program.

RESULTS

Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging.

CONCLUSION

Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

Comparison of technical errors in pediatric bitewing radiographs acquired with round vs rectangular collimation

OBJECTIVE

To compare technical errors in bitewing radiographs acquired with round vs rectangular collimation in a hospital-based pediatric dentistry training program.

STUDY DESIGN

A retrospective chart review was conducted of 176 digital bitewing radiographs exposed with round collimation and 106 exposed with rectangular collimation. The number of re-exposures was calculated, and errors in central ray entry (CRE; "cone cuts"), horizontal and vertical positioning, and angulation were measured.

RESULTS

There were no greater re-exposures but significantly more CRE errors with rectangular collimation (21.7%; n = 23; 95% confidence interval [CI], 13.9%-30.0%) than with round collimation (3.4%; n = 6; 95% CI, 0.7%-6.1%). CRE error location, horizontal positioning errors, and size of horizontal overlapped contacts were statistically different but not clinically important.

CONCLUSIONS

Use of rectangular collimation resulted in increased CRE errors but no other clinically significant problems. This technique should be used to reduce radiation exposure to patients.

Dentists' knowledge about osteoporosis and their ability to identify the disease

BACKGROUND

Osteoporosis is an underdiagnosed condition, and its seriousness is not considered until severe complications arise. This study aimed to evaluate general dentists' knowledge about osteoporosis and their ability to identify patients with this disease by assessing mandibular cortical width (MCW) and mandibular cortical index (MCI) on panoramic dental radiographs using a visual method.

METHODS

In this cross-sectional study, an email questionnaire regarding the diagnosis and prevention of osteoporosis was sent to 20,773 dentists in 2016. Those who completed the questionnaire were invited to participate in radiomorphometric training and then to analyze the MCI and MCW of 114 panoramic radiographs of postmenopausal women who underwent both panoramic radiography and bone densitometry. Based on the radiomorphometric indices and while blinded to the densitometry results, the dentists determined whether they would indicate densitometry for these patients.

RESULTS

The response rate was 2.3%: 485 dentists completed the questionnaire, and 50 evaluated panoramic radiographs using the MCW and MCI. All of them reported some knowledge about osteoporosis, but 41.6% demonstrated a misleading conceptualization of the disease. Approximately 90% reported minimal access to this information during graduation, and only 27.0% were exposed to the topic during their postgraduate studies. Interest in osteoporosis prevention was expressed by 70.7% of the respondents, and interest in learning the radiomorphometric indices was expressed by 99.0%. The sensitivity in the detection of low bone mineral density through the MCW and MCI was 52.9%, and the specificity was 64%.

CONCLUSIONS

Brazilian dentists demonstrated insufficient knowledge about osteoporosis and a low ability to detect osteopenia or osteoporosis by applying radiomorphometric indices.

The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research.

Dosimetry of Occupational Radiation around Panoramic X-ray Apparatus

Background:

Panoramic imaging is one of the most common imaging methods in dentistry. Regarding the side-effects of ionizing radiation, it is necessary to survey different aspects and details of panoramic imaging. In this study, we compared the absorbed x-ray dose around two panoramic x-ray units: PM 2002 CC Proline (Planmeca, Helsinki, Finland) and Cranex Tome (Soredex, Helsinki, Finland).

Materials and Methods:

In this cross-sectional study, 15 thermoluminescet dosemeters (TLD-100) were placed in 3 semi-circles of 40cm, 80cm and 120cm radii in order to estimate x-ray dose. Around each unit, the number of TLDs in each semi-circle was 5 with equal intervals. The center of semicircles accords with the patient’s position. Each TLD was exposed 40 times. These dosemeters were read out with a Harshaw Model 4000 TLD Reader (USA). The calibration processing and the reading of dosemeters were performed by the Atomic Energy Organization of Iran.

Results:

The mean absorbed dose in three lines of PM 2002 CC Proline was 123.2±15.1, 118.0±11.0 and 108.0±9.1 µSv, (p=0.013). The results were 140.4±15.2, 120.2±10.4 and 111.6±11.2 µSv in Cranex Tome (p=0.208), which reveals no significant difference between two systems.

Conclusion:

There are no significant differences between the mean absorbed dose of surveyed models in panoramic imaging by two units (PM 2002 CC Proline and Cranex Tome). These results were less than occupational exposure recommended by ICRP, even at the highest calculated doses.

Dentists' use of digital radiographic techniques: Part II - extraoral radiography: a questionnaire study of Swedish dentists

OBJECTIVE

The present study aims to gain knowledge about the dentist's use and choice of digital extraoral imaging methods, panoramic radiography and cone beam computed tomography (CBCT).

MATERIALS AND METHODS

A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the panoramic technique and CBCT technique used, education, clinic size and type of service. The response rate was 53%.

RESULTS

The study showed that 61% of the Swedish dentists had access to panoramic techniques and that 84% used a direct digital sensor, while 6% used storage phosphor plate techniques. Around 8% of the Swedish dentists had access to CBCT. It was also observed that group practices had two times higher odds of having panoramic equipment compared with solo practices. Approximately 40% of the dentists had undergone postgraduate education in oral radiology during the last 5 years. Dental nurses and dental hygienists exposed 92% of the panoramic radiographs and 75% of the CBCTs. Thirty per cent of those clinics with access to a panoramic unit exposed >30 panoramic radiographs per month and 56% of the clinics having access to CBCT did more than 75 examinations per year.

CONCLUSIONS

Today 61% of Swedish dentists have access to panoramic radiography and 8% have access to CBCT. There is a greater likelihood of having access if the dentist works in the public dental health service or in a group practice and if the dentist has undergone any postgraduate course in oral radiology.

Digital dental radiology in Belgium: a nationwide survey

OBJECTIVES

The aim of this study is to analyse the use of digital dental radiology in Belgium, by focussing on the use of extraoral and intraoral radiographic techniques, digitalisation and image communication.

METHODS

A nationwide survey has been performed amongst Belgian general dentists and dental specialists. Questionnaires were distributed digitally via mailings lists and manually on multiple refresher courses and congresses throughout the country. The overall response rate was 30%.

RESULTS

Overall, 94% of the respondents had access to an intraoral radiographic unit, 76% had access to a panoramic unit, 21% has an attached cephalometric arm. One in five Belgian dentists also seem to have direct access to a cone beam CT. 90% of all intraoral radiography unit worked with digital detectors, while this was 91% for panoramic units (with or without cephalometrics). In 70% of the cases, general dental practitioners with a digital intraoral unit used a storage phosphor plate while in 30% of the cases they used sensor technology (charge-coupled device or complementary metal-oxide-semiconductor). The most common method for professional image transfer appeared to be email. Finally, 16% of all respondents used a calibrated monitor for image analysis.

CONCLUSIONS

The survey indicates that 90% of the respondents, Belgian dentists, make use of digital image techniques. For sharing images, general dental practitioners mainly use methods such as printout and e-mail. The usage of calibrated monitors, however, is not well established yet.

Dentists' use of digital radiographic techniques: Part I - intraoral X-ray: a questionnaire study of Swedish dentists

OBJECTIVE

The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.

MATERIALS AND METHODS

A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.

RESULTS

Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.

CONCLUSIONS

This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique.

Thyroid Radiation Dose to Patients from Diagnostic Radiology Procedures over Eight Decades: 1930-2010

This study summarizes and compares estimates of radiation absorbed dose to the thyroid gland for typical patients who underwent diagnostic radiology examinations in the years from 1930 to 2010. The authors estimated the thyroid dose for common examinations, including radiography, mammography, dental radiography, fluoroscopy, nuclear medicine, and computed tomography (CT). For the most part, a clear downward trend in thyroid dose over time for each procedure was observed. Historically, the highest thyroid doses came from the nuclear medicine thyroid scans in the 1960s (630 mGy), full-mouth series dental radiography (390 mGy) in the early years of the use of x rays in dentistry (1930s), and the barium swallow (esophagram) fluoroscopic exam also in the 1930s (140 mGy). Thyroid uptake nuclear medicine examinations and pancreatic scans also gave relatively high doses to the thyroid (64 mGy and 21 mGy, respectively, in the 1960s). In the 21st century, the highest thyroid doses still result from nuclear medicine thyroid scans (130 mGy), but high thyroid doses are also associated with chest/abdomen/pelvis CT scans (18 and 19 mGy for males and females, respectively). Thyroid doses from CT scans did not exhibit the same downward trend as observed for other examinations. The largest thyroid doses from conventional radiography came from cervical spine and skull examinations. Thyroid doses from mammography (which began in the 1960s) were generally a fraction of 1 mGy. The highest average doses to the thyroid from mammography were about 0.42 mGy, with modestly larger doses associated with imaging of breasts with large compressed thicknesses. Thyroid doses from dental radiographic procedures have decreased markedly throughout the decades, from an average of 390 mGy for a full-mouth series in the 1930s to an average of 0.31 mGy today. Upper GI series fluoroscopy examinations resulted in up to two orders of magnitude lower thyroid doses than the barium swallow. There are considerable uncertainties associated with the presented doses, particularly for characterizing exposures of individual identified patients. Nonetheless, the tabulations provide the only comprehensive report on the estimation of typical radiation doses to the thyroid gland from medical diagnostic procedures over eight decades (1930-2010). These data can serve as a resource for epidemiologic studies that evaluate the late health effects of radiation exposure associated with diagnostic radiologic examinations.

Occupational radiation procedures and doses in South Korean dentists

OBJECTIVES

Dentistry is among the occupations involving chronic exposure to ionizing radiation. Although several cohort studies on medical radiation workers have been conducted in some countries, only a few epidemiological studies on dentists have been performed to examine occupational radiation exposure worldwide. The aim of this study was to investigate occupational characteristics and radiation exposures in South Korean dentists.

METHODS

A total of 658 dentists were surveyed from April 2012 to May 2013, and survey data were linked with dosimetry data from the National Dose Registry. Multiple linear regression analysis was used to identify the relationship between demographic or occupational factors and individual radiation doses.

RESULTS

Of the dentists sampled, 78% were men, 51% were younger than age 40, and 61% began employment after 2000. The most frequent procedures performed by dentists were panoramic radiography, followed by intraoral and portable dental radiography. Male dentists were more frequently involved in radiation procedures, and a higher proportion of male than female dentists wore a lead apron for diagnostic radiology. The average annual effective dose was 0.18 mSv for male and 0.13 mSv for female dentists. Female dentists working in provincial areas had significantly higher average annual and cumulative effective doses than those in metropolitan areas. The cumulative effective doses were significantly greater for older dentists, those who entered the field in the 1990s, and those with longer employment duration.

CONCLUSIONS

Our findings provided detailed information on work practices, number of procedures performed on a weekly basis, and occupational radiation doses, which enabled in-depth evaluation of occupational radiation exposure and work status among dentists.

Repeat film analysis and its implications for quality assurance in dental radiology: An institutional case study

CONTEXT

The goal of any radiologist is to produce the highest quality diagnostic radiographs, while keeping patient exposure as low as reasonably achievable (ALARA).

AIMS

The aim of this study was to describe the reasons for radiograph rejections through a repeat film analysis in an Indian dental school.

SETTINGS AND DESIGN

An observational study conducted in the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal.

MATERIALS AND METHODS

During a 6-month study period, a total of 9,495 intra-oral radiographs and 2339 extraoral radiographs taken in the Radiology Department were subjected to repeat film analysis.

STATISTICAL ANALYSIS USED

SPSS Version 16. Descriptive analysis used.

RESULTS

The results showed that the repeat rates were 7.1% and 5.86% for intraoral and extraoral radiographs, respectively. Among the causes for errors reported, positioning error (38.7%) was the most common, followed by improper angulations (26.1%), and improper film placement (11.2%) for intra-oral radiographs. The study found that the maximum frequency of repeats among extraoral radiographs was for panoramic radiographs (49%) followed by lateral cephalogram (33%), and paranasal sinus view (14%). It was also observed that repeat rate of intraoral radiographs was highest for internees (44.7%), and undergraduate students (28.2%).

CONCLUSIONS

The study pointed to a need for more targeted interventions to achieve the goal of keeping patient exposure ALARA in a dental school setting.

Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis

Different quantitative and qualitative indices calculated on oral panoramic radiographs have been proposed as useful tools to screen for reduced skeletal bone mineral density (BMD). Our aim was to systematically review the literature on linear and qualitative panoramic measures and to assess the accuracy of these indices by performing a meta-analysis of their sensitivity and specificity. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Fifty studies were included in the qualitative appraisal and 19 were considered for meta-analysis. The methodological quality of the retrieved studies, assessed with the QUADAS-2 tool, was on average low. Three indices were reported by most of the studies: mandibular cortical width, panoramic mandibular index, and the Klemetti index. Mandibular cortical width presented with a better accuracy in excluding osteopenia/osteoporosis (specificity), since patients with a cortical width more than 4 mm had a normal BMD in 90% of the cases. Almost all studies used a cutoff of 0.3 for the panoramic mandibular index, resulting in an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.723 (SE 0.160; 95% confidence interval [CI], 0.352-0.926) and 0.733 (SE 0.066; 95% CI, 0.587-0.841). The presence of any kind of mandibular cortical erosion gave an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.789 (SE 0.031; 95% CI, 0.721-0.843) and 0.562 (SE 0.047; 95% CI, 0.47-0.651) and a sensitivity and specificity in detecting osteoporosis, respectively, of 0.806 (SE 0.105; 95% CI, 0.528-0.9200) and 0.643 (SE 0.109; 95% CI, 0.417-0.820). The mandibular cortical width, panoramic mandibular index, and Klemetti index are overall useful tools that potentially could be used by dentists to screen for low BMD. Their limitations are mainly related to the experience/agreement between different operators and the different image quality and magnification of the panoramic radiographs.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners

PURPOSE

Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed.

MATERIALS AND METHODS

All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected.

RESULTS

Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54±2.54, 59.39±7.01, and 5.80±3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice.

CONCLUSION

Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.

Effective dose from direct and indirect digital panoramic units

Purpose

This study aimed to provide comparative measurements of the effective dose from direct and indirect digital panoramic units according to phantoms and exposure parameters.

Materials and Methods

Dose measurements were carried out using a head phantom representing an average man (175 cm tall, 73.5 kg male) and a limbless whole body phantom representing an average woman (155 cm tall, 50 kg female). Lithium fluoride thermoluminescent dosimeter (TLD) chips were used for the dosimeter. Two direct and 2 indirect digital panoramic units were evaluated in this study. Effective doses were derived using 2007 International Commission on Radiological Protection (ICRP) recommendations.

Results

The effective doses of the 4 digital panoramic units ranged between 8.9 µSv and 37.8 µSv. By using the head phantom, the effective doses from the direct digital panoramic units (37.8 µSv, 27.6 µSv) were higher than those from the indirect units (8.9 µSv, 15.9 µSv). The same panoramic unit showed the difference in effective doses according to the gender of the phantom, numbers and locations of TLDs, and kVp.

Conclusion

To reasonably assess the radiation risk from various dental radiographic units, the effective doses should be obtained with the same numbers and locations of TLDs, and with standard hospital exposure. After that, it is necessary to survey the effective doses from various dental radiographic units according to the gender with the corresponding phantom.

Questionnaire surveys of dentists on radiology

OBJECTIVES

Survey by questionnaire is a widely used research method in dental radiology. A major concern in reviews of questionnaires is non-response. The objectives of this study were to review questionnaire studies in dental radiology with regard to potential survey errors and to develop recommendations to assist future researchers.

METHODS

A literature search with the software search package PubMed was used to obtain internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. A search of the English language peer-reviewed literature was conducted of all published studies, with no restriction on date. The search strategy found articles with dates from 1983 to 2010. The medical subject heading terms used were "questionnaire", "dental radiology" and "dental radiography". The reference sections of articles retrieved by this method were hand-searched in order to identify further relevant papers. Reviews, commentaries and relevant studies from the wider literature were also included.

RESULTS

53 questionnaire studies were identified in the dental literature that concerned dental radiography and included a report of response rate. These were all published between 1983 and 2010. In total, 87 articles are referred to in this review, including the 53 dental radiology studies. Other cited articles include reviews, commentaries and examples of studies outside dental radiology where they are germane to the arguments presented.

CONCLUSIONS

Non-response is only one of four broad areas of error to which questionnaire surveys are subject. This review considers coverage, sampling and measurement, as well as non-response. Recommendations are made to assist future research that uses questionnaire surveys.

A study to determine the added value of 740 screening panoramic radiographs compared to intraoral radiography in the management of adult (>18 years) dentate patients in a primary care setting

OBJECTIVES

To measure the added value of panoramic radiography in new dentate patients attending for routine treatment.

METHODS

Thirty-seven general dental practitioners using panoramic radiographs routinely were recruited. Twenty dentate patients were identified prospectively by each participating dentist if they were new to the practice, attending for an examination and requesting any treatment deemed necessary. A panoramic radiograph was taken with appropriate intraoral radiographs in line with national guidelines. Each dentist completed a radiological report for the panoramic radiograph only and these 20 reports were forwarded to the researchers along with the 20 panoramic radiographs, their accompanying bitewing and periapical radiographs and twenty completed clinical assessment sheets.

RESULTS

740 panoramic, 1418 bitewing and 325 periapical radiographs were assessed by the researchers. Only 32 panoramic films provided any additional diagnostic value when compared to intraoral films when guidelines had been observed resulting from the poor technical and processing quality of the accompanying intraoral films. Assessment of the number of caries and periapical lesions and the degree of periodontal bone loss from the intraoral films provided a greater diagnostic yield at the p<0.001 level of significance. The research found that dentists underestimated the number of caries lesions present and level of periodontal bone loss when compared to the researchers but overestimated the presence of periapical pathology, at the level of significance at p<0.001.

CONCLUSIONS

The study found that there was no support for the use of panoramic radiographs in routine screening as there was no net diagnostic benefit to the patient.

Compliance of Iranian dentists with safety standards of oral radiology

OBJECTIVES

Dentists use radiographs in their daily practice. Their knowledge and behaviour towards radiographic examination can affect patients' exposure to radiation. The aim of this study was to survey the knowledge and behaviour of Iranian dentists regarding oral radiology safety standards.

METHODS

1000 questionnaires were given to the participants of the 48th Annual Congress of the Iranian Dental Association, of which 700 were returned. The participants were asked about demographic data, primary knowledge of radiation protection, selection criteria, radiographic equipment and technique, methods of patient and personnel protection and management of radiographic waste. Descriptive analysis of data was performed.

RESULTS

44% of respondents said the initial radiograph they took was of the periapical view of a limited area. 12% preferred the periapical paralleling technique. F-speed film was used by 9% and E-speed film by 62%. Only 2% had digital receptors. Proper exposure time was selected by 26.5%. The use of long and rectangular collimators was 15% and 6%, respectively. 34% occasionally covered their patients with both thyroid shields and lead aprons. 36% used the position and distance rule correctly for their own protection. Proper disposal of the used processing solutions and the lead foils were done by only 1% and 3%, respectively.

CONCLUSIONS

It can be concluded that the majority of dentists in the study group did not select the proper method, material and equipment in order to minimize the exposure of their patient to unnecessary radiation in dental radiography.

An Investigation into the Bitewing Radiographic Prescribing Patterns of West Kent General Dental Practitioners

Aims

The primary aims of the study were to investigate the use of bitewing radiography within primary dental care and adherence to guidelines on bitewing radiography by general dental practitioners (GDPs) in the West Kent Primary Care Trust (PCT) area. Within the overall aims, the study had objectives to investigate the use of radiographic guidelines, audit and caries risk assessment, the influence of private and National Health Service (NHS) practice, and the influence of the demographic profile of the GDPs on these variables.

Methods

Data were gathered via a piloted self-completion questionnaire, circulated to all GDPs listed on the NHS Choices website as practising in the West Kent PCT area. Three mailings and follow-up telephone calls were used. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test.

Results

Of 223 GDPs, 167 responded (75%). GDPs with a high NHS commitment were significantly less likely to follow Faculty of General Dental Practice (UK) guidance on prescribing bitewing radiographs for adults ( P<0.01) and children ( P<0.05) than were mainly private GDPs. Mainly NHS GDPs were more likely ‘always/mostly’ to follow National Institute for Health and Clinical Excellence guidance (83 compared to 59) ( P<0.05) and also to risk-assess patients (83 compared to 62). Only 115 (71%) had carried out a radio graphic audit or peer review in the preceding three years. Those with postgraduate qualifications were more likely ( P<0.05) to carry out radiographic audit.

Conclusions

The study confirmed previous research reporting the under-use of radiography for caries detection and also the failure of some GDPs to comply with ionising radiation regulations. West Kent GDPs with a high NHS commitment were less likely to follow radiographic guidance than their private counterparts. This suggests that further efforts to disseminate information on radiographic guidelines and to educate GDPs are necessary to improve adherence with all aspects of radiography within general dental practice. Research into factors that influence GDPs’ decision-making with regards to radiographic prescription may further inform the profession as to the best methods to lead to behavioural change. The dental profession and its regulators need to make a concerted effort to educate and inform GDPs so that this behaviour is modified.

An Investigation into Dental Digital Radiography in Dental Practices in West Kent following the Introduction of the 2006 NHS General Dental Services Contract

Aims

The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners’ (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006.

Methods

Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient.

Results

Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these ‘mainly private’ GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 ‘mainly NHS’ GDPs reported using digital radiographic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more.

Conclusions

In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radiography. Mainly private GDPs were more likely to use digital radiography than their mainly NHS counterparts. A link between digital radiography and increased prescription of radiographs was not specifically apparent from this study. There was no evidence that West Kent GDPs were taking fewer radiographs than they did prior to the introduction of the new GDS contract in April 2006. Research is needed to investigate whether the uptake of digital radiography by GDPs in the rest of the country is similar to that in West Kent.

A comparison between bitewing radiographs taken with rectangular and circular collimators in UK military dental practices: a retrospective study

OBJECTIVES

The aim of this study was to determine any increase in the incidence of cone cut errors that adversely affected diagnostic yield resulting in more retakes using rectangular collimation with film holders in bitewing radiography. Comparisons were also made with other positioning errors that occurred when bitewings were taken with circular collimation, with and without film holders.

METHODS

A preliminary questionnaire was used to determine the year that rectangular collimation was adopted by military dental practice. 3 time-framed subsets, each of 1000 bitewing radiographs, were identified: subset 1, films taken with circular collimators without film holders; subset 2, films taken with circular collimators with film holders; and subset 3, films taken with rectangular collimators with film holders. Each subset was assessed for positioning errors of cone cut, horizontal overlap, vertical distortion and film centring. The χ(2) test was used to test significant differences amongst the three subsets.

RESULTS

The use of film holders with circular collimation significantly reduced the incidence of cone cut errors from 21.7% to 3.3%. There was an increase in the incidence of cone cut errors from 3.3% to 20.9% when rectangular collimation was used, but the actual number considered "rejects" was very small, only 0.1% (1 in 1000 films) in subset 2 and 0.3% (3 of 1000 films) in subset 3, when assessed for diagnostic yield.

CONCLUSIONS

This study provides evidence that rectangular collimation did not significantly affect the diagnostic yield of bitewing radiographs despite the presence of cone cut. Therefore, all practitioners should adopt rectangular collimation.

Flemish general dental practitioners' knowledge of dental radiology

The aim of this study was to assess general dental practitioners' knowledge of dental radiography and radiation protection in order to alert the Belgian authorities and dental professional societies. Prior to attending a postgraduate course on intraoral radiology, general dental practitioners in Flanders, Belgium, were asked to fill in a questionnaire regarding the radiological equipment and the techniques they used for intraoral radiography. The availability and type of dental panoramic equipment were also assessed. A total of 374 questionnaires were available for this study. 15% of the attendants used radiographic equipment that was more than 27 years old and 43% reported equipment that operated with a clockwork timer. 32% and 75% respectively had no idea what the kV or mA settings were on their intraoral equipment. 5% were unaware which cone geometry or geometric technique (paralleling or bisecting angle technique) they were using. 81% claimed to be using a short cone technique. 47% did not know what collimation meant, whereas 40% stated that they were using circular collimation. 38% used digital intraoral image detectors (63% were photostimulable storage phosphorplate (PSPP)), but 16% were not sure about the type of sensor they were using (PSPP or solid-state sensors). 61% also had dental panoramic equipment available, 25% of which was digital (10% charge coupled device (CCD) and 15% PSPP). These results clearly indicate the need for continued education on this subject. The latter is an important signal to Belgian authorities and dental professional societies.

Relationship between the mandibular inferior cortex and bone stiffness in elderly Japanese people

SUMARRY: This study assessed the relationship between the mandibular inferior cortex (MIC) and bone stiffness in elderly Japanese subjects. Results suggest that MIC classification may be useful for screening patients for the possibility of osteoporosis by measuring bone stiffness with ultrasound bone densitometry.

INTRODUCTION

The prevention of fractures is a priority for patients with osteoporosis. Dental panoramic radiographs are frequently taken for the examination of teeth and jaws in general dental practice worldwide. This study assessed the relationship between the mandibular inferior cortex (MIC) and bone stiffness in elderly Japanese subjects.

METHODS

This study included 519 healthy subjects (263 men and 256 women) aged 70 years old. We evaluated the relationship between MIC classification and bone stiffness using Scheffe's multiple comparison test. Multiple linear regression analysis was used to assess the relationship between MIC classification and bone stiffness after controlling for confounding factors.

RESULTS

A significant correlation was found between MIC classification and bone stiffness in men (C1 vs C2: p < 0.05) and women (C1 vs C2: p = NS, C1 vs C3: p < 0.01, C2 vs C3: p < 0.05). MIC classification was significantly associated with bone stiffness on multiple linear regression analysis after controlling for sex, body mass index, regular exercise, and smoking (beta = -0.11, p < 0.01, R(2) = 0.387, p < 0.001).

CONCLUSIONS

Our study suggests that MIC classification may be useful for screening patients for the possibility of osteoporosis by measuring bone stiffness with ultrasound bone densitometry.

Relationship between mandibular inferior cortex and general bone metabolism in older adults

The purpose of this study was to investigate whether a link exists between the jawbone and general bone metabolism. The results of our study indicate that a mandibular inferior cortical erosion finding on dental panoramic radiographs is significantly associated with increased biochemical markers of bone turnover.

INTRODUCTION

The purpose of this study was to investigate whether a link exists between the jawbone and general bone metabolism.

METHODS

We measured values of serum bone-specific alkaline phosphatase (S-BAP) and urinary N-telopeptide cross-links of type I collagen (U-NTX). To evaluate the jawbone, we used mandibular inferior cortex (MIC) classification on dental panoramic radiographs. After 134 subjects were divided into three groups (C1: normal cortex, C2: mildly to moderately eroded cortex, C3: severely eroded cortex), we evaluated the relationship between S-BAP or U-NTX and MIC classification by Scheffe's multiple comparison test.

RESULTS

A significant correlation was found between MIC classification and S-BAP (C1 vs. C2: p < 0.01, C1 vs. C3: p < 0.01, C2 vs. C3: NS). A significant correlation was found between MIC classification and U-NTX (C1 vs. C2: p < 0.01, C1 vs. C3: p < 0.001, C2 vs. C3: p < 0.01).

CONCLUSIONS

The results of our study indicate that the mandibular inferior cortical erosion finding on dental panoramic radiographs is significantly associated with increased S-BAP and U-NTX levels. We suggest that there is an association between the jawbone and general bone metabolism.

Head-and-neck organ doses from an episode of orthodontic care

INTRODUCTION

The high prevalence of orthodontic treatment in young people makes the associated radiation to the head and neck of potential public-health significance. In this study, we estimated secular changes (1963-2003) in age-specific organ doses associated with orthodontic care and collective organ doses in the United States in 1999.

METHODS

A survey of radiographic records at 1 university clinic was combined with published estimates to provide organ-specific radiation doses. Collective organ doses were estimated from the 1999 US Nationwide Evaluation of X-ray Trends and published orthodontic utilization surveys.

RESULTS

Before 1992, orthodontic care in a university setting was associated with mean doses of 7.0 milligrays (mGy) to the thyroid, 0.8 mGy to the red bone marrow, 2.7 mGy to the brain, 13.2 mGy to the salivary glands, and 5.1 mGy to the bone. After 1992, the doses decreased to 2.8 mGy to the thyroid, 0.3 mGy to the red bone marrow, 0.7 mGy to the brain, 6.2 mGy to the saliva glands, and 2.4 mGy to the bone. Around 1999, the collective doses associated with orthodontic care in the United States in patients less than 19 years of age were 400 Gy to the red bone marrow and 3800 Gy to the thyroid.

CONCLUSIONS

Orthodontic care, in part due to its high prevalence, potentially contributes significantly to the diagnostic radiation burden in those less than 19 years old in the United States.

Spanish dental hygienist attitudes to dental radiological protection: assessment of a 1-day pilot course

OBJECTIVES

To determine hygienists' knowledge of and attitudes to X-ray equipment and film processing, and to assess both after a 1-day course.

STUDY POPULATION

One-hundred and four dental hygienists from the south-east of Spain attending a 1-day course in oral radiology.

METHODOLOGY

A questionnaire comprising different sections related with socio-demographic items, X-ray equipment and the processing of dental films was answered before and after a 1-day pilot course on radiation protection.

RESULTS

The response rate was 89.42% (n = 93). Of the participants 94.6% were women, with a mean age of 29.52 (SD 6.861) and 7.20 years of professional experience (SD 5.089). The level of knowledge before the course was 48.28%, which increased to 85.62% after the course (P < 0.001).

CONCLUSIONS

The prescribed standard was reached by <23.65% of those attending the course at the beginning. Although attending the course led to a considerable improvement, it did not always result in a high level of knowledge of basic radiation equipment and processing.

Automated osteoporosis risk assessment by dentists: a new pathway to diagnosis

General dental practitioners use a vast amount of panoramic radiography in their routine clinical work, but valuable information about patients' osteoporotic status is not collected. There are many reasons for this, but one of the prime reasons must be the disruption involved in clinical routine with lengthy manual radiographic assessment. We have developed computer software, based on active shape modeling that will automatically detect the mandibular cortex on panoramic radiographs, and then measure its width. Automatic or semi-automatic measurement of the cortical width will indicate the osteoporotic risk of the patient. The aim of our work was to assess the computer search technique's ability to measure the mandibular cortical width and to assess its potential for detection of osteoporosis of the hip, spine and femoral neck. Mandibular cortical width was measured using the manually initialized (semi-automatic) method and, when assessed for diagnosing osteoporosis at one of the three measurement sites, gave an area under the ROC curve (A(z))=0.816 (95% CI=0.784 to 0.845) and for the automatically initialized searches, A(z)=0.759 (95% CI=0.724 to 0.791). The difference between areas=0.057 (95% Confidence interval=0.025 to 0.089), p<0.0001. For diagnosing osteoporosis at the femoral neck, mandibular cortical width derived from the manually initialized fit gave an area under the ROC curve (A(z))=0.835 (95% CI=0.805 to 0.863) and for the automatically initialized searches A(z)=0.805 (95% CI=0.773 to 0.835). The difference in A(z) values between active shape modeling search methods=0.030 (95% CI=-0.010 to 0.070), and this was not significant, p=0.138. We concluded that measurement of mandibular cortical width using active shape modeling is capable of diagnosing skeletal osteoporosis with good diagnostic ability and repeatability.

Practice characteristics associated with patient-specific receipt of dental diagnostic radiographs

OBJECTIVE

To quantify the role of practice characteristics in patient-specific receipt of dental diagnostic radiographic services.

DATA SOURCE/STUDY SETTING

Florida Dental Care Study (FDCS). Study Design. The FDCS was a 48-month prospective observational cohort study of community-dwelling adults. Participants' dentists were asked to complete a questionnaire about their practice characteristics.

DATA COLLECTION/EXTRACTION METHODS

In-person interviews and clinical examinations were conducted at baseline, 24, and 48 months, with 6-monthly telephone interviews in between. A single multivariate (four radiographic service outcomes) multivariable (multiple explanatory covariates) logistic regression was used to model service receipts.

PRINCIPAL FINDINGS

These practice characteristics were significantly associated with patient-specific receipt of radiographic services: number of different practices attended during follow-up; dentist's rating of how busy the practice was; typical waiting time for a new patient examination; practice size; percentage of patients that the dentist reported as interested in details about the condition of their mouths; percentage of African American patients in the practice; percentage of patients in the practice who do not have dental insurance; and dentist's agreement with a statement regarding whether patients should be dismissed from the practice. Effects had differential magnitudes and directions of effect, depending upon radiograph type.

CONCLUSIONS

Practice characteristics were significantly associated with patient-specific receipt of services. These effects were independent of patient-specific disease level and patient-specific sociodemographic characteristics, suggesting that practitioners do influence receipt of these diagnostic services. These findings are consistent with the conclusion that practitioners act in response to a mix of patients' interests, economic self-interests, and their own treatment preferences.

A randomized double blinded study to assess the efficacy of a laser-guided collimator on dental radiography training

OBJECTIVES

To assess the effect of a laser-guided collimator in intraoral radiography training.

METHODS

A custom-made collimator with four red laser diodes on each corner on the rim of an aluminium alloy cubic housing was fabricated. The laser used low power diodes, which are classified as laser-safe by the United States Food and Drug Administration (FDA). When activated, the effective dimensions of the laser beams were 4 cm x 4.5 cm. Eighteen dental hygiene students were randomized into test and control groups. The Laser group used a rectangular collimator with the laser device, while the Non-laser group used a conventional rectangular collimator. Each group attended nine intraoral radiography training sessions. All radiographs were assessed and were classified into three categories: Excellent, Acceptable and Repeat, by a masked academic staff member. Reasons for repeats were marked. Statistical comparisons between the two groups were made.

RESULTS

A total of 2334 radiographs were made. Conecut was more common on bitewings than periapicals. The Laser group produced fewer conecuts than the Non-laser group. The Laser group produced more excellent radiographs with fewer repeats than the Non-laser group, but there was not a significant difference.

CONCLUSIONS

The laser-guided collimator helped the students to produce fewer repeats in a shorter period of time. It was an effective training aid.

Survey of dental radiological practice in Turkey

OBJECTIVES

The aim of this study was to determine the dentist's knowledge about dose reduction techniques, radiographic equipment and quality of dental radiographic service in general dental practice in Turkey.

METHODS

The survey was performed on 636 dentists who attended the 11th International Congress organized by the Turkish Dental Association. Information on the demographic characteristics of the dentists, radiographic equipment, techniques and processing they used and radiation protection was obtained with a 32 point questionnaire.

RESULTS

The respondents' knowledge concerning the technical details of their equipment was limited, with 512 (86.9%) not knowing the kilovoltage peak (kVp) of their machine. Only 34 (5.5%) respondents reported having rectangular collimators. The dentists had little knowledge about the speed of film they used. D-speed film was the most preferred one with 21.6%. Fifty-eight (10.2%) dentists used E-speed film and the F-speed film was used only by 13 (2.3%) dentists. The most preferred technique (62%) for periapical radiography was the bisecting angle technique. Four hundred and eighty five (82.5%) of the dentists reported that they took the radiographs by themselves.

CONCLUSIONS

In the present study, the results indicate that for minimizing any unnecessary radiation, attempts should be made to improve dentists' knowledge about radiation dose reduction techniques.

A quality assurance program in dental radiographic units in western Greece

OBJECTIVE

This survey reports on successful efforts to establish a quality assurance (QA) program for 50 intraoral x-ray units in the public and private sectors in the region of Achaia, Greece. It was conducted in 2 phases, in 1996 and in 2003, including on-site inspections, QA tests, and standard questionnaires. The aim of the study was to assess equipment conditions, knowledge, and adoption of radiographic QA guidelines by general dentists and, more importantly, the impact of the recommendations and training provided.

STUDY DESIGN

The tested parameters focused on radiation protection, equipment maintenance, film speed used, film processing conditions, and radiologic characteristics such as voltage, radiation leakage, type of collimation, source-to-skin distance, timer accuracy, and entrance dose.

RESULTS

The data gathered in 1996 demonstrate minimal compliance with equipment function requirements and radiation safety measures. 1 The comparative evaluation of all the parameters gathered from the 2 surveys, indicated that in 2003 the vast majority of the dentists followed the recommendations given in 1996. Only 2 dentists persisted in neglecting the guidelines.

Dosimetry of digital panoramic imaging. Part II: occupational exposure

OBJECTIVES

To measure occupational radiation dose during panoramic exposure from five digital panoramic X-ray units.

METHODS

Exposures were made with five different digital panoramic units, of which four were equipped with a direct digital CCD (charge coupled device, "direct digital" technique), and one used storage phosphor plates ("indirect digital" technique). An anthropomorphic phantom served as the patient. An ionization chamber recorded the scattered radiation at 1 m from the phantom at five different locations around the panoramic units, both at the level of the thyroid gland and the level of the gonads, and effective organ doses were calculated. Exposure parameters were set as recommended by the manufacturers for the particular image and patient size: tube potential settings ranged between 64 kV and 74 kV, exposure times between 8.2 s and 19.0 s, tube current values between 4 mA and 7 mA.

RESULTS

The maximum organ equivalent dose at 1 m from the panoramic unit was 0.60 microGy, the maximum organ effective dose was 0.10 microSv. Organ equivalent doses varied between 0.18 microGy and 0.30 microGy and organ effective doses between 0.01 microSv and 0.05 microSv for the different positions around the units (average for the different panoramic units). The variations in organ doses for the various machines were 0.04-0.53 microGy organ equivalent dose and 0.01-0.08 microSv organ effective dose.

CONCLUSIONS

Assuming that 500 panoramic radiographs per year are taken by a dental practitioner at 1 m distance from the panoramic unit, he or she will receive an annual additional organ effective dose between 5 microSv and 15 microSv for the thyroid gland and between 5 microSv and 40 microSv for the gonads, depending on the type of digital panoramic unit.

Attitude of the Belgian dentist population towards radiation protection

OBJECTIVES

To perform a survey of private dental offices in Belgium and gain insight in the knowledge and attitude of Belgian dentists towards quality care in radiography and radiation protection.

METHODS

A questionnaire was distributed among 700 Belgian dental offices, which were included based on demographic data and the use of intraoral radiographic equipment.

RESULTS

The response rate was 71%. Implementation of standards for quality care and radiation protection was suboptimal. In most offices, exposure settings of the intraoral radiation tube were 65 kV/kVp to 70 kV/kVp and 10 mA to 12 mA, with an average exposure time of 0.45 s. No reduction of exposure time was noticed when using faster film types. About one-third of the responders worked with digital image receptors. Aiming devices and rectangular collimation were used in a minority of practices (40% and 6%, respectively). The distance of the dentist to the radiation tube during exposure was on average 2.2 m, although 8% of the dentists assisted in holding the image receptor inside the patient's mouth. One quarter of the dentists were standing behind a wall when taking radiographs. Lead aprons were worn more often by female dentists. Dose estimation revealed that male dentists received a significantly larger effective dose per year than female dentists (8.3 mSv vs 3.2 mSv).

CONCLUSIONS

The implementation of standards of quality care for radiography and radiation protection could be improved among Belgian dentists. An elaborate educational programme in dental radiography is a prerequisite. Furthermore, recommendations could help to attain a change in attitude towards the use of ionizing radiation in order to meet European guidelines.

Use of the basic periodontal examination and radiographs in the assessment of periodontal diseases in general dental practice

OBJECTIVES

The aims of this study were to investigate (1) the use of the basic periodontal examination (BPE) by general dental practitioners (GDPs) and their selection of radiographs for the assessment of periodontal disease and (2) whether this selection concurred with existing selection (referral) criteria.

METHODS

Three mailings of a self-completion questionnaire were sent to 800 GDPs working in the National Health General Dental Service in England and Wales. Dentists were presented with six clinical scenarios for which they were asked to describe their use of radiographs.

RESULTS

Ninety-one percent of dentists reported that they used the BPE in new patients, with 56% using it for all patients; 84% of dentists used BPE in recall patients. BPE use was related to the dentists' age and postgraduate qualifications. There was a wide variation in the radiographic views used for periodontal disease assessment. The choice of radiographs was not generally in line with the Faculty of General Dental Practitioners (UK) 1998 selection criteria, particularly for the clinical scenarios of pocketing >5 mm, irregular pocketing or pockets associated with teeth with heavy restorations. Sixty seven percent of dentists concurred with recommendations for radiographs for a suspected periodontal-endodontic lesion.

CONCLUSIONS

A majority of dentists reported clinical screening for periodontal diseases using the BPE. There was considerable variation in the selection and use of radiographs and practice was not in line with existing guidelines for many clinical situations. Evidence-based referral criteria should be actively promoted to ensure high standards of radiographic practice in general dental practice.