An analysis of the scientific basis for the radiographic guideline for new edentulous patients

Radiograph prescription practices of dentists in Ontario, Canada

BACKGROUND

With the advent of new ionizing radiation technologies, consideration must be given to the use of radiography in clinical practice. The authors aimed to determine how general dentists obtain oral and maxillofacial images and whether dentists' demographic characteristics and practice environments affect imaging decisions.

METHODS

The authors conducted a cross-sectional study using an electronic survey to collect information from general dentists in Ontario, Canada's most populous province.

RESULTS

The authors received 1,332 responses from 9,052 general dentists registered to practice in Ontario. A total of 57.2% of dentists used a nonindividualized approach to obtaining images for new adult dentate patients. Using clinical case scenarios, the authors found that 18.8% through 55.1% of dentists did not follow evidence-based guidelines when obtaining images. Overprescribing imaging was 5.8 times more common than underprescribing. Seeing patients after images were obtained (odds ratio [OR], 5.5), owning a panoramic and a cone-beam computed tomography imaging system (OR, 4.4), and the belief that images should be obtained to screen for occult pathoses (OR, 3.5) were the factors most strongly associated with overprescription.

CONCLUSIONS

Radiography prescription practices varied considerably among general dentists in Ontario and did not conform to established guidelines. Factors other than patient needs appeared to influence imaging practices.

PRACTICAL IMPLICATIONS

Overprescription of imaging by general dentists can result in unnecessary radiation exposure and financial costs to patients. To mitigate this, changes are needed in dental education, continuing education courses, and regulatory requirements.

A study of the impact of screening or selective radiography on the treatment and postdelivery outcome for edentulous patients

OBJECTIVE

The purpose of this study was to assess the impact of radiographic findings on complete denture treatment and on the postdelivery course of those patients who had pretreatment radiographs (the screening group) and those who did not (the selection group).

METHOD

In total, 375 cases were randomly selected by systematic sampling. Data collected included patient demographic information and denture history, predenture fabrication radiographic findings, and postdenture delivery complaints.

RESULTS

Of the screening patients, 100% had pretreatment radiographs made; this compared with 13.5% of the selection patients. In the screening group, 68.3% of patients had one or more positive radiographic findings recorded. Of the screening patients, 8.3% received treatment before denture fabrication; this compared with 1.2% of the selection patients. Of the 375 cases, 2 screening patients had postdelivery complaints that required management other than denture adjustment.

CONCLUSION

The results indicate that there is weak scientific support for the guideline recommending routine pretreatment radiography for new denture patients.