ABSTRACT
The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.
Subject(s)
Clinical Coding , Dental Caries/diagnostic imaging , Faculty, Dental , Radiography, Bitewing/classification , Dental Caries/therapy , Education, Dental/standards , Electronic Health Records , Humans , Pilot Projects , United StatesABSTRACT
OBJECTIVES: The aims of the present study were (1) to evaluate the percentage of recurrent caries with respect to the estimated caries risk profile obtained with a Cariogram, (2) to evaluate the quality of restorations in a Saudi population with several restorations and (3) to determine the additional value of bite-wing radiographs as an aid to quality evaluation. MATERIAL AND METHODS: A total of 803 restorations were examined in 100 adults according to the United States Public Health Service/Ryge criteria. Salivary and microbiological factors, dietary habits and plaque index were investigated. The Cariogram was used to evaluate the risk profiles. Class II bite-wing radiographs (n = 281) were taken to examine the marginal integrity and the anatomic form proximally. RESULTS: The patients were categorized according to 'the chance of avoiding caries' into three risk groups: 0%-20% (n = 38), 21%-40% (n = 28) and 41%-100% (n = 34). ANOVA revealed statistically significant differences between the risk groups with respect to the recurrent caries (P < 0.05). A high percentage of the total restorations (56%) were diagnosed with recurrent caries. The quality of anatomic form and surface texture was unacceptable in the majority of cases. After adding the evaluations of class II bite-wings, the percentage of unacceptable restorations increased by 28% and 17% with regard to marginal integrity and anatomic form, respectively (P < 0.001). CONCLUSIONS: Recurrent caries was related to the percentage 'chance of avoiding caries' as estimated by the Cariogram. The importance of bite-wings was emphasized as an aid to quality evaluation.
Subject(s)
Dental Caries Susceptibility/physiology , Dental Caries/therapy , Dental Restoration, Permanent/standards , Adult , Buffers , Cariostatic Agents/therapeutic use , Cross-Sectional Studies , Crowns/standards , DMF Index , Dental Marginal Adaptation/standards , Dental Materials/chemistry , Dental Plaque Index , Feeding Behavior , Female , Fluorides/therapeutic use , Humans , Male , Quality Assurance, Health Care , Radiography, Bitewing/classification , Recurrence , Risk Assessment , Saliva/metabolism , Saudi Arabia , Secretory Rate/physiology , Streptococcus mutans/isolation & purification , Surface PropertiesABSTRACT
The bitewing radiograph (BWR) has been used in dental practice for over 90 years and is a widely used technique. This paper outlines the ideal technique for producing reproducible BWR of good diagnostic quality. In particular, it reviews the technical errors that may occur while exposing and processing BWR and the psychological errors that may result when radiographs are viewed. The consequences of these errors, (unnecessary patient exposure to radiation, poor diagnosis and potentially inappropriate treatment) are outlined in detail. Steps to improve the quality of BWR and decrease patient exposure to radiation are given in line with recent recommendations.
