The Additional Information of Bitewing Radiographs in the Detection of Established or Severe Dentinal Decay in 14-Year Olds: A Cross-Sectional Study in Low-Caries Population

Aija-Maaria Hietala-Lenkkeri,Kaisu Pienihäkkinen,Mimmi Tolvanen,Pentti Alanen

doi:10.1155/2014/175358

Aija-Maaria Hietala-Lenkkeri, Kaisu Pienihäkkinen + Show 2 more

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https://doi.org/10.1155/2014/175358

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Abstract

Aim. To reveal the additional value of radiographic bitewings (BW) in detection of caries and in comparing the occurrence of clinically undetected severe decay between 14-year olds with and without clinically observed dentinal caries in a low-caries prevalence population. Design. The cross-sectional study used 363 pairs of radiographs read by one examiner without knowledge of the clinical findings. The yield was analyzed on a tooth surface level by cross tabulating the clinical and radiographic information and on an individual level by counting the number of yield surfaces for all subjects. Mann-Whitney U test was used. Results. On a tooth surface level, the contribution of BW was the greatest on the occlusal surfaces of the first molars, where established or severe dentinal decay was registered in BW in 11% of clinically sound surfaces and in 40% of established cavitated enamel lesions. On an individual level, 53% of subjects benefited from BW. The subjects clinically DMFS > 0 benefited more than the clinically DMFS = 0 subjects (P = .004), nearly 60% in relation to 47%, respectively. Conclusions. In a low-caries prevalence population a remarkable portion of both clinically DMFS = 0 and DMFS > 0 14-year olds benefit from BW examination. Most of the benefit is obtained on the occlusal surfaces of the first and the second permanent molars.

Highlights

In Sweden and Norway, for example, bitewings have been routinely—in more than 90% of subjects over 11 years of age—obtained in connection with the annual clinical dental examination or every two years [1]
The authors stated that the radiographic examination has a high specificity but low sensitivity in the detection of dentine caries of approximal surfaces
Fifty percent of the clinically examined DMFS = 0 subjects benefited from the radiographs, in comparison with the DMFS > 0 subjects, where in nearly sixty percent of the subjects an extra diagnostic bitewing examination (BW) yield was obtained (Table 3)

Summary

Introduction

In Sweden and Norway, for example, bitewings have been routinely—in more than 90% of subjects over 11 years of age—obtained in connection with the annual clinical dental examination or every two years [1]. The Finnish Current Care Guidelines of caries [2] recommend that the radiographs should be taken if dentine caries is detected in a clinical examination. In a systematic review of the Swedish Council on Technology Assessment in Health Care (SBU) it was concluded that visual/tactile examination has limited reliability in the detection of enamel and early dentine caries in occlusal surfaces of the posterior teeth. This method was not considered sufficient in establishing the presence of dentine caries in the approximal surfaces of the posterior teeth, either. The radiographic examination may lead to a moderate overregistration of dentine caries and the probability of a false-positive registration increases significantly with decreasing prevalence of caries

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