Intraoral Dental Radiographs Research Articles

Diagnostic yield of dental radiography and digital tomosynthesis for the identification of anatomic structures in dogs.

The purpose of this study was to evaluate the use of a novel imaging modality, digital tomosynthesis (DT), for identification of predefined anatomic dental and maxillomandibular structures in dogs. DT images were compared to conventional intraoral dental radiography (DR) for the diagnostic yield regarding the presence and quality of visualization of 35 structures. DT imaging and full mouth DR were obtained on 16 canine cadaver heads and a semi-quantitative scoring system was used to characterize the ability of each imaging method to identify the anatomic structures. The results demonstrated that each imaging modality, and orientation, was superior for certain anatomic structures. Overall, although one modality did not prove superior to the other, digital tomosynthesis appears to be an appropriate novel tool for identification of specific anatomic structures in the dog skull.

Real-world diagnostic potential of bacterial biomarkers of canine periodontitis.

The objective of this study was to investigate the diagnostic potential of bacterial biomarkers by comparing the performance of molecular detection assays with clinical assessments of dog's oral health performed by veterinarians. Supragingival and subgingival plaque samples were collected from 127 client-owned dogs, pre-booked for procedures under general anesthesia, visiting veterinary practices in the United States. DNA was extracted and bacterial biomarkers quantified using quantitative polymerase chain reaction. Gingivitis and periodontitis were recorded by a trained clinician using the Weighted Gingivitis Periodontitis Score which involved assessing the buccal surfaces of 18 teeth while under general anesthesia. Intraoral dental radiographs of the left and right mandibular first molar teeth were also obtained. These data were then used to establish the diagnostic performance of the molecular assay to detect periodontitis. An initial conscious, visual oral examination performed by the veterinarian identified 67.7% of dogs as having periodontitis, but examination under general anesthesia indicated a higher proportion (86.6%). Analysis of supragingival plaque samples collected by veterinarians from conscious and unconscious dogs demonstrated the assay had an accuracy of 77.7 to 80.9%, a sensitivity of 77.6 to 81.0%, and a specificity of 80.0%. Use of this molecular screening tool in conscious dogs has the potential to improve early periodontal disease detection and support veterinary decision making, ultimately improving the oral health of dogs and consequently their quality of life.

Diagnostic yield of dental radiography and digital tomosynthesis for the identification of anatomic structures in cats.

Digital tomosynthesis (DT) has emerged as a potential imaging modality for evaluating anatomic structures in veterinary medicine. This study aims to validate the diagnostic yield of DT in identifying predefined anatomic structures in feline cadaver heads, comparing it with conventional intraoral dental radiography (DR). A total of 16 feline cadaver heads were utilized to evaluate 19 predefined clinically relevant anatomic structures using both DR and DT. A semi-quantitative scoring system was employed to characterize the ability of each imaging method to identify these structures. DT demonstrated a significantly higher diagnostic yield compared to DR for all evaluated anatomic structures. Orthogonal DT imaging identified 13 additional anatomic landmarks compared to a standard 10-view feline set obtained via DR. Moreover, DT achieved statistically significant higher scores for each of these landmarks, indicating improved visualization over DR. These findings validate the utility of DT technology in reliably identifying clinically relevant anatomic structures in the cat skull. This validation serves as a foundation for further exploration of DT imaging in detecting dentoalveolar and other maxillofacial bony lesions and pathologies in cats.

Proposed values for diagnostic reference levels in intraoral dental radiography in Serbia

Values for diagnostic reference levels are proposed for intraoral dental radiography in the Republic of Serbia. Proposed numbers for diagnostic reference levels were based on measurements on 119 intraoral units in clinical settings for an adult posterior bitewing X-ray. Values of 3.17 mGy, 3.11 mGy, and 1.58 mGy incident air kerma were found for image receptors film E class, charge-coupled device, and photostimulable phosphor plate, respectively. Similarly, 89.6 mGycm2, 88 mGycm2, and 44.6 mGycm2 air kerma-area products were found for the same detectors. All values are greater than those published in several other similar studies. This is especially true for charge-coupled device image receptors since this technology enables lower patient doses as reported before. This calls for urgent action to optimize intraoral dental imaging, so we present the radiographic techniques used and equipment description to help guide optimization actions.

Influence of Pixel Size Difference on Imaging Plate Computed Radiography on the Quality of Digital Images in Intraoral Dental Radiography Examination

This research aims to determine the assessment of digital image quality from 18 x 24 cm Imaging Plates of the ST (Standard) and HR (High-Resolution) types by engineering the dimensions on intraoral dental radiographic examinations so that we can determine the differences in image quality for each type of imaging. Plate Computed Radiography. The research method took the form of an experiment using the subjective quality assessment method of digital images in intraoral dental radiographic examinations using the object of patients who carried out the examination and brought a referral letter for 60 patients. Analyze image quality by measuring MSE (Mean et al.), PSNR (Peak Signal to Noise) and PIQE (Perception-based Image Quality Evaluator) score. The results of the research show that the analysis of differences in IP FCR ST and HR types with the Mann-Whitney Test shows the significance values of all digital images (< 0.05), namely: MSE (0.041), PSNR (0.041), PIQE score (0.012), meaning that there is a difference in digital image quality between IP FCR ST and HR, while with subjective analysis the respondents gave IP FCR HR results of 57.14% and IP FCR ST 42.86%. The difference in the results of the two types shows that IP FCR HR can be used as the main alternative in selecting IP FCR in intraoral dental radiographic examinations).

Assessment of the Occupational Radiation Dose from a Handheld Portable X-ray Unit During Full-mouth Intraoral Dental Radiographs in the Dog and the Cat - A Pilot Study.

Occupational radiation protection is an important consideration in small animal clinics world-wide. With the increased use of portable handheld X-ray devices in veterinary dentistry, concerns related to occupational radiation protection are being raised. Annual occupational dose limits for dental workers are expressed as Total Dose Equivalent (TDE) or Effective Dose. The permitted TDE can vary depending on the anatomical region, ranging from 50 millisieverts (mSv) for the external whole body exposure dose to 500 mSv for external exposure of the skin or an extremity. Although several studies have been performed in human dentistry to establish the amount of backscatter radiation produced using portable handheld X-ray devices, no similar research has been conducted in veterinary dentistry. This study aimed to determine the TDE while acquiring a full mouth intraoral radiograph set in dogs and cats and to estimate the TDE for a handheld X-ray device's operator. For this, the backscatter radiation dose recorded by three sets of monitoring dosimeters located in strategic anatomical areas of the operator was assessed after taking one hundred intraoral radiographs in each group. The study concluded that the backscatter radiation levels were far below the permitted annual occupational doses in the three patient groups of this study. Even though the portable handheld X-ray unit was demonstrated to be a safe dental radiographic unit regarding backscattering radiation, the operator's eye, ovary, and breast regions were exposed to unnecessary radiation.

Radiation Exposure and Frequency of Dental, Bitewing and Occlusal Radiographs in Children and Adolescents.

Dental radiographs are valuable diagnostic aids for oral healthcare, but exposure to ionizing radiation carries health risks, especially in children due to their high radio-sensitivity. Valid reference values for intraoral radiographs in children and adolescents are still missing. This study aimed to investigate the radiation dose values and underlying justifications of dental, bitewing and occlusal X-rays in children and adolescents. Data from routinely executed intraoral radiographs between 2002 and 2020 with conventional and digital tube-heads were extracted from the Radiology Information System. The effective exposure was calculated from technical parameters and statistical tests performed. A total number of 4455 intraoral (3128 dental, 903 bitewing and 424 occlusal) radiographs were investigated. For dental and bitewing radiographs, the dose area product (DAP) was 2.57 cGy × cm2 and the effective dose (ED) 0.77 µSv. For occlusal radiographs, the DAP was 7.43 cGy × cm2 and the ED 2.22 µSv. Overall, 70.2% of all intraoral radiographs were dental, 20.3% bitewing and 9.5% occlusal radiographs. The most frequent indication for intraoral radiographs was trauma (28.7%), followed by caries (22.7%) and apical diagnostics (22.7%). Moreover, 59.7% of all intraoral radiographs were taken in boys, especially for trauma (66.5%) and endodontics (67.2%) (p ≤ 0.00). Girls were significantly more frequently X-rayed for caries diagnostics than boys (28.1% vs. 19.1%, p ≤ 0.00). The average ED of 0.77 µSv for intraoral dental and bitewing radiographs in this study was within the range of other reported values. The technical parameters of the X-ray devices were found at the lowest recommended levels to best limit the radiation exposure and to assure acceptable diagnostic efficacy. Intraoral radiographs were performed predominantly for trauma, caries and apical diagnostics-reflecting general recommendations for the use of X-rays in children. For improved quality assurance and radiation protection, further studies are necessary to determine the meaningful dose reference level (DRL) for children.

Evaluation of Dental and Oral Pathologies of 36 Captive Lions (Panthera leo) and Tigers (Panthera tigris).

The documented increase in the occurrence of dental diseases in captive big cats over the past decades has necessitated the need to target dental medical research accordingly. The aim of this study was the systematic evaluation of dental and oral pathologies of lions and tigers which included intraoral dental radiography. Thirty-six animals of both sexes, ranging in age from nine months to 18 years, predominantly in circus husbandry, served as the basis of the present study, and their dental health status was investigated. The preliminary report and history, adspection of the awake animal, and examination under anesthesia provided important information. Eight animals were specifically presented for oral examination because of known dental disease. The remaining 28 animals were anesthetized for other medically necessary procedures, and each animal's oral and dental health status was also evaluated while under anesthesia. In the 28 animals that underwent routine oral cavity examination, pathological changes that had not previously been noticed were found in two-thirds of the animals (19/28). One-quarter of all the animals (9/36) had no abnormal oral cavity findings. Dentoalveolar trauma such as tooth fractures and abrasion (24/36) were diagnosed most frequently. The results highlight the importance of regular oral examinations in big cats. Furthermore, the results suggest that there is a relationship between husbandry conditions and the incidence of dentoalveolar trauma in captive big cats.

A Standard Method for Intraoral Dental Radiography With Dental Photo-Stimulative Phosphor (PSP) Plates in Big Cats

In recent years, dentistry has steadily gained more prominence in veterinary medicine, including exotic and wild animal medicine. It is known that dental diseases are among the most common diseases in captured big cats. However, so far, there is no standardized method for dental radiography in these animals. Therefore, this study aimed to develop a standardized procedure for the systematic radiographic examination of the teeth in big cats. In total, 34 big cats, including 21 lions and 13 tigers, of different ages were examined. Animals that needed treatment for known dental diseases and those that had to be anesthetized for other medically necessary procedures and dental health status examinations were included. Intraoral dental radiographs were captured with digital imaging plates designed for intraoral dental radiography in horses. Based on the intraoral dental radiography procedures used in domestic cats, both the bisecting angle technique and parallel technique were used. A hemisphere model originally developed for horses was used to describe the path and position of the x-ray beam as accurately as possible. The results demonstrated that it was possible to completely image all the teeth of big cat dentition on seven radiographs using the described method. This method can be used to acquire high-quality intraoral dental radiographs in big cats, aiding in the quick and reliable diagnosis of dental diseases.

Association between Type 2 Diabetes and Classification of Periodontal Disease Severity in Japanese Men and Women: A Cross-Sectional Study.

Background: to evaluate the association between type 2 diabetes and periodontal disease severity using the rate of alveolar bone loss (ABL) and high-sensitivity C-reactive protein (hs-CRP) value as indices. Methods: In this cross-sectional study of 372 patients (mean age ± SD, 53.2 ± 11.8 years) from a Japanese hospital, we measured ABL and number of teeth on either panoramic radiographs or intraoral dental radiographs of all teeth. Periodontal disease severity was classified into nine groups by combining ABL and hs-CRP. Results: 48 subjects had type 2 diabetes; 324 did not. Univariate analysis showed that type 2 diabetes was significantly associated with age, sex, body mass index, number of teeth, ABL, hs-CRP, and periodontal disease severity. Multivariate analysis showed significant associations between type 2 diabetes and the groups with high severity of periodontal disease. In receiver operating characteristic (ROC) curve analysis, predicting the presence of diabetes, area under the ROC curve was 0.762 (95%CI = 0.688–0.835) for ABL, and 0.709 (95%CI = 0.635–0.784) for hs-CRP, which was significant. Conclusions: this study showed that diabetes can be associated with a periodontal disease severity classification using the combination of ABL and hs-CRP.

Delaying Intraoral Radiographs during the COVID-19 Pandemic: A Conundrum.

Background The COVID-19 pandemic has made dentists very assiduous about cross-infection during dental treatment, thereby delaying dental radiographs for treatment. However, patients needing dental emergency treatment in the ongoing pandemic require relevant intra/extraoral dental radiography for adequate diagnosis and treatment planning. Methods This article is aimed at adding to the hot debate: Is delay for intraoral radiographs justified or a possible proxy? As a narrative review, it provides an insight into the reasons for delaying intra-oral dental radiographs during in the pandemic and options of the nontraditional radiographic techniques available until the pandemic subsides. Discussion and Conclusion. Cross-contamination concerns through respiratory droplets grow while using intraoral film holders that stimulate gag reflex, coughing, saliva secretion, and if proper disinfection protocols are not applied. Since the patients' acquiring emergency dental treatment cannot be neglected, the return-to-work guidelines by the health regulatory bodies urge to prioritize extraoral radiographic imaging techniques to curb the infection, offering the best diagnostic efficacy. The dental professionals can consider cone-beam computed tomography (CBCT) scans and sectional dental panoramic radiographs (SDPRs), followed by a risk assessment for COVID-19, a safer modality in reducing cross-contamination and assuring an innocuous environment for both patient and coworkers.

Knowledge, Perceptions, and Attitudes Regarding COVID-19 and Infection Control Measures Against it among Dental Students in Saudi Arabia

Background Coronavirus disease (COVID-19) is a highly infectious disease caused by an RNA virus named SARS CoV2. The increased risk of infection by this virus among dental students necessitates updated knowledge and highlights their important role in preventing and controlling its transmission. Objective: This study aims to assess knowledge, perceptions, and attitudes regarding COVID-19 and infection control measures among dental students in Saudi Arabia. Methods: A cross-sectional study was conducted among dental students in different Saudi universities using an online self-administered questionnaire. It gathered data on students’ demographic information, knowledge of COVID-19 and infection control measures, risk perception and attitudes toward the disease, and their preparedness for treating infected patients. Results: A total of 327 dental students responded to the questionnaire. Of these students, 92.4% had received training in infection control in dental practice, but only 24.2% had attended training regarding COVID-19. The majority of students had adequate knowledge regarding the modes of transmission and the common symptoms of COVID-19, with statistically significant total mean knowledge scores among students in different academic years (p<0.05). A large percentage of the students (92.7%) agreed that the use of rubber dams or high-volume saliva ejectors could reduce the possibility of transmitting infection. However, 58.4% of the students disagreed that intraoral dental radiographs should be avoided to reduce the possibility of transmitting infection. Conclusion: Although knowledge of and risk perception concerning COVID-19 among students is good, additional training sessions integrating recent international guidelines for infection control are required to update their knowledge and achieve safe dental practice.

Localization of the First Mandibular Molar Roots in Relationship to the Mandibular Canal in Small Breed Dogs-A Tomography Imaging Study.

The intimate relationship between the mandibular canal (MC) and the first mandibular molar tooth presents challenges when performing dentoalveolar surgical procedures due to the probability of causing iatrogenic injury to the inferior alveolar neurovascular bundle. Superimposition between the MC and the first molar (M1) tooth roots is often observed on intraoral dental radiographs in small breed dogs. However, due to the radiograph's bidimensional nature, it is impossible to determine the buccal or lingual localization of the first molar roots with respect to the MC. Thus, this study's objective was to determine the localization of the first molar tooth's roots in relation to the position of the MC and their overlapping percentage with the canal in small-bodyweight dogs (<15 kg) using tomographic diagnostic images. For this, cone-beam computed tomography and high-definition computed tomography exams from 103 small breed dogs (under 15 kg) were retrospectively assessed to determine the lingual or buccal localization of the first molar tooth's roots with respect to the MC and the degree of overlap of the roots with the canal. In conclusion, most of the roots of M1 of dogs under 15 kg were located at the MC's lingual aspect (82.7%) with an overall superimposition median with the MC of 100 and 90% for the mesial and distal roots, respectively. Straddle tooth roots were not a common anatomical presentation in the dogs of this study.

The effects of examiner fatigue on the diagnostic accuracy of dental radiographs.

The aim of the study was to find out whether and to what extent the performance of dentists regarding diagnostic evaluation of dental radiographs is influenced by symptoms of fatigue. Over a period of 40 minutes, 21 dentists evaluated a database of 96 randomly selected, infinitely repeating intraoral dental radiographs for the presence of periapical radiolucencies. Both before and after, participants were asked to assess their subjective fatigue using the Swedish Occupational Fatigue Inventory (SOFI), Visual Analogue Scale (VAS), and Numerical Rating Scale (NRS). Diagnostic accuracy was analyzed using the Receiver Operating Characteristics (ROC) method. Furthermore, the correlation between diagnostic accuracy and radiographic experience, image viewing time, and level of training was also evaluated. The study showed that despite increasing fatigue, the diagnostic accuracy of the examiners remained consistent with an average AUC value of 0.768 ± 0.091. Within the 40-min reporting period, no statistically significant fluctuations were found. The diagnostic accuracy varied depending on the radiographic experience: with many years of radiographic experience, the diagnostic accuracy increased. At the same time, the older study participants with greater radiographic experience became less tired compared to younger study participants during the examination. Although an increase in fatigue was observed during the 40-min examination, the diagnostic accuracy of the doctors remained constant. Due to the high workload which needs to be handled in a limited time, medical and dental professionals have reached a certain level of exposition to stress that can lead to physical fatigue. However, the increasing fatigue should not negatively influence the work of the doctors. The study shows that the radiodiagnostic accuracy remained the same.

Dental Pathology of the Domestic Pig (Sus Scrofa Domesticus).

Antemortem domestic pig (Sus scrofa domesticus) dental pathology literature is sparse. This observational descriptive study evaluated 23 client-owned pigs that while sedated/anesthetized for routine annual care had intraoral dental radiographs and an oral examination performed. Age, gender, weight, and breed for each pig were recorded. Oral examination and radiographic findings were reviewed to create a comprehensive list of dental abnormalities identified. Descriptive statistics were performed to summarize the data. The study population included 14 castrated males and 20 Vietnamese pot-bellied mini-pigs. The median age was 3 years (range 2-12 years), and the median weight was 39 kg (range 11-140 kg). The most common finding was missing teeth (21/23 pigs); the first premolar tooth was the most likely to be absent (64/106 missing teeth). Periodontal disease was common (20/23 pigs). Advanced stages primarily affected the first molar teeth frequently in the form of a mucogingival defect. Supernumerary roots were discovered on the maxillary canine teeth in female pigs only (10/25 teeth with supernumerary roots). The most common persistent deciduous tooth was the maxillary second incisor (15/19 persistent deciduous teeth). Non-age or gender related open apices were most likely associated with mandibular first and second incisor teeth (26/96 teeth with open apices). Tooth resorption was also identified (7/23 pigs). The study findings prove that pet pigs commonly have dental pathology; therefore, thorough oral examinations with intraoral radiographs should be included in porcine routine health care regimens.

INTRAORAL DENTAL X-RAY RADIOGRAPHY IN BOSNIA AND HERZEGOVINA: STUDY FOR REVISING DIAGNOSTIC REFERENCE LEVEL VALUE

This paper presents the study that would allow a revision of the currently valid diagnostic reference level in intraoral dental X-ray radiography in Bosnia and Herzegovina. The study was conducted for six procedures that are used to capture incisor, premolar and molar teeth, of both maxilla and mandible, in adults. Measurements were performed on 41 intraoral X-ray devices, 20 of which were systems with digital image receptor and 21 film-based X-ray systems. In this study, incident air kerma (Ki) and air kerma-area product (PKA) were used as patient dose descriptors. The third quartile (Q3) of the measured incident air-kerma values was used to compare with the current national diagnostic reference level (DRL) for intraoral dental procedures. The obtained results of Q3 for both types of devices, with film-based and digital image receptors, have shown that the third quartile values are lower (3.5 and 1.2mGy, respectively) than the current national DRL (7.0mGy). Hence, new data can be used to re-establish the diagnostic reference levels in intraoral dental X-ray examinations in Bosnia and Herzegovina.

Radiation dose measurements in intraoral and panoramic dental radiography in the Southern Region of Saudi Arabia

Objective: This study aims to estimate patient radiation doses for intraoral and panoramic dental radiography in the southern region of Saudi Arabia. Material and Methods: For intraoral units, the radiation doses were measured in terms of incident air kerma, Ki, and the detector was placed at 50 cm from the focus point. For panoramic dental radiography, the radiation doses were measured in terms of air Kerma-area product, PKA, using a calibrated CT ionization chamber. Results: For intraoral, the values for the estimated incidence of air kerma, Ki, ranged from 1.25 to 4.61 mGy (average: 2.55 mGy). For panoramic, the values for estimated Kerma-area product, PKA, values ranged from 79.5 to 122.1 mGy.cm2 (average: 99 mGy.cm2) for adults and ranged from 43.3 to 80.2 mGy.cm2 (average: 58.5mGy.cm2) for paediatrics. Conclusion: The study’s outcomes were compared with previous studies from other countries, indicating similar or slightly higher values. These results could serve as baseline data for radiation protection optimization and the development of national diagnostic reference levels in Saudi Arabia.

Diagnostic reference levels in paediatric intra oral peri apical (IOPA) dental radiography at University Dental Hospital, Peradeniya

Dental radiography is a common diagnostic technique practiced among the paediatric patients visiting the dentist. Therefore, to abide the ALARA (as low as reasonably achievable) principal and reduce the undesired exposure especially for the pediatric patients the DRLs in paediatric intraoral periapical dental radiographs was developed using the patient entrance surface doses (ESD).

Trends in Estimated Thyroid, Salivary Gland, Brain, and Eye Lens Doses From Intraoral Dental Radiography Over Seven Decades (1940 TO 2009).

The purpose of this study is to support retrospective dose estimation for epidemiological studies by providing estimates of historical absorbed organ doses to the brain, lens of the eye, salivary glands, and thyroid from intraoral dental radiographic examinations performed from 1940 to 2009. We simulated organ doses to an adult over 10 y time periods from 1940 to 2009, based on commonly used sets of x-ray machine settings collected from the literature. Simulations to estimate organ dose were performed using personal computer x-ray Monte Carlo software. Overall, organ doses were less than 1 mGy for a single intraoral radiograph for all decades. From 1940 to 2009, doses to the brain, eye lens, salivary glands, and thyroid decreased by 86, 96, 95, and 89%, respectively. Of these four organs, the salivary glands received the highest doses, with values decreasing from about 0.23 mGy in the 1940s to 0.025 mGy in the 2000s for a single intraoral radiograph. Based on simulations using collected historical data on x-ray technical parameters, improvements in technology and optimization of the technical settings used to perform intraoral dental radiography have resulted in a decrease in absorbed dose to the brain, eye lens, salivary glands, and thyroid over the period from 1940 to 2009.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document.

The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. Several clinical-based recommendations and statements were agreed upon. There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).