No diagnostic benefit from routine screening with panoramic radiographs


More than 50% of dental practitioners are thought to use panoramic radiographs  to screen their new adult patients. While the UK Faculty of General Dental Practitioners recommend  the use of intra-oral radiographs  for the assessment of the adult dentate patient for the presence of caries, periodontal bone loss and apical pathology.  One of the aims of this study was to measure the added value of panoramic radiography in new dentate patients attending for routine treatment.

What did they do

37  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.

What did they find

  • 740 patients were examined(The majority in 18–24 and 25–34 age groups), 533 were pain free, 207 were experiencing some degree of pain.
  •  105 patients (14.2%) had no restorations and 385 (52.0%) had only simple restorations, (1.8%) had teeth with full coronal restorations, and (0.7%) had bridges.
  • 310 (42%) patients were found to be caries free at examination, 350 (47.3%) had between one and five caries lesions, 53 (7.2%) had between six and ten caries lesions, 20 (2.7%) had between eleven and fifteen caries lesions.
  •  A Basic Periodontal Examination( BPE) score of 4 or less in any sextant was recorded for 37 patients (6.2%).
  •  The dentists reported the presence of partially erupted teeth in 162 (21.9%) cases and 155 (20.9%) patients were assessed as having clinically suspected unerupted teeth.
  •  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.
  • 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.

They concluded

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

Rushton MN, Rushton VE. 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. J Dent. 2012 Apr 27. [Epub ahead of print] PubMed PMID: 22542499


The authors also pointed out that  5.1% of the panoramic films that were only of benefit because of:-  ‘deficiencies regarding the intraoral films, of which 27 were of such low contrast due to spent processing chemistry that they were unreadable and the other 11 were incorrectly positioned so that areas of clinical interest were not imaged’

This is an interesting study coming on the back of the recent reports  that linked  dental x-rays with meningioma and to me it further highlights the need to only take radiographs  following a thorough clinical examination and  further that we should favour the use of intra-oral films for caries and periodontal disease diagnosis as recommended by UK Faculty of General Dental Practitioners


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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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