by Leif Kullman
About indications for dental radiographing
During he last decades dentistry has succeeded to steadily diminish the absorbed doses for our patients when we make radiographic investigations. This trend will continue in the future when digital equipements make their entrances in practices. The doses will be reduced to at least one third.
However, even during these circumstances the decision to conduct an investigation must be individualized and since a risk is involved the main ambition must always be to take radiographs only if a clinical indication has been found. There must exist a question at issue which is judged possible to answer after the radiological investigation, the overwhelming goal being to establish a treatment plan for the patient.
The following factors must all be evaluated before a judgment is taken about radiographing:
Age of the patient. The younger patient the more restrictive use
of radiographs should be carried out. In the same time the risk
for different diseases increases with age.
General health of the patient
Available previous radiographs ( existing may explain the
problem at hand)
Prevalence of the disease that may be diagnosed ( the
probability to find a disease should be acceptable high)
Caries: Radiographs are necessary for especially interproximal
caries. In low caries incidence cases annual radiographs are
not necessary.
Periodontitis: The importance of evaluating periodontal disease
with radiographs is proved and agreed upon. If there are clinical
findings of a more serious degree of the disease than gingivitis
radiographs are essential. Annual or even closer radiographs
may be necessary in cases where failure to halt the marginal
bone destruction exist.
Finally the consequences of undetected and thereby untreated disease must be evaluated. Thus for example, are the consequences of caries very small compared with the consequences of an undetected malignant disease. If clinical findings indicate a malignancy, an elaborated investigation with all possible methods should be carried out preferably by specialists. Usually it is well defined visible differences between benign and malign diseases in our radiographs.
Next month I will tell you more about a new imaging method MRI ( magnetic resonance imaging) and its potential for diagnosing pathology in for example the temporomandibular joint.
Leif Kullman
