Dutch dentists' decisions to take bitewing radiographs

Abstract

A postal questionnaire was sent to a 10% (n = 444) national random sample of Dutch dental practitioners. The response was 77% (n = 344). The practitioners prescribed bitewings on average for 57% of "new" 25-yr-old patients. Five significant (P less than 0.05) variables explained 24% of the variation in bitewing prescribing for these "new" patients. These were, in declining level of importance: the initial dental condition of the patient, the proportion of restorative treatment decisions based solely on radiographs, the level of urbanization of the practice location, the technical level of the practice equipment and the importance attached by dentists to the diagnostic use of dental floss for interproximal caries diagnosis. The low power of the regression model in explaining variation in the decision to take bitewings indicates an idiosyncratic use of bitewing radiographs for caries diagnosis. A weak tendency to adopt different diagnostic sets of procedures was demonstrated.

Practice Characteristics Associated with Patient‐Specific Receipt of Dental Diagnostic Radiographs

“…Indeed, our earlier work (Gilbert, Coke et al 2004) showed a very strong effect due to clinical and sociodemographic characteristics, lending further evidence that practice-level studies should account for patient-level differences between practices. Our finding that clinical characteristics are strongly associated with dentists' variation in radiographic service rates, is consistent with conclusions made using dentists' responses to hypothetical scenarios (Matteson et al 1983;Mileman et al 1988). These findings are consistent with the notion (i.e., a necessary but not sufficient condition) that dentists are appropriately tailoring radiographic prescription to the clinical needs and disease risk of their patients, instead of prescribing on a regimen based on the time since last radiographic examination or other nonclinical reasons, which would not be in accord with recommended practice guidelines.…”

“…This circumstance could reflect the substantial expense of purchasing a PAN machine, as well as having a patient population that demands services that require a higher level of diagnostic detail and for which a PAN would therefore not be specific receipt of radiographic services. These findings underscore the distinction between what dentists hypothetically would prescribe based on responses to hypothetical scenarios when queried in questionnaires (Matteson et al 1983;Kaugars, Broga, and Collett 1985;Mileman et al 1988;Swan and Lewis 1993), compared with what is actually received. These results suggest that practitioners can and do influence receipt of diagnostic radiographic services, and are consistent with the notion that practitioners act in response to a combination of patients' interests, economic self-interests, and their own treatment preferences.…”

“…Some studies have proposed hypothetical scenarios and requested that dentists make recommendations about whether dental radiographs should be taken (Matteson et al 1983; Kaugars, Broga, and Collett 1985; Mileman et al 1988; Swan and Lewis 1993). Although much has been learned from these studies, one limitation has been that these studies queried what dentists would recommend in a hypothetical circumstance.…”

Validity and Reproducibility of Different Combinations of Methods for Occlusal Caries Detection: An in vitro Comparison

“…Other studies reported reproducibility ranging from substantial to excellent [Lussi et al, 1999;Pinelli et al, 2002]. Nevertheless, coeffi cients reported in different studies of caries detection cannot be directly compared, as differences in experimental design, in the number of scoring categories and especially the observers' background will infl uence the decisions and hence the results obtained [Espelid et al, 1985;Mileman and Espelid, 1988;Wenzel et al, 2000]. Even when the examiners are accurately trained, there is no guarantee that they will agree on diagnoses, since their decisions will be made based on knowledge and experience previously acquired [Bulman and Osborn, 1989], as observed in the current study.…”

Relationships between free smooth surface and proximal caries in the young permanent dentition

“…Gfowing concefn fegafding the biological effects of ionizing fadiation, how-evef, calls fof litnilation of fadiogfaphic exposufes. While fegulations fof use of fadiogfaphy in cafies diagnosis have been issued iti tnany countfies, decisions to suppletnent clinical examinations with bitewing fadiogfaphs afc often afbitfafy (13)(14)(15)(16)(17)(18)(19)(20)(21), feflecting pfofessiotial unceftainty about selection cfitefia in scheduling fadiogfaphic exatninations, Incfeased cafies fisk (22,23) and histofy of cafies expefience, specifically pfevious fadiogfaphic evidence of pfoxitnal lesions have been fecotntnended as indicatiotis to pcffoftn suppletnentafy fadiogfaphy (14,19,(23)(24)(25), ln absence of eaflier fadiogfaphs of in cases oflong intcfvals since pfevious examinations decisions to obtain bitewing fadiogfaphs are frequently based on clinical observations (17), a pfactice so faf supported by scafce feseafch evidence (12-28).…”