Economic and health implications of routine CBCT examination before surgical removal of the mandibular third molar in the Danish population

Abstract

Objectives: This epidemiological study aimed to analyse economical and societal consequences in Denmark if CBCT is used routinely as a diagnostic method before removal of the mandibular third molar. Furthermore, the aim was to calculate the excess cancer incidence from this practice. Methods: 17 representative dental clinics in the regions of Denmark were visited by two observers, who registered the total number of patients in each clinic, the number of removed mandibular third molars from patients' files together with the age and gender of these patients. The data were collected from 2008 to 2014. The total number of removed mandibular third molars in Denmark each year was derived from the collected data and information on patients' contacts with dentists from Statistics Denmark as a sum of contributions from each region. The contribution of a region was obtained as the number of removed mandibular third molars in the selected clinics in the region times the ratio of the number of patients in the selected clinics in the region to the total number of patients with contact to a general practitioner in the region in 2011. Existing knowledge on the costs for panoramic and CBCT imaging was used to calculate total costs. The cancer incidence was calculated from lifetime attributable risk curves based on linear risk assumptions. Results: The selected clinics included 109,686 patients, and 1369 mandibular third molars had been surgically removed. Using data from Statistics Denmark gave an estimated annual number of removed mandibular third molars of 36,882 at a total cost of €6,633,400. The additional cancer incidence was estimated to be approximately 0.46 per year. Conclusions: The data should be used in a cost-effectiveness analysis of the clinical efficacy of CBCT imaging before removal of mandibular third molars.

Efficacy of CBCT for assessment of impacted mandibular third molars: a review – based on a hierarchical model of evidence

“…One epidemiologic study estimated costs for a CBCT examination, if undertaken, in all dental clinics in the country before third molar removal. 71 17 randomly selected dental clinics in different regions of Denmark were visited by 2 observers, who registered the total number of patients in each clinic and the number of removed lower thirds molars. Approximately 1400 lower third molars were removed in a sample of 110,000 patients in these general dental practices.…”

Radiographic methods used before removal of mandibular third molars among randomly selected general dental clinics

“…The clinics were evenly distributed according to the population in the five administrative regions of DK. 5 The random selection of clinics represents the best epidemiological design to secure that sex, age, experience and other demographic variables of the included dentists are representative of all Danish dental practices. In this way, the results are representative and reproducible.…”

“…Data on economic issues and radiation exposure estimates to the patient have been reported in a recent article. 5 In comparison with that study, one more clinic was included in the present study.…”

“…2 Moreover, it has been documented that the use of CBCT is connected with higher costs and radiation to the patient than conventional methods. [4][5][6][7][8] Currently, no exact protocol of the radiographic examination of mandibular third molars exists, and therefore no strict guidelines for general practitioners (GPs) to follow have been advocated. 2 Before guidelines are issued, it may be of interest to know which radiographic protocols are actually used in practices, where removal of third molars is performed.…”

“…It may be assumed that third molars were evenly distributed according to tooth impaction state, root morphology and intimate relation to the mandibular canal among general dental clinics in DK; moreover, that one clinic in the study did not treat more "difficult" molars than others since specialist clinics were excluded. Thus, one could speculate that some of the clinics having CBCT used it more frequently because it was available and needed to be depreciated, 4,5 whereas others would stick to conventional equipment for other reasons, e.g. because they were still insecure with CBCT or because they had the opinion that CBCT examination does not provide enough benefit for the patient before removal of a third molar.…”