Effects of healthcare policy and education on reading accuracy of bitewing radiographs for interproximal caries

Abstract

Objectives The aim of this study is to assess the accuracy of bitewing radiograph interpretation of predoctoral students, residents and general dentists who work under different core curriculum of dental education and healthcare policy. Methods A total of 118 examiners including predoctoral dental students, residents and general dentists from USA and Japan were tasked with evaluating a series of bitewing radiographs and diagnosing interproximal carious lesions. This study was approved by the Harvard Medical School Institutional Review Board (IRB). Participants graded interproximal aspects of those images and categorized the following criteria; “intact”, “enamel caries <1/2 width”, “enamel caries >1/2 width” or “caries into dentin”. The gold-standard was determined by the consensus of two HSDM full-time faculty. Results There was significant difference in the sensitivity for all three caries levels between the two groups but there was no significant difference on specificity. The positive-predictive and negative-predictive values of the USA group for the enamel caries (<1/2 of enamel) were significantly higher than the Japanese group. The average of AUC (ROC) was significantly higher in the USA group (0.885 ± 0.04) than the Japanese group (0.785 ± 0.08, p<0.01). Conclusion Teaching and adopting BW radiographs for diagnosis of interproximal caries is integral for dental providers to accurately and efficiently use them in their practices. It is critical that all dental educators approach policymakers to explain the importance of BW radiographs and promote their efficacy for prevention and early diagnosis of interproximal caries.

Importance of bitewing radiographs for the early detection of interproximal carious lesions and the impact on healthcare expenditure in Japan

“…Although there have been many developments in the methods of caries detection, including transillumination (6,7), quantitative light fluorescence (8), and laser fluorescence (9)(10)(11), radiographs are still the primary diagnostic tool for the detection of interproximal dental caries (12). Accurate reading of radiographs is paramount for caries detection (13). Bitewing radiographs (BWR) have been shown to be superior to periapical or panoramic radiographs for diagnosing interproximal carious lesions, particularly in the early stages of caries formation (14).…”