The Additional Information of Bitewing Radiographs in the Detection of Established or Severe Dentinal Decay in 14-Year Olds: A Cross-Sectional Study in Low-Caries Population

Abstract

Aim. To reveal the additional value of radiographic bitewings (BW) in detection of caries and in comparing the occurrence of clinically undetected severe decay between 14-year olds with and without clinically observed dentinal caries in a low-caries prevalence population. Design. The cross-sectional study used 363 pairs of radiographs read by one examiner without knowledge of the clinical findings. The yield was analyzed on a tooth surface level by cross tabulating the clinical and radiographic information and on an individual level by counting the number of yield surfaces for all subjects. Mann-Whitney U test was used. Results. On a tooth surface level, the contribution of BW was the greatest on the occlusal surfaces of the first molars, where established or severe dentinal decay was registered in BW in 11% of clinically sound surfaces and in 40% of established cavitated enamel lesions. On an individual level, 53% of subjects benefited from BW. The subjects clinically DMFS > 0 benefited more than the clinically DMFS = 0 subjects (P = .004), nearly 60% in relation to 47%, respectively. Conclusions. In a low-caries prevalence population a remarkable portion of both clinically DMFS = 0 and DMFS > 0 14-year olds benefit from BW examination. Most of the benefit is obtained on the occlusal surfaces of the first and the second permanent molars.

Awareness of bitewings among polish dentists

“…In Sweden and Norway, bitewings are routinely taken along with a clinical examination in 90% of patients. 4 In Poland, these X-rays are less common than periapical radiographs despite obvious indications. 7 In Poland, the panoramic radiograph is a more popular method of radiographic diagnosis than bitewing X-ray.…”

“…1,2 This is not easy in practice, because tooth caries develop slowly and do not produce any symptoms in the early stages. 3,4 As carious lesions are often present on the proximal surfaces, it is recommended to perform not only a visual and clinical examination but also use bitewing X-rays. [4][5][6] Other guidelines for taking such radiographs are examinations to determine if restorations are correct and to examine the periodontium.…”

“…3,4 As carious lesions are often present on the proximal surfaces, it is recommended to perform not only a visual and clinical examination but also use bitewing X-rays. [4][5][6] Other guidelines for taking such radiographs are examinations to determine if restorations are correct and to examine the periodontium. 1,2,[7][8][9][10] On a properly taken X-ray, the crowns of both upper and lower teeth and also their cervical areas are visible at the same time, but it is not possible to demonstrate root apices and periapical area 7,11 ( Fig.…”

“…The combination of these two methods significantly improves the chances of proper diagnosis. 4 If a dental caries is discovered early enough, it can easily be cured and in this way invasive treatment and excessive destruction of tooth hard tissue can probably be avoided. 1,12 Radiography increases the sensitivity of the visual examination, which is why it is now considered the best performing test available for discovering dental caries on proximal surfaces.…”

“…5 This method is a very useful diagnostic tool used in everyday dental practice. 1,4,14 The aim of the paper is to verify dentists' knowledge of bitewing radiographs, the awareness of the indications for its use and the frequency of referral for such examinations.…”