This document discusses appropriate intervals between bitewing X-ray examinations for schoolchildren based on their caries risk. The authors analyzed longitudinal data from 591 Swiss schoolchildren examined every 4 years. They found that 7-year-olds without caries experience had a low 2.2% caries risk, while those with experience had a higher 24.2% risk. Similarly, 11-year-olds without experience had a 7.5% risk versus 38.5% for those with experience. Based on these risks, the authors propose an 8-year interval for 7-year-olds without experience, and 1 year for those with experience.
Digital technologies have enabled new methods for diagnosing dental caries beyond traditional visual and tactile exams. Fiber-optic transillumination uses light passed through the tooth to detect shadows from demineralized areas. Digital imaging fiber-optic transillumination captures and stores transillumination images. Intraoral cameras provide magnified views of the mouth to examine hard and soft tissues. Electrical conductance methods measure differences in conductivity between sound and demineralized tooth structure to identify caries. Recent advances have improved sensitivity and specificity for early caries detection compared to conventional techniques.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
This study aimed to determine the prevalence of impacted maxillary canines in the Palestinian population visiting a dental center in Israel between 2006-2013. The researchers examined 4250 patient records and found an overall prevalence of impacted canines to be 3.7%, higher than previous studies. Specifically, the prevalence was 0.8% in males and 1.1% in females, suggesting a higher rate in females. Most impacted canines were palatally positioned. The results differed slightly from other studies, possibly due to differences in sample selection, study methods, and patient populations examined. Accurate assessment of an impacted canine's position is important to determine the appropriate treatment approach.
This study examined the prevalence of impacted maxillary canines in the Arab population in Israel. The researchers reviewed records of 4250 patients and found 82 cases of impacted canines, a prevalence of 3.7%. Females had a higher prevalence than males, at 1.1% versus 0.8%. Most cases were unilateral, with the left side being more commonly impacted. The results suggest racial and genetic factors may influence canine impaction rates, as this population had a higher prevalence than previous studies in other areas. Early diagnosis and treatment of impacted canines can help guide them into proper alignment and avoid more complex treatment needs.
The document reviews various methods for localizing impacted canines, noting that early diagnosis is important to prevent impaction. Clinical examination and various radiographic techniques like panoramic radiographs, periapical views, and cephalograms can be used to locate displaced canines. Advanced 3D imaging modalities like CT, spiral CT, and CBCT are also discussed which provide more accurate 3D localization of impacted canines compared to conventional 2D radiography.
This document discusses various methods for analyzing dental casts and radiographs to predict the size of unerupted teeth during mixed dentition, including Moyer's analysis, Tanaka-Johnston analysis, Ballard-Wylie analysis, and the use of prediction charts combined with radiographs like the Hixon-Oldfather method. It provides details on the procedures, advantages, and limitations of each approach. Mixed dentition analysis is important for orthodontic diagnosis and treatment planning to determine if space needs to be maintained, gained, or if extractions will be required.
This study evaluated the periodontal health status and prevalence of root caries in 200 Brazilian adults in Aracaju city. The outcomes demonstrated a mean of 4.54% missing teeth per patient, 29.72% bleeding score, 1.26 root caries, and a 9.21% root caries index. The most prevalent periodontal screening and recording scores were 2 for the mandibular sextants and 0-1 for other sextants, indicating gingivitis as the most common finding. Based on these results, the prevalence of periodontal disease and root caries was low in this population.
Digital technologies have enabled new methods for diagnosing dental caries beyond traditional visual and tactile exams. Fiber-optic transillumination uses light passed through the tooth to detect shadows from demineralized areas. Digital imaging fiber-optic transillumination captures and stores transillumination images. Intraoral cameras provide magnified views of the mouth to examine hard and soft tissues. Electrical conductance methods measure differences in conductivity between sound and demineralized tooth structure to identify caries. Recent advances have improved sensitivity and specificity for early caries detection compared to conventional techniques.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs
Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel,
4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec
2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental
records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6
(N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of
impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for
maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies.
The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample
selection, method of the study and area of patient selection, which suggest racial and genetic differences.
This study aimed to determine the prevalence of impacted maxillary canines in the Palestinian population visiting a dental center in Israel between 2006-2013. The researchers examined 4250 patient records and found an overall prevalence of impacted canines to be 3.7%, higher than previous studies. Specifically, the prevalence was 0.8% in males and 1.1% in females, suggesting a higher rate in females. Most impacted canines were palatally positioned. The results differed slightly from other studies, possibly due to differences in sample selection, study methods, and patient populations examined. Accurate assessment of an impacted canine's position is important to determine the appropriate treatment approach.
This study examined the prevalence of impacted maxillary canines in the Arab population in Israel. The researchers reviewed records of 4250 patients and found 82 cases of impacted canines, a prevalence of 3.7%. Females had a higher prevalence than males, at 1.1% versus 0.8%. Most cases were unilateral, with the left side being more commonly impacted. The results suggest racial and genetic factors may influence canine impaction rates, as this population had a higher prevalence than previous studies in other areas. Early diagnosis and treatment of impacted canines can help guide them into proper alignment and avoid more complex treatment needs.
The document reviews various methods for localizing impacted canines, noting that early diagnosis is important to prevent impaction. Clinical examination and various radiographic techniques like panoramic radiographs, periapical views, and cephalograms can be used to locate displaced canines. Advanced 3D imaging modalities like CT, spiral CT, and CBCT are also discussed which provide more accurate 3D localization of impacted canines compared to conventional 2D radiography.
This document discusses various methods for analyzing dental casts and radiographs to predict the size of unerupted teeth during mixed dentition, including Moyer's analysis, Tanaka-Johnston analysis, Ballard-Wylie analysis, and the use of prediction charts combined with radiographs like the Hixon-Oldfather method. It provides details on the procedures, advantages, and limitations of each approach. Mixed dentition analysis is important for orthodontic diagnosis and treatment planning to determine if space needs to be maintained, gained, or if extractions will be required.
This study evaluated the periodontal health status and prevalence of root caries in 200 Brazilian adults in Aracaju city. The outcomes demonstrated a mean of 4.54% missing teeth per patient, 29.72% bleeding score, 1.26 root caries, and a 9.21% root caries index. The most prevalent periodontal screening and recording scores were 2 for the mandibular sextants and 0-1 for other sextants, indicating gingivitis as the most common finding. Based on these results, the prevalence of periodontal disease and root caries was low in this population.
This study evaluated the diagnostic accuracy of cone beam computed tomography (CBCT) and panoramic radiography in predicting exposure of the inferior alveolar nerve during third molar extraction surgery. The study assessed 59 impacted third molar extraction sites, examining pre-operative panoramic and CBCT images for signs suggesting nerve exposure. During surgery, actual nerve exposure was evaluated and compared to the radiographic predictions. CBCT correctly classified nerve exposure in 93.3% of cases, significantly more accurately than panoramic radiography which correctly classified 67.7% of cases. CBCT demonstrated high sensitivity, specificity, and predictive values, while panoramic radiography had lower sensitivity but high positive predictive value. This study indicates CB
Forensic dentistry is the complete evaluation and examination of dental evidence to aid in administration of criminal as well as civil justice.
Medicolegal significance of teeth, bite marks, dental development ( from neonates to adults and changes at old age )
Used for identification, racial significance in mass disasters, mutilated bodies, DNA analysis, toxicological analysis in cases of poisoning.
Age estimation in civil cases, solving discrepancy of age for athletes playing sports for national and international academy.
various others importance too.
This document provides an overview of dental radiology, including its history, physics, biology, techniques, and safety considerations. It discusses the components of dental x-ray machines and how they produce images. Film types, positioning, and normal anatomy are described for various intraoral and extraoral views like bitewings, periapicals, occlusals, and panoramic radiographs. Pediatric radiographic guidelines and factors affecting radiation dose are also summarized. The document aims to inform dental professionals about best practices in dental radiography.
This case report describes a 3-year-old child who suffered craniofacial trauma due to a wall collapse. The child presented with critical injuries including a laceration to the face, fractures to the mandible, occipital bone, and temporal bone. Computed tomography scans revealed displaced fractures of the mandible as well as fractures to the base of the skull. Due to the severity and need for ventilation, the child was referred to a higher level trauma center for multidisciplinary management and treatment of the craniofacial injuries.
The document discusses the history and development of dental radiography techniques, provides guidelines for selecting appropriate radiographs for pediatric patients based on their age and dental development, and describes commonly used intraoral and extraoral radiographic techniques including advantages and indications for each. It also covers topics like digital radiography, cone beam computed tomography, and radiation safety protocols.
This document discusses various methods of mixed dentition analysis used to predict the size of unerupted permanent teeth during childhood. It describes Moyer's, Tanaka Johnston, Hixon-Oldfather, Nance, Ballard and Wylie, and Huckaba methods. Each method uses dental casts and sometimes radiographs to measure erupted teeth and predict unerupted tooth sizes using regression equations or charts. The most accurate methods are Hixon-Oldfather and refinements like Staley-Kerber, but other methods may be more practical or applicable to different populations.
Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic...Quách Bảo Toàn
This study evaluated the diagnostic ability to differentiate between ameloblastoma and odontogenic keratocyst using different imaging modalities and observers with varying levels of experience. Six oral radiologists diagnosed 83 cases using panoramic radiograph only, CT only, or both combined. Their ability to differentiate the lesions was assessed using ROC analysis. Experienced observers performed best when using both panoramic and CT images together, followed by CT only, and worst with panoramic only. Less experienced observers performed worst with CT only. Combining imaging modalities and experience level of observers can improve accurate differentiation of these lesions.
This study evaluated the clinical and radiographic outcomes of diode laser pulpotomy compared to formocresol pulpotomy in human primary teeth. A total of 40 teeth in 14 children were randomly assigned to receive either diode laser pulpotomy or formocresol pulpotomy. At 6-month and 12-month follow-ups, both treatments showed high clinical success rates of 100%, but the diode laser group had slightly lower radiographic success rates of 95% at 6 months and 90% at 12 months compared to 100% for the formocresol group. However, the differences in success rates between the two treatments were not statistically significant. This study suggests that diode laser pulpotomy may be an effective alternative to traditional formoc
Dental Patterns in Peruvians: A Panoramic Radiography StudyIván E Pérez
The dental pattern is defined as the combination of distinct codes assigned to describe specific tooth conditions including virgin, missing, and restored teeth that comprise the complete dentition or from discrete groups of teeth. This pattern can be then compared to the dentition of individual/s in an attempt to determine positive identification. The aims of the present investigation were to study and determine the diversity of dental patterns in Peruvian citizens based on a sample of panoramic radiographs. Digital panoramic radiographs of 900 adult Peruvian patients (450 female and 450 male) were evaluated to determine the dental patterns. The most frequent dental patterns found in the complete dentition, maxillae, upper-anterior and lower-anterior sextants were all-virgin-teeth (0.3%), all-extracted teeth (1.9%), all-virgin teeth (1%) and all-virgin-teeth (34.2% and 72.3%) respectively. The diversity was calculated by the use of the Simpson´s diversity index, the resulting values for the full-dentition, maxilla and mandible were over the 99.8% value and were similar to those previously reported in the scientific literature. This study demonstrates the positive benefit of dental patterns in the process of identification. Additionally a combination of codes is proposed that could prove useful in cases where a better radiographic description is required.
This study analyzed 66 patients with mandibular fractures to determine patterns and epidemiology in Lucknow, India. The highest percentage of fractures occurred in patients ages 21-30, who were predominantly male. Road traffic accidents were the primary cause, with the parasymphysis as the most common fracture site. The most frequent fracture combination involved the parasymphysis and subcondyle. While most fractures occurred singly, the number of fracture sites correlated with younger and older age groups.
This study compared two radiographic techniques - vertical parallax and magnification - for localizing impacted maxillary canines. Six examiners used each technique to predict the position of 133 impacted canines based on panoramic and occlusal radiographs. Their predictions were compared to the actual positions identified during surgery. Localization was more successful using vertical parallax (76% correct) than magnification (66% correct), though the difference was not significant. Both techniques correctly identified almost 90% of palatally impacted canines, but less than half of buccally impacted canines could be detected using parallax and only 10% using magnification. The study suggests vertical parallax may be slightly better but neither technique is clearly superior, and additional views are
This study examined the association between darkening of third molar roots seen on preoperative panoramic radiographs and exposure of the inferior alveolar nerve during surgery. 116 patients with darkening of third molar roots were selected as the case group, and 193 patients with other high-risk radiographic signs near the roots were selected as the control group. The nerve was exposed in 27.6% of cases with isolated darkening and 7.8% of controls. Darkening alone or with other signs significantly increased the risk of nerve exposure compared to other signs alone. Having both darkening and other adjacent signs carried the greatest risk of exposure compared to darkening alone or other signs alone or combined. Differentiating between isolated dark
This study examined the association between darkening of third molar roots seen on preoperative panoramic radiographs and exposure of the inferior alveolar nerve during surgery. 116 patients with darkening of third molar roots were selected as the case group, and 193 patients with other high-risk radiographic signs near the roots were selected as the control group. The nerve was exposed in 27.6% of cases with isolated darkening and 7.8% of controls. Darkening alone or with other signs significantly increased the risk of nerve exposure compared to other signs alone. The risk was greatest for darkening accompanied by other adjacent signs, with an odds ratio over 5 times higher than for other signs alone. This suggests differentiating
2.tahrir n. aldelaimi article the evaluation of impacted third molars using...MohammedAbdulhammed
Tahrir N. Aldelaimi's ( dean of college of dentistry / Anbar University ) Published paper Show plagiarized paragraph (High light ) from article belong to Faiez N. Hattab, Ma'amon A. Rawashdeh and Mourad S. Fahmy
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
This document discusses various methods of mixed dentition analysis used to predict the size and space needed for unerupted permanent teeth based on measurements of erupted primary and permanent teeth. It describes Nance analysis, Huckaba's method, Moyer's analysis, Tanaka Johnston analysis, Hixon-Oldfather prediction method, and Staley and Kerber method. The document emphasizes that mixed dentition analysis helps evaluate space availability and plan treatment during the transition from primary to permanent dentition.
1) The study assessed the reliability of panoramic radiographs in determining the relationship between impacted mandibular third molars and the mandibular canal by comparing panoramic findings to CBCT scans.
2) Panoramic radiographic markers such as interrupted white lines and darkened tooth roots were statistically associated with direct contact between teeth and the mandibular canal as seen on CBCT.
3) Horizontal and mesioangular impactions showed the strongest association with direct contact between teeth and the mandibular canal, increasing the risk of nerve injury during extraction.
This study evaluated the diagnostic accuracy of cone beam computed tomography (CBCT) and panoramic radiography in predicting exposure of the inferior alveolar nerve during third molar extraction surgery. The study assessed 59 impacted third molar extraction sites, examining pre-operative panoramic and CBCT images for signs suggesting nerve exposure. During surgery, actual nerve exposure was evaluated and compared to the radiographic predictions. CBCT correctly classified nerve exposure in 93.3% of cases, significantly more accurately than panoramic radiography which correctly classified 67.7% of cases. CBCT demonstrated high sensitivity, specificity, and predictive values, while panoramic radiography had lower sensitivity but high positive predictive value. This study indicates CB
Forensic dentistry is the complete evaluation and examination of dental evidence to aid in administration of criminal as well as civil justice.
Medicolegal significance of teeth, bite marks, dental development ( from neonates to adults and changes at old age )
Used for identification, racial significance in mass disasters, mutilated bodies, DNA analysis, toxicological analysis in cases of poisoning.
Age estimation in civil cases, solving discrepancy of age for athletes playing sports for national and international academy.
various others importance too.
This document provides an overview of dental radiology, including its history, physics, biology, techniques, and safety considerations. It discusses the components of dental x-ray machines and how they produce images. Film types, positioning, and normal anatomy are described for various intraoral and extraoral views like bitewings, periapicals, occlusals, and panoramic radiographs. Pediatric radiographic guidelines and factors affecting radiation dose are also summarized. The document aims to inform dental professionals about best practices in dental radiography.
This case report describes a 3-year-old child who suffered craniofacial trauma due to a wall collapse. The child presented with critical injuries including a laceration to the face, fractures to the mandible, occipital bone, and temporal bone. Computed tomography scans revealed displaced fractures of the mandible as well as fractures to the base of the skull. Due to the severity and need for ventilation, the child was referred to a higher level trauma center for multidisciplinary management and treatment of the craniofacial injuries.
The document discusses the history and development of dental radiography techniques, provides guidelines for selecting appropriate radiographs for pediatric patients based on their age and dental development, and describes commonly used intraoral and extraoral radiographic techniques including advantages and indications for each. It also covers topics like digital radiography, cone beam computed tomography, and radiation safety protocols.
This document discusses various methods of mixed dentition analysis used to predict the size of unerupted permanent teeth during childhood. It describes Moyer's, Tanaka Johnston, Hixon-Oldfather, Nance, Ballard and Wylie, and Huckaba methods. Each method uses dental casts and sometimes radiographs to measure erupted teeth and predict unerupted tooth sizes using regression equations or charts. The most accurate methods are Hixon-Oldfather and refinements like Staley-Kerber, but other methods may be more practical or applicable to different populations.
Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic...Quách Bảo Toàn
This study evaluated the diagnostic ability to differentiate between ameloblastoma and odontogenic keratocyst using different imaging modalities and observers with varying levels of experience. Six oral radiologists diagnosed 83 cases using panoramic radiograph only, CT only, or both combined. Their ability to differentiate the lesions was assessed using ROC analysis. Experienced observers performed best when using both panoramic and CT images together, followed by CT only, and worst with panoramic only. Less experienced observers performed worst with CT only. Combining imaging modalities and experience level of observers can improve accurate differentiation of these lesions.
This study evaluated the clinical and radiographic outcomes of diode laser pulpotomy compared to formocresol pulpotomy in human primary teeth. A total of 40 teeth in 14 children were randomly assigned to receive either diode laser pulpotomy or formocresol pulpotomy. At 6-month and 12-month follow-ups, both treatments showed high clinical success rates of 100%, but the diode laser group had slightly lower radiographic success rates of 95% at 6 months and 90% at 12 months compared to 100% for the formocresol group. However, the differences in success rates between the two treatments were not statistically significant. This study suggests that diode laser pulpotomy may be an effective alternative to traditional formoc
Dental Patterns in Peruvians: A Panoramic Radiography StudyIván E Pérez
The dental pattern is defined as the combination of distinct codes assigned to describe specific tooth conditions including virgin, missing, and restored teeth that comprise the complete dentition or from discrete groups of teeth. This pattern can be then compared to the dentition of individual/s in an attempt to determine positive identification. The aims of the present investigation were to study and determine the diversity of dental patterns in Peruvian citizens based on a sample of panoramic radiographs. Digital panoramic radiographs of 900 adult Peruvian patients (450 female and 450 male) were evaluated to determine the dental patterns. The most frequent dental patterns found in the complete dentition, maxillae, upper-anterior and lower-anterior sextants were all-virgin-teeth (0.3%), all-extracted teeth (1.9%), all-virgin teeth (1%) and all-virgin-teeth (34.2% and 72.3%) respectively. The diversity was calculated by the use of the Simpson´s diversity index, the resulting values for the full-dentition, maxilla and mandible were over the 99.8% value and were similar to those previously reported in the scientific literature. This study demonstrates the positive benefit of dental patterns in the process of identification. Additionally a combination of codes is proposed that could prove useful in cases where a better radiographic description is required.
This study analyzed 66 patients with mandibular fractures to determine patterns and epidemiology in Lucknow, India. The highest percentage of fractures occurred in patients ages 21-30, who were predominantly male. Road traffic accidents were the primary cause, with the parasymphysis as the most common fracture site. The most frequent fracture combination involved the parasymphysis and subcondyle. While most fractures occurred singly, the number of fracture sites correlated with younger and older age groups.
This study compared two radiographic techniques - vertical parallax and magnification - for localizing impacted maxillary canines. Six examiners used each technique to predict the position of 133 impacted canines based on panoramic and occlusal radiographs. Their predictions were compared to the actual positions identified during surgery. Localization was more successful using vertical parallax (76% correct) than magnification (66% correct), though the difference was not significant. Both techniques correctly identified almost 90% of palatally impacted canines, but less than half of buccally impacted canines could be detected using parallax and only 10% using magnification. The study suggests vertical parallax may be slightly better but neither technique is clearly superior, and additional views are
This study examined the association between darkening of third molar roots seen on preoperative panoramic radiographs and exposure of the inferior alveolar nerve during surgery. 116 patients with darkening of third molar roots were selected as the case group, and 193 patients with other high-risk radiographic signs near the roots were selected as the control group. The nerve was exposed in 27.6% of cases with isolated darkening and 7.8% of controls. Darkening alone or with other signs significantly increased the risk of nerve exposure compared to other signs alone. Having both darkening and other adjacent signs carried the greatest risk of exposure compared to darkening alone or other signs alone or combined. Differentiating between isolated dark
This study examined the association between darkening of third molar roots seen on preoperative panoramic radiographs and exposure of the inferior alveolar nerve during surgery. 116 patients with darkening of third molar roots were selected as the case group, and 193 patients with other high-risk radiographic signs near the roots were selected as the control group. The nerve was exposed in 27.6% of cases with isolated darkening and 7.8% of controls. Darkening alone or with other signs significantly increased the risk of nerve exposure compared to other signs alone. The risk was greatest for darkening accompanied by other adjacent signs, with an odds ratio over 5 times higher than for other signs alone. This suggests differentiating
2.tahrir n. aldelaimi article the evaluation of impacted third molars using...MohammedAbdulhammed
Tahrir N. Aldelaimi's ( dean of college of dentistry / Anbar University ) Published paper Show plagiarized paragraph (High light ) from article belong to Faiez N. Hattab, Ma'amon A. Rawashdeh and Mourad S. Fahmy
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
This document discusses various methods of mixed dentition analysis used to predict the size and space needed for unerupted permanent teeth based on measurements of erupted primary and permanent teeth. It describes Nance analysis, Huckaba's method, Moyer's analysis, Tanaka Johnston analysis, Hixon-Oldfather prediction method, and Staley and Kerber method. The document emphasizes that mixed dentition analysis helps evaluate space availability and plan treatment during the transition from primary to permanent dentition.
1) The study assessed the reliability of panoramic radiographs in determining the relationship between impacted mandibular third molars and the mandibular canal by comparing panoramic findings to CBCT scans.
2) Panoramic radiographic markers such as interrupted white lines and darkened tooth roots were statistically associated with direct contact between teeth and the mandibular canal as seen on CBCT.
3) Horizontal and mesioangular impactions showed the strongest association with direct contact between teeth and the mandibular canal, increasing the risk of nerve injury during extraction.
Similar to Rischi di carie e intervalli appropriati tra gli esami radiografici bitewing in età scolare (20)
The document summarizes a study that investigated the effects of iron supplementation alone and in combination with vitamins on hematological status, oxidative stress, and erythrocyte membrane fluidity in anemic pregnant women. 164 anemic pregnant women were randomly assigned to receive placebo, iron alone, iron with folic acid, or iron with folic acid, retinol, and riboflavin for 2 months. The study found that supplementation significantly increased hemoglobin and ferritin levels and decreased oxidative stress markers in all treatment groups compared to placebo. Erythrocyte membrane fluidity also increased with supplementation.
Mitochondrial dysfunction and oxidative damage are thought to play a role in Parkinson's disease (PD) pathogenesis. Recent animal studies show that inhibiting mitochondrial complex I with rotenone closely mimics PD's biochemical and histological features. Several agents like creatine, coenzyme Q10, and acetyl-L-carnitine have shown benefits in animal models by modulating energy metabolism and reducing oxidative stress. These agents warrant further study as potential neuroprotective treatments for PD.
La conduzione del nervo surale dorsale in pazienti con carenza di vitamina B1...MerqurioEditore_redazione
This study investigated peripheral neuropathy in vitamin B12 deficient patients with megaloblastic anemia using dorsal sural nerve conduction studies and tibial sensory-evoked potentials. Dorsal sural nerve responses were absent in over half of patients but only one third had abnormalities on conventional nerve conduction studies. Patients with recordable dorsal sural nerves had prolonged latencies, reduced amplitudes, and slower conduction velocities compared to controls, suggesting dorsal sural nerve conduction is more sensitive for detecting early neuropathy. Over 70% of patients showed evidence of myelopathy on tibial sensory-evoked potentials and neurological examination.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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Rischi di carie e intervalli appropriati tra gli esami radiografici bitewing in età scolare
1. Marcel Steiner Caries risks and appropriate
Saskia Bühlmann
Giorgio Menghini
Carola Imfeld
intervals between bitewing
Thomas Imfeld
Clinic for Preventive Dentistry,
X-ray examinations
in schoolchildren
Periodontology and Cariology,
Center of Dental Medicine,
University of Zurich
Corresponding author
Dr. med. dent. M. Steiner Key words: bitewing X-ray examination, X-ray interval, approximal caries,
Preventive Dentistry and caries risk, schoolchildren
Oral Epidemiology
Center of Dental Medicine
University of Zurich
Plattenstrasse 11
8032 Zurich, Switzerland
Tel. (01) 634 34 82
Fax (01) 634 43 01 Summary Short intervals between bitewing was 7.1%, i. e., the caries risk in the population
E-mail: marcel.steiner@zzm.uzh.ch examinations favor the timely detection of was 7.1%. In the 11-year-olds, the caries risk
Schweiz Monatsschr Zahnmed 121: lesions on approximal surfaces. Long intervals was 17.6%.
12–18 (2011) reduce the exposure to radiation. Thus, the Seven-year-olds without caries experience on
Accepted for publication: question arises which intervals between bite- selected approximal surfaces had a low caries
10 June 2010
wing examinations are appropriate. risk of 2.2%. However, 7-year-olds with caries
The length of intervals between bitewing ex- experience on selected approximal surfaces
aminations should be adapted to the caries had a high risk of 24.2%.The same applied to
risk on approximal surfaces of molars and 11-year-olds: those without caries experience
premolars. In order to estimate the caries risk had a low risk (7.5%), and those with caries
in the Swiss school population, longitudinal experience had a high risk (38.5%).
data of 591 schoolchildren from the Canton For the 7-year-old schoolchildren without any
(County) of Zurich were analyzed. These caries experience, an X-ray interval of 8 years
schoolchildren had been examined at 4-year is proposed. For the 7-year-old schoolchildren
intervals. with caries experience, an X-ray interval of
The proportion of 7-year-olds with caries in- 1 year is proposed.
crement on approximal surfaces within 4 years
Introduction lion intraoral dental X-ray images produced (European Com-
mission 2004). The risk must be multiplied by a factor of 3 for
Bitewing X-ray images play an important role in the detection children under 10 years, and by a factor of 2 for children and
of approximal caries on molars and premolars. A review (Pitts adolescents between 10 and 20 years (European Commission
& Kidd 1990) showed that around half of the lesions were de- 2004). However, it should be noted that people are also ex-
tected only thanks to bitewing X-ray images. Two more recent posed to natural ionizing radiation (background radiation).
studies (Machiulskiene et al. 1999, Machiulskiene et al. 2004) The exposure from two bitewing X-ray images is equivalent to
are of particular interest because, despite a meticulous clinical the exposure from background radiation over a one-day period
examination, 24–26% of enamel lesions and 38–44% of dentin (European Commission 2004).
lesions were detected only by radiological means. The percent- Short X-ray intervals (the time period between bitewing
ages are based on the total number of lesions detected clini- X-ray examinations) favor the timely detection of lesions on
cally and/or radiologically. approximal surfaces. Long X-ray intervals reduce the exposure
The use of ionizing radiation is associated with risks. The risk to radiation. Thus, the question arises as to which intervals
of death from cancer is estimated at 0.02–0.6 deaths per mil- between bitewing X-ray examinations are appropriate.
12 Schweiz Monatsschr Zahnmed Vol. 121 1/2011
2. The dental literature offers various recommendations for the The approximal surfaces of the permanent molars and pre-
length of intervals between bitewing X-ray examinations (Pitts molars were assessed as follows:
& Kidd 1992, Espelid et al. 2003, European Commission 2004, – No radiolucency = Healthy
American Dental Association 2004, Schweizerische Zahn- – Radiolucency in the outer half of the enamel = D1
ärzte-Gesellschaft [Swiss dental association] 2005). In each – Radiolucency in the inner half of the enamel = D2
case, the length of the X-ray intervals was based on the caries – Radiolucency in the dentin = D3
risk. – Radiolucency in the dentin at the margin of a filled approxi-
A whole range of studies (Lith & Gröndahl 1992, Lith et al. mal surface = D4
2002, Stenlund et al. 2002, Sköld et al. 2005, David et al. – Extracted = M
2006) reported that the caries risk on approximal surfaces in – Filled = F
adolescents depended on whether or not they had already had – Unassessable = X
caries experience on approximal surfaces.
The approximal surfaces of the primary molars were assessed
The present study had the following objectives: as follows:
1) To estimate the risk for approximal caries on permanent – No radiolucency = Healthy
molars and premolars in the Swiss school population. – Radiolucency in the enamel = d12
2) To estimate the risks for approximal caries in schoolchildren – Radiolucency in the dentin = d34
with and without caries experience on approximal surfaces. – Missing = m
3) To propose intervals between bitewing X-ray examinations – Filled = f
based on these caries risks. – Unassessable = x
Materials and methods All bitewing X-ray images were analyzed by one and the same
employee of the Oral Epidemiology department (M. S.). To
Material assess the reliability the X-ray images of a portion of the sub-
The data were obtained from schoolchildren from 16 rural jects (N = 242) were analyzed a second time.
communities of the Canton (County) of Zurich. In these com-
munities, caries epidemiological studies were undertaken every Statistical evaluation
4 years (Menghini et al. 2003). The schoolchildren in each The target variable “caries increment” was generated for each
community were randomly selected. In order to obtain suffi- schoolchild. This measures the quantity of new radiolucencies
cient longitudinal data, the schoolchildren who had been se- extending into the dentin and/or fillings (new D34FS) appearing
lected were asked to return for another examination in 4 years’ on the approximal surfaces of the molars and premolars within
time. Schoolchildren with fixed appliances in both the maxilla 4 years (maximum = 24). So-called “reversals” (transitions from
and in the mandible were excluded. There were two longitu- D3/D4/F to Sound/D1/D2) were subtracted (net increment).
dinal data sets: data set A (children examined in 1995/1996 The target variable was dichotomized (new D34FS = 0/> 0).
and 2000), and data set B (children examined in 2000 and
2004/2005). It was possible to combine both data sets into a Predictor variables were generated for each child. They measure
single data set, because there were no statistical differences the caries experience at the first examination on selected ap-
between them (Steinegger 2008). proximal surfaces:
Two age groups were extracted, one group with the youngest – D14F6mes = Number of carious (D1, D2, D3, D4) or filled
possible age at the start (6.5–8.0 years) and one group with the mesial surfaces on the first permanent molars (max. = 4)
highest possible age at the start (10.0–12.0 years). The 6.5- to – D14FS = Number of carious (D1, D2, D3, D4) or filled ap-
8.0-year-olds had an average age of 7.33 years; in the following, proximal surfaces on the permanent molars and premolars
they will be referred to as 7-year-olds. The 10.0- to 12.0-year- (max. = 24)
olds had an average age of 10.78 years; in the following, they – d14mf5dis = Number of carious (d12, d34), filled, or missing
will be referred to as 11-year-olds. distal surfaces on the second primary molars (max. = 4)
A total of 296 7-year-olds and 295 11-year-olds were studied. – d14mfs = Number of carious (d12, d34), filled, or missing
approximal surfaces on the primary molars (max. = 12)
Method – D34FS = Number of carious (D3, D4) or filled approximal
The standardized method (Marthaler 1966) records the condi- surfaces on the permanent molars and premolars (max. = 24)
tion of 92 predilection sites. The approximal surfaces of the
posterior teeth were analyzed using bitewing X-ray images. A Predictors were generated by combining and dichotomizing the
maximum of 12 approximal surfaces of the primary molars predictor variables. These predictors have two categories (with-
(second primary molar distal to first primary molar distal), and out/with caries experience):
a maximum of 24 approximal surfaces of the permanent mo- Predictor A
lars and premolars (second molar mesial to first premolar – D14F6mes = 0 and d14mf5dis = 0
distal) were assessed. – D14F6mes > 0 and/or d14mf5dis > 0
Digital bitewing X-ray images were produced (Digora, Orion
Corporation Soredex, Helsinki, Finland). The images were Predictor B
produced using a 0.65-KV X-ray machine, HDX Intraoral X-ray – D14F6mes = 0
(DentalEZ, Lancaster, PA, USA), with an exposure time of – D14F6mes >0
0.12 seconds. The imaging plates were fixed in a support at a
right angle to the radiation beam. The X-ray images were ana- Predictor C
lyzed in a darkened room on a FlexScan L768-type screen (EIZO – d14mf5dis = 0
Nanao Corporation, Ishikawa, Japan) using Digora 2.5 software. – d14mf5dis > 0
Schweiz Monatsschr Zahnmed Vol. 121 1/2011 13
3. Predictor D
– d14mfs = 0 faces. In this group, 24.2% of the schoolchildren exhibited
– d14mfs > 0 caries increment. The sensitivity of the predictor A was 0.76,
the specificity was 0.82, Youden’s J was 0.58; the negative
Predictor E predictive value was 0.98 and the positive predictive value was
– D14FS = 0 0.24. The predictors B, C, and D were less powerful (Youden’s
– D14FS > 0 J 0.48, 0.45, and 0.29).
The proportion of 11-year-olds with caries increment was
Predictor F 17.6% (Tab. II). Using predictor B, schoolchildren were divided
– D34FS = 0 into those with and those without caries experience (at the
– D34FS > 0 first examination) on the mesial surfaces of the first permanent
molars. A total of 67.5% of the schoolchildren had no caries
The reliability of the measurements was assessed using kappa on any of the four surfaces at baseline. In this group, 7.5% of
statistics. The predictive power of the predictors was assessed the schoolchildren exhibited caries increment. A total of 32.5%
based on the measures of sensitivity, specificity, Youden’s J, of the schoolchildren had caries on at least one of the four
negative predictive value, and positive predictive value. The surfaces. In this group, 38.5% of the schoolchildren exhibited
evaluations were carried out using the SPSS program. caries increment. The sensitivity of the predictor B was 0.71,
the specificity was 0.76, Youden’s J was 0.47; the negative
Results predictive value was 0.92 and the positive predictive value was
0.39. The predictor E was similarly powerful (Youden’s J 0.49);
Reliability predictor F was less powerful (Youden’s J 0.21).
The reliability (reproducibility) of the measurements was
checked for the dichotomized variables D14F6mes, D14FS, and Discussion
d14mf5dis and for the variable D34FS (not dichotomized). The
reliability was good (kappa values between 0.73 and 0.90). Generally low risk for approximal caries
In order to estimate the risk for approximal caries in Swiss
Proportion of schoolchildren with caries increment, predictive schoolchildren, longitudinal data from 16 communities of the
power of the predictors Canton of Zurich were analyzed. The caries risk of an indi-
The proportion of 7-year-olds with caries increment was 7.1% vidual in the population is equal to the percentage of school-
(Tab. I). Using predictor A, schoolchildren were divided into children with caries increment (new D34FS > 0) in the sample.
those with and those without caries experience (at the first The caries risk of the schoolchildren in the 16 communities is
examination) on the mesial surfaces of the first permanent most likely similar to that of the schoolchildren in the Canton
molars and the distal surfaces of the second primary molars. of Zurich and in the rest of Switzerland.
At baseline a total of 77.7% of the schoolchildren had no car- The present study revealed a generally low risk for approxi-
ies on any of the eight surfaces. In this group, 2.2% of the mal caries. This assessment is based on comparisons with stud-
schoolchildren exhibited caries increment. A total of 22.3% of ies abroad. In the present study, caries increment within 4 years
the schoolchildren had caries on at least one of the eight sur- was observed in 7% of the 7-year-olds and in 18% of the
Tab. I Proportion of 7-year-olds with caries increment1 within 4 years
N children % children N children N children % children % children SN SP YJ NPV PPV
without with with with
caries caries caries caries
increment increment increment increment
95% CI
All 296 100% 275 21 7.1% 4.7–10.6%
Predictor A
D14F6mes = 0 and
d14mf5dis = 0 230 77.7% 225 5 2.2% 0.9–4.5% 0.76 0.82 0.58 0.98 0.24
D14F6mes > 0 and/or
d14mf5dis > 0 66 22.3% 50 16 24.2% 15.5–35.8%
Predictor B
D14F6mes = 0 273 92.2% 263 10 3.7% 2.0–6.6% 0.52 0.96 0.48 0.96 0.48
D14F6mes > 0 23 7.8% 12 11 47.8% 29.2–67.0%
Predictor C
d14mf5dis = 0 236 79.7% 228 8 3.4% 1.7–6.6% 0.62 0.83 0.45 0.97 0.22
d14mf5dis > 0 60 20.3% 47 13 21.7% 13.1–33.9%
Predictor D
d14mfs = 0 107 36.1% 105 2 1.9% 0.5–6.6% 0.90 0.38 0.29 0.98 0.10
d14mfs > 0 189 63.9% 170 19 10.1% 6.5–15.2%
1
Appearance of new radiolucencies extending into the dentin or fillings on approximal surfaces of molars and premolars within 4 years (new D34FS > 0)
SN = sensitivity / SP = specificity / YJ = Youden’s J (SN+SP–1) / NPV = negative predictive value / PPV = positive predictive value / 95% CI = 95% confidence interval
14 Schweiz Monatsschr Zahnmed Vol. 121 1/2011
4. Tab. II Proportion of 11-year-olds with caries increment1 within 4 years
N children % children N children N children % children % children SN SP YJ NPV PPV
without with with with
caries caries caries caries
increment increment increment increment
95% CI
All 295 100% 243 52 17.6% 13.7–22.4%
Predictor B
D14F6mes = 0 199 67.5% 184 15 7.5% 4.6–12.1% 0.71 0.76 0.47 0.92 0.39
D14F6mes > 0 96 32.5% 59 37 38.5% 29.4–48.5%
Predictor E
D14FS = 0 193 65.4% 180 13 6.7% 4.0–11.1% 0.75 0.74 0.49 0.93 0.38
D14FS > 0 102 34.6% 63 39 38.2% 29.4–47.9%
Predictor F
D34FS = 0 277 93.9% 237 40 14.4% 10.8–19.1% 0.23 0.98 0.21 0.86 0.67
D34FS > 0 18 6.1% 6 12 66.7% 43.8–83.7%
1
Appearance of new radiolucencies extending into the dentin or fillings on approximal surfaces of molars and premolars within 4 years (new D34FS > 0)
SN = sensitivity / SP = specificity / YJ = Youden’s J (SN+SP–1) / NPV = negative predictive value / PPV = positive predictive value / 95% CI = 95% confidence interval
11-year-olds. In a Norwegian study, 47% of 12-year-olds devel- High negative predictive values and moderate positive
oped new lesions on the approximal surfaces within 6 years predictive values
(David et al. 2006). In a Swedish study of 13-year-olds, 39% The negative predictive values of the predictors A and B were
(with fluoridated drinking water) and 64% (without fluori- 0.98 and 0.92, respectively. This means that over 90% of the
dated drinking water) developed new lesions on approximal schoolchildren who were classified as having a low caries risk
surfaces within 5 years (Lith & Gröndahl 1992). In another did not develop any caries on approximal surfaces.
Swedish study, 82% of 11- to 13-year-olds developed new le- The positive predictive values of the predictors A and B were
sions within 4 years (Stenlund et al. 2002). However, the only 0.24 and 0.39, respectively. This means that only 24%
latter study included newly developed D2 lesions (radiolucen- and 39%, respectively, of the schoolchildren who were classi-
cies in the inner half of the enamel). fied as having a high caries risk actually developed caries on
The generally low risk for approximal caries at the present approximal surfaces.
time is also evident from cross-sectional data from the Canton The quality of prediction can be affected by various factors,
of Zurich. The examinations, which have been undertaken such as insufficient validity and reliability of the measured
every 4 years since 1964, show a steady decline in caries on the variables, as well as by changes in caries activity. Hintze et al.
approximal surfaces of molars and premolars up until the (1994) established insufficient validity of radiological diagno-
1990s (Menghini & Steiner 2007). The decline in caries is de- sis of approximal carious lesions in enamel.
picted in Fig. 1 with respect to 15-year-olds.
Bitewing X-ray examinations in the first and last school year
Predictors for differentiating between schoolchildren with In Switzerland, in the first school year, X-ray images have to
a high risk and schoolchildren with a low risk date been proposed according to individual requirements. In the
In order to differentiate between schoolchildren with a high final school year, bitewing X-ray images are proposed for every
risk and those with a low risk for approximal caries, powerful young person (SSO [Swiss Dental Association] 1997). In light of
predictors (discriminators) are necessary. One important pre- the findings of this study, a bitewing X-ray examination is also
dictor is caries experience on approximal surfaces ( Lith & recommended for all schoolchildren in the first school year.
Gröndahl 1992, Lith et al. 2002, Stenlund et al. 2002, Sköld
et al. 2005, David et al. 2006). The schoolchildren in the There are good grounds for a bitewing X-ray examination in
present study were therefore divided into those with and those the first school year (for 7-year-olds):
without caries experience on selected approximal surfaces. 1) As this paper shows, the 7-year-olds can be easily divided
In the case of the 7-year-olds, predictor A (see Tab. I) proved into those with a low risk and those with a high risk for
to be the best discriminator for differentiating between school- approximal caries. Ideally, the schoolchildren should be at
children with a low risk and schoolchildren with a high caries least 7.0 years old at the time of the risk assessment. At this
risk (Youden’s J = 0.58). Schoolchildren without caries experi- age, the mesial surfaces of the first permanent molars and
ence had a caries risk of 2.2%. This caries risk was classified as the distal surfaces of the second primary molars have been
low. Schoolchildren with caries experience had a caries risk of in contact with one another for approximately one year,
24.2%. This risk was classified as high. and there has thus been a sufficient exposure period for
In the case of the 11-year-olds, the predictors B and E (see caries to develop.
Tab. II) proved to be powerful predictors (Youden’s J = 0.47 and 2) In around half of the 7-year-olds (16 communities in the
0.49, respectively). Schoolchildren without caries experience Canton of Zurich, 2000), lesions on approximal surfaces of
had a caries risk of 7.5% (predictor B) and 6.7% (predictor E). primary molars that extended into the dentin were ob-
This caries risk was classified as low. Schoolchildren with caries served. In a quarter of the 7-year-olds, such lesions could
experience had a high caries risk of 38.5% (predictor B) and be detected only on the X-ray images (unpublished data
38.2% (predictor E). from the Oral Epidemiology department).
Schweiz Monatsschr Zahnmed Vol. 121 1/2011 15
5. Fig. 1 Caries experience on approximal surfaces of molars and premolars in 15-year-old schoolchildren from 16 communities of the Canton (County) of Zurich
There are also good grounds for a bitewing X-ray examination dren benefit from the bitewing X-ray examination, since caries
in the last school year (for 15-year-olds): increment can be expected in 20% of cases; however, it also
1) In just over 10% of 15-year-olds (16 communities in the means that 80% do not benefit.
Canton of Zurich, 2000), lesions extending into the dentin For the 7-year-olds without caries experience, the caries risk
were discovered on approximal surfaces of molars and pre- up to the age of 11 years was just 2.2%; the risk was well below
molars. In just over 10% of the 15-year-olds, lesions extend- the threshold of 20%. Producing X-rays after just 4 years would
ing into the dentin were also detected under clinically in- thus be premature. It is therefore recommended that 7-year-
tact fissures of molars and premolars (so-called “hidden olds without caries experience undergo further X-rays only in
caries”) (unpublished data from the Oral Epidemiology the last school year (after 8 years).
department). Such lesions should be detected before the The caries risk over 8 years can be estimated as follows: of
child is released from the school dental service. the 7-year-olds without caries experience, around 98% remain
2) In just over one-third of the 15-year-olds, advanced lesions “healthy” after 4 years (see predictor A/7-year-olds). Of these
were detected in the enamel (D2) on approximal surfaces schoolchildren, who are now 11 years old, around 86% remain
of molars and premolars (unpublished data from the Oral healthy (see predictor F/11-year-olds). Over the full time period
Epidemiology department). Schoolchildren and their par- of 8 years, 84% (98 0.86) remain healthy, or, to put it another
ents should receive appropriate advice on the matter upon way, 16% develop approximal caries. The caries risk thus re-
release from the school dental service. mains below 20%.
3) The X-ray images serve as an important reference document For the 7-year-olds with caries experience, the caries risk up
for dentists who subsequently assume responsibility for to the age of 11 years was 24.2%; the risk was higher than the
young persons’ dental care. threshold of 20%. Producing further X-rays after only 4 years
would thus be too late. An initial interval of 1 year is recom-
Bitewing X-ray examinations between the first and the last mended. If, after 1 or 2 years, no development of the lesions
school year can be detected, a prolongation of the interval is recom-
The question arises whether additional bitewing X-ray exami- mended.
nations are required between the first and the last school year,
and if so, at what intervals these should take place. In order to Recommendations based on this study
answer this question, it is necessary to make an essential deci- For the 7-year-old schoolchildren without caries experience,
sion, namely, to determine the level of caries risk that warrants an X-ray interval of 8 years is proposed. For the 7-year-old
a bitewing X-ray examination. A threshold of 20% was adopted schoolchildren with caries experience, an X-ray interval of
in the present study. This means that 20% of the schoolchil- 1 year is proposed.
16 Schweiz Monatsschr Zahnmed Vol. 121 1/2011
6. Exceptions to these recommendations further, this would also speak in favor of longer X-ray inter-
Caution must be exercised in schoolchildren for whom an vals.
X-ray interval of 8 years is scheduled. Living conditions and
health behavior may change over the years, meaning that car- Costs
ies risk may also change. Approximal surfaces must therefore Based on the present recommendations, approximately 3 bite-
be carefully inspected during the yearly clinical examinations. wing examinations during the school years would be necessary
At the first suspicion of approximal caries, an unscheduled per child (75% of the schoolchildren need only 2 bitewing
bitewing examination may be advisable. examinations, 25% need more than 2). It is not known how
In schoolchildren for whom an X-ray interval of 1 year is many X-ray examinations are currently performed during
scheduled, this interval may be prolonged if no progression of schooling. Consequently, it is impossible to tell whether the
lesions is observed during 1 or 2 years. recommendations would increase or decrease the costs in-
In schoolchildren who do not reach age 7 in the first school volved.
year, or schoolchildren with delayed eruption of first molars,
bitewing examination must be postponed to the second school Résumé
year.
De courts intervalles entre la prise de radiographies (bite-wing)
Previous recommendations favorisent une détection précoce des lésions carieuses aux faces
The dental literature contains various recommendations on approximales. De longs intervalles permettent de réduire
the length of the X-ray intervals (Tab. III). The authors pro- l’exposition aux rayons x. De là se pose la question quels sont
posed intervals of 6 months to 1 year in the case of high caries les délais appropriés entre les prises de radiographies.
risk; in the case of low caries risk, intervals of 1 to 3 years were Les intervalles entre la prise de radiographies devraient être
recommended. These intervals are considered to be too short, adaptés au risque de carie aux faces approximales des molaires
based on the current caries risk in Switzerland. The cited stud- et des prémolaires. Les données longitudinales de 591 élèves
ies provided no information with respect to the predictive du canton de Zurich ont été analysées afin d’estimer le risque
power of the predictors that were used to determine the risk. de carie de la population scolaire en Suisse. Les élèves avaient
été soumis à deux examens bucco-dentaires dans l’intervalle
Less exposure to radiation de quatre ans.
X-ray intervals that are twice to four times as long as the previ- La proportion d’élèves âgés de 7 ans avec de nouvelles caries
ous recommendations of the SSO (Swiss Dental Association) en quatre ans était de 7,1%; cela veut dire que le risque de
(Tab. III) are suggested here. Accordingly, this entails only a carie dans la population était de 7,1%. Chez les élèves âgés de
quarter to half the exposure to radiation. 11 ans, le risque de carie était de 17,6%.
Les écoliers de 7 ans sans caries aux faces approximales sé-
Prevention rather than X-rays lectionées avaient un faible risque de carie de 2,2%. Par contre,
Extending the X-ray intervals should go hand in hand with a les écoliers de 7 ans ayant déjà des caries avaient un risque de
greater focus on prevention. The application of fluoride var- carie élevé de 24,2%. De même, le risque de carie était faible
nish on approximal surfaces of molars and premolars is thus chez les écoliers de 11 ans sans caries (7,5%) et haut chez ceux
recommended for all schoolchildren as part of the school avec caries (38,5%).
dental service. A semi-annual application of fluoride varnish Pour les élèves de 7 ans sans caries approximales, un délai de
can greatly diminish the development of approximal caries 8 ans jusqu’au prochain examen radiographique est proposé.
(Sköld et al. 2005). Pour ceux qui, à cet âge, ont déjà développé des lésions ca-
Presently, preventive activities are being moved forward to rieuses approximales, ce délai est de 1 an seulement.
the pre-school age. If caries experience can be diminished
Tab. III Recommended X-ray intervals for children and adolescents
Authors Age X-ray intervals where X-ray intervals where X-ray intervals where
there is a high caries there is a moderate there is a low caries
risk caries risk risk
Pitts & Kidd 1992 7–13 6 months 1 year 1–2 years
14–17 6 months 1 year 2 years
Espelid et al. 2003 51 1 year2 – 3 years2
8/91 1 year2 3–4 years2
12/13/141 1 year2 2 years2
161 1 year2 3 years2
European Commission 2004 Children 6 months 1 year 1–2 years
ADA 2004 Children 6–12 months – 1–2 years
Adolescents 6–12 months 1.5–3 years
SSO 2005 7–25 6 months 1 year 2 years
Present study 71 1 year2 – 8 years2
1
Initial bitewing X-ray examination
2
Interval until the next bitewing X-ray examination
Schweiz Monatsschr Zahnmed Vol. 121 1/2011 17
7. References
American Dental Association, ADA: Guidelines for Machiulskiene V, Nyvad B, Baelum V: A comparison Pitts N B, Kidd E A M: The prescription and tim-
prescribing dental radiographs. www.ada.org of clinical and radiographic caries diagnoses ing of bitewing radiography in the diagnosis
(2004) in posterior teeth of 12-year-old Lithuanian and management of dental caries: contempo-
children. Caries Res 33: 340–348 (1999) rary recommendations. Br Dent J 21: 225–227
David J, Raadal M, Wang N J, Strand G V: Caries
(1992)
increment and prediction from 12 to 18 years Machiulskiene V, Nyvad B, Baelum V: Comparison
of age: A follow-up study. Eur Arch Paediatr of diagnostic yields of clinical and radiographic Schweizerische Zahnärzte-Gesellschaft, SSO: Qua-
Dent 7: 31–37 (2006) caries examinations in children of different litätsleitlinien in der Zahnmedizin (Swiss Den-
age. Eur J Paediatric Dent 5: 157–162 (2004) tal Association, SSO: Quality guidelines for
Espelid I, Mejare I, Weerheijm K: EAPD guidelines
dental medicine). Schweiz Monatsschr Zahn-
for use of radiographs in children. Eur J paedi- Marthaler T M: A standardized system of record-
med 115: 25–35 (2005)
atric Dent 4: 40–48 (2003) ing dental conditions. Helv Odont Acta 10:
1–18 (1966) Schweizerische Zahnärzte-Gesellschaft, SSO: Schul-
European Commission: Radiation protection 136.
zahnpflege. Eine Anleitung für Gemeinden und
European guidelines on radiation protection Menghini G, Steiner M, Marthaler T, Helfenstein U,
Schulzahnärzte (Swiss Dental Association, SSO:
in dental radiology. (2004) www.europa.eu.int Brodowski D, Imfeld C, Weber R, Imfeld T: Karies-
School dental care. A manual for communities
prävalenz von Schülern in 16 Zürcher Landge-
Hintze H, Wenzel A, Jones C: In vitro comparison and school dentists). (1997)
meinden in den Jahren 1992 bis 2000 (Caries
of D- and E-speed film radiography, RVG, and
prevalence in schoolchildren from 16 commu- Sköld U M, Petersson L G, Lith A, Birkhed D: Effect
visualix digital radiography for the detection
nities of the Canton of Zurich between 1992 of school-based fluoride varnish programmes
of enamel approximal and dentinal occlusal
and 2000). Schweiz Mschr Zahnmed 113: 267– on approximal caries in adolescents from dif-
caries lesions. Caries Res 28: 363–367 (1994)
277 (2003) ferent caries risk areas. Caries Res 39: 273–279
Lith A, Gröndahl H G: Predicting development of (2005)
Menghini G, Steiner M: Orale Gesundheit in der
approximal dentin lesions by means of past
Schweiz (Oral Health in Switzerland). Valid Steinegger S J: In welchen Zeitabständen sollen
caries experience. Community Dent Oral Epi-
as at 2006. Schweizerisches Gesundheitsob- bei Schulkindern in der Schweiz Bitewing-
demiol 20: 25–29 (1992)
servatorium, working document 26 (2007) Röntgenbilder gemacht werden? (At what in-
Lith A, Lindstrand C, Gröndahl H G: Caries devel- www.obsan.ch tervals should bitewing X-ray images be pro-
opment in a young population managed by a duced for schoolchildren in Switzerland?)
Pitts N B, Kidd E A M: A reappraisal of the value
restrictive attitude to radiography and opera- Medical Dissertation, Zurich (2008)
of the bitewing radiograph in the diagnosis of
tive intervention: I. A study at the patient
posterior approximal caries. Br Dent J 169: Stenlund H, Mejare I, Källestal C: Caries rates
level. Dentomaxillofacial Radiol 31: 224–231
195–200 (1990) related to approximal caries at ages 11–13:
(2002)
A 10-year follow-up study in Sweden. J Dent
Res 81: 455–458 (2002)
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