A study of panoramic radiography in adult patients

Key Points

In Brief

• This study in a general dental practice setting looked at the diagnostic yield from routine panoramic radiography of new adult patients

• Many of the dentists involved in the study did not follow current guidelines on the choice of radiographic examination for new patients

• Radiological abnormalities were identified on the overwhelming majority of radiographs, but many of these would have duplicated findings available on more accurate posterior bitewing radiographs

• When the treatment plans of the dentists were taken into account, the majority (56.3%) of radiographs made no contribution to patient management

• The routine use of panoramic radiography on new adult patients is not supported by the findings of this study

Abstract

Aim To identify the radiological findings from routine screening panoramic radiographs taken of adult (≥18 years) patients in general dental practice.

Method Forty-one general dental practitioners (GDPs) who routinely took panoramic radiographs of all new adult patients were recruited. In total, they submitted 1,818 panoramic radiographs of consecutive patients along with basic patient information, radiological reports and treatment plans. The radiographs were also reported by 'experts' (consensus of two dental radiologists). Radiological findings were recorded from the GDP assessments (dentist RY), the experts (expert RY), after exclusion of findings that would have been seen on posterior bitewing radiographs (MRY) and after exclusion of findings of no relevance to treatment (MRYT).

Results There was no significant difference in age profile between the study sample and Dental Practice Board population figures (P = 0.26). No radiographs other than the panoramic radiograph had been taken for 57.1% of patients. For the GDP assessments, only 4.6% of patients had radiographs with no radiological findings, while for the experts this proportion was 3.1%. With the exception of the assessment of periodontal bone loss, the experts diagnosed significantly greater proportions of cases as having positive radiological findings. Agreement between dentist and expert assessments varied greatly. When findings from bitewing radiographs were excluded, no radiological findings were recorded on the radiographs of 17.2% of patients. When proposed treatment plans were taken into account, the majority of patients' radiographs (56.3%) had no radiological findings of relevance to treatment.

Conclusions The choice of radiographic examination for the majority of patients in the study did not follow current guidelines. Dentists diagnosed fewer abnormalities than did experts. While many radiological findings are revealed by panoramic radiography, these may either duplicate information from bitewing radiographs or are often of no significance to treatment planning. This study did not provide evidence to support the practice of routine panoramic radiography of all new adult patients.

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