Abstract
Due to the coronavirus pandemic, all routine dental care in the UK ceased on 25 March 2020. Liverpool University Dental Hospital (LUDH) responded by commencing an emergency dental service on the same date. Clinicians were redeployed within the Hospital to meet the needs of the service, including staffing of the radiology department. LUDH followed Royal College recommendations by taking extraoral radiographs in preference to intraoral radiographs due to the risk of inducing an aerosol. Issues were identified with clinical diagnosis from sectional panoramic radiographs, which led to the introduction of extraoral bitewings being taken as an alternative. A quality assurance audit found that these images provided a substantially lower radiation dose and produced excellent quality images with improved diagnostic accuracy. This article aims to summarise how our radiography practices changed in response to the coronavirus and how the lessons that we have learnt provide an opportunity to modify and improve future practice, beyond the pandemic.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
NHS England and NHS Improvement. Letter to chief executives of all NHS trusts and foundation trusts, CCG Accountable Officers, GP practices and Primary Care Networks, and providers of community health services. 2020. Available at https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgentnextstepsonnhsresponsetocovid19lettersimon-stevens.pdf (accessed May 2020).
Royal College of Surgeons of England. Recommendations for Diagnostic Imaging during COVID-19 pandemic. 2020. Available at https://www.rcseng.ac.uk/dental-faculties/fds/coronavirus/ (accessed May 2020).
Gijbels F, De Meyer A M, Bou Serhal C et al. The subjective image quality of direct digital and conventional panoramic radiography. Clin Oral Investig 2000; 4: 162-167.
Abdinian M, Razavi S M, Faghihian R, Samety A A, Faghihian E. Accuracy of digital bitewing radiography versus different views of digital panoramic radiography for detection of proximal caries. J Dent (Tehran) 2015; 12: 290-297.
Royal College of Surgeons of England and Faculty of General Dental Practice (UK). Selection Criteria for Dental Radiography. 1998. Available online at https://www.fgdp.org.uk/guidance-standards/selectioncriteriadental-radiography (accessed May 2020).
Issacson K G, Thom A R, Horner K, Whaites E. Orthodontic radiographs: guidelines. 3rd ed. London: British Orthodontic Society, 2008.
Department of Health. National Radiological Protection Board - Guidance Notes for Dental Practitioners on the Safe Use of XRay Equipment. 2001. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/337178/misc_pub_DentalGuidanceNotes.pdf (accessed May 2020).
Arkarslan Z Z, Akdevelioğlu M, Güngör K, Erten H. A comparison of the diagnostic accuracy of bitewing, periapical, unfiltered and filtered digital panoramic images for approximal caries detection in posterior teeth. Dentomaxillofac Radiol 2008; 37: 458-463.
Kamburoglu K, Kolsuz E, Murat S, Yüksel S, Ozen T. Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography. Dentomaxillofac Radiol 2012; 41: 450-459.
Terry G L, Noujeim M, Langlais R P, Moore W S, Prihoda T J. A clinical comparison of extraoral panoramic and intraoral radiographic modalities for detecting proximal caries and visualizing open posterior interproximal contacts. Dentomaxillofac Radiol 2016; DOI: 10.1259/dmfr.20150159.
Abu El-Ela W H, Farid M M, Mostafa M S ED. Intraoral versus extraoral bitewing radiography in detection of enamel proximal caries: an ex vivo study. Dentomaxillofac Radiol 2016; DOI: 10.1259/dmfr.20150326.
Chan M, Dadul T, Langlais R, Russell D, Ahmad M. Accuracy of extraoral bite-wing radiography in detecting proximal caries and crestal bone loss. J Am Dent Assoc 2018; 149: 51-58.
Sabarudin A, Tiau Y J. Image quality assessment in panoramic dental radiography: a comparative study between conventional and digital systems. Quant Imaging Med Surg 2013; 3: 43-48.
Baksi B G, Alpöz E, Soğur E, Mert A. Perception of anatomical structures in digitally filtered and conventional panoramic radiographs: a clinical evaluation. Dentomaxillofac Radiol 2010; 39: 424-430.
Fujita M, Kodera Y, Ogawa M et al. Digital image processing of dentomaxillofacial radiographs. Oral Surg Oral Med Oral Pathol 1987; 64: 485-493.
Kaeppler G, Dietz K, Reinert S. The effect of dose reduction on the detection of anatomical structures on panoramic radiographs. Dentomaxillofac Radiol 2006; 35: 271-277.
Lehmann T M, Troeltsch E, Spitzer K. Image processing and enhancement provided by commercial dental software programmes. Dentomaxillofac Radiol 2002; 32: 262-272.
Yalcinkaya S, Künzel A, Willers R, Thomas M, Becker J. Subjective image quality of digitally filtered radiographs acquired by the Durr Vistascan system compared with conventional radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101: 643-651.
Harvey S, Ball F, Brown J, Thomas B. 'Non-standard' panoramic programmes and the unusual artefacts they produce. Br Dent J 2017; 223: 248-252.
Public Health England. Dose to patients from dental radiographic Xray imaging procedures in the UK. 2017. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/817972/2019_dental_NDRL_report.pdf (accessed May 2020).
Lecomber A R, Faulkner K. Dose reduction in panoramic radiography. Dentomaxillofac Radiol 1993; 22: 69-73.
College of General Dentistry and Faculty of General Dental Practice (UK). Implications of COVID-19 for the safe management of general dental practice. A practical guide. 2020. Available at https://www.fgdp.org.uk/sites/fgdp.org.uk/files/editors/Implications%20of%20COVID-19%20for%20the%20safe%20management%20of%20general%20dental%20practice%C2%A0-%20a%20practical%20guide.pdf (accessed June 2020).
Hurley S. Why re-invent the wheel if you've run out of road? Br Dent J 2020; 228: 755-756.
Acknowledgements
The authors would like to thank the LUDH radiographers, Christine Smith, Charlotte Titley and Gemma Langley, for providing a training update to clinical staff and for their advice and assistance with data collection.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Little, R., Howell, J. & Nixon, P. COVID-19 and beyond: implications for dental radiography. Br Dent J 229, 105–109 (2020). https://doi.org/10.1038/s41415-020-1842-x
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-020-1842-x
This article is cited by
-
Dental pedagogy in the ‘new normal’ COVID-19 era: a transition template of teaching protocols
BMC Medical Education (2022)


