White S C, Atchison K A, Hewlett E R, Flack V F
Section of Oral Radiology, UCLA School of Dentistry.
Oral Surg Oral Med Oral Pathol. 1994 May;77(5):531-40. doi: 10.1016/0030-4220(94)90237-2.
This study evaluated the effect on caries diagnosis of using the Food and Drug Administration (FDA) guidelines for ordering radiographs on a sample of new adult patients seeking general dental care at a dental school clinic. These guidelines recommend posterior bitewing views accompanied by supplemental periapical views as indicated by the patient's clinical signs or symptoms. We compared the findings from the use of this protocol to those from a full-mouth set of radiographs made on the same new patient. We examined 490 patients and ordered periapical radiographs in accordance with the FDA guidelines, namely, when there was some clinical sign or symptom suggesting the need for radiographs. A full-mouth set of radiographs was obtained, and both the full and selected sets were evaluated separately. We found that 95% of our patients had one or more carious lesions, with an average of 5.7 carious teeth per patient. Of the 2808 carious teeth detected in the study, 1949 (69%) were found radiographically and 1564 (56%) were found clinically. Indeed, 1244 (44%) of the carious teeth were detected only by radiographic examination. Use of the FDA guidelines resulted in a 43% reduction in the number of radiographs ordered. Reduction in the number of images made on patients resulted in failure to detect 93 lesions (3.3%) located on 88 teeth in 11.4% of the study patients. Most of the missed lesions (2.9%) were radiographically confined to the enamel of anterior maxillary teeth. Only 36 of the missed lesions (1.6% of all radiographic lesions) extended into the dentin. We believe that this number is very small and most likely inconsequential compared with the considerable diversity among dentists regarding radiographic detection of caries, as well as the diversity of opinion regarding the indications for restorative treatment.
本研究评估了使用美国食品药品监督管理局（FDA）的X线片拍摄指南对在牙科学校诊所寻求普通牙科护理的成年新患者样本进行龋齿诊断的影响。这些指南建议，根据患者的临床体征或症状，拍摄后牙咬合翼片并辅以根尖片。我们将使用该方案的检查结果与对同一新患者拍摄的全口X线片的检查结果进行了比较。我们检查了490名患者，并根据FDA指南，即当有某些临床体征或症状提示需要拍摄X线片时，拍摄根尖片。获取了全口X线片，并分别对全口片和选拍片进行了评估。我们发现，95%的患者有一个或多个龋损，每位患者平均有5.7颗龋齿。在该研究中检测出的2808颗龋齿中，1949颗（69%）是通过X线片发现的，1564颗（56%）是临床发现的。实际上，1244颗（44%）龋齿仅通过X线检查发现。使用FDA指南使拍摄的X线片数量减少了43%。减少对患者拍摄的影像数量导致未能检测出11.4%的研究患者中位于88颗牙齿上的93处龋损（3.3%）。大多数漏诊的龋损（2.9%）在X线片上局限于上颌前牙的牙釉质。只有36处漏诊的龋损（占所有X线片发现龋损的1.6%）延伸至牙本质。我们认为，与牙医在龋齿X线检测方面的显著差异以及关于修复治疗适应证的观点差异相比，这个数字非常小，很可能无关紧要。
