Lecture Notes: Selection Criteria for Dental Radiography

Introduction

• Purpose: Guide for selecting appropriate dental radiographs.
• Remit: Formulation by FGDP(UK) for primary dental care.
• Justification: Radiographs justified based on individual patient history and clinical examination to avoid unnecessary radiation exposure.

Why Guidelines Are Needed

• To minimize unnecessary radiographic exams.
• To ensure radiographs contribute to optimal diagnosis and patient care.
• Legal requirement for adequately trained personnel using X-rays.

Evidence-Based Guidelines

• Methodology: Follows SIGN approach, linking recommendations with levels of evidence.
• Implementation: Guidelines to be adapted locally, with regular audits.

Use of Ionising Radiation

• Radiation Damage: DNA mutations from X-rays can lead to tumors.
• Radiation Dose: Effective dose calculated considering tissue sensitivity.
• Diagnostic Reference Levels: Audits required to match national standards.

Panoramic Radiography

• Routinely used but should be based on clinical indications.
• New Patients: Not justified routinely unless significant oral disease present.
• Edentulous Patients: Only if implants are planned.
• Orthodontic Patients: Useful for assessing dentition.

Radiographs in the Management of Dentition

• Divided into early and late mixed dentition.
• Radiographs justified when they alter clinical management.

Radiographs in Caries Diagnosis

• Children: Use bitewings for caries detection.
• Adults: Radiographs based on caries risk; routine use not justified.

Alternatives to Radiographs

• New Methods: Include CBCT, fibreoptic transillumination.
• CBCT: Not routine for caries diagnosis due to artefacts.

Periodontal Assessment

• Radiographs supplement clinical exams when they can change management.
• CBCT not standard but useful for detailed bone imaging.

Endodontics

• Essential for diagnosis and treatment planning.
• Electronic apex locators now supplement radiographic determination of working length.

Implant Dentistry

• Radiographs critical for treatment planning and maintenance.
• CBCT often used for detailed imaging to guide implant placement.

Imaging Strategy for Adults

• Radiographic selection should be individualized based on clinical need.
• Routine panoramic radiography not justified without specific indications.

Good Practice

• Follow standard procedures for taking and processing radiographs.
• Regular audits and adherence to guidelines essential for maintaining quality.