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Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review

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Abstract

Purpose

To systematically evaluate the diagnostic efficacy of intraoral radiographs and evidence supporting the indications for taking of intraoral radiographs in children in the following five clinical categories: caries, pathological conditions (including acute odontogenic infections and periodontal disease), dental/developmental anomalies, dental trauma, and enhancement of comfort/technique for taking radiographs in children. This was carried out to facilitate the updating of existing European Academy of Paediatric Dentistry (EAPD) guidelines on dental radiography in pediatric dentistry.

Methods

A systematic electronic literature search was conducted on Cochrane Library (1992–24 July 2018), MEDLINE (PubMed, 1946–24 July 2018), EMBASE (Embase.com, 1974–24 July 2018) and Scopus (pre-1970–24 July 2018). Hand search of handbooks and grey literature search was also performed. Study screening and study inclusions were agreed upon by three authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies.

Results

A total of 9581 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the final analysis. The included studies were further categorized into five main clinical categories for analysis: caries, pathological conditions, dental/developmental anomalies, dental trauma and comfort/technique-related studies. Only one paper was found to be of good quality and at low risk of bias; while, 9 papers were found of be at moderate risk of bias and 26 papers were at high risk of bias. Meta-analysis was not possible for any of the aforementioned clinical situations, and only a narrative synthesis was done.

Conclusion

There is insufficient high-quality evidence for the use of intraoral radiographs in pediatric dentistry and current guidelines are based largely on expert opinion. There is a clear need for well-conducted and standardized studies regarding the use of intraoral radiography in pediatric dentistry.

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References

  • Albandar JM, Abbas DK, Waerhaug M, Gjermo P. Comparison between standardized periapical and bitewing radiographs in assessing alveolar bone loss. Community Dent Oral Epidemiol. 1985;13(4):222–5.

    PubMed  Google Scholar 

  • Albandar JM, Baghdady VS, Ghose LJ. Periodontal disease progression in teenagers with no preventive dental care provisions. J Clin Periodontol. 1991;18(5):300–4.

    PubMed  Google Scholar 

  • American Academy of Pediatric Dentistry (AAPD), Review Council. Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. AAPD Ref Man. 2017;39(6):205–7.

    Google Scholar 

  • Anderson M, Stecksen-Blicks C, Stenlund H, Ranggard L, Tsilingaridis G, Mejare I. Detection of approximal caries in 5-year-old Swedish children. Caries Res. 2005;39(2):92–9.

    PubMed  Google Scholar 

  • Aps J. Imaging in Pediatric Dental Practice. A guide to equipment, techniques and clinical considerations. Cham: Springer; 2019. https://doi.org/10.1007/978-3-030-12354-3.

    Book  Google Scholar 

  • Aps JKM, Lee J. Radiology. In: Nowak A, Casamassimo P, editors. The handbook of pediatric dentistry. Chicago: American Academy of Pediatric Dentistry; 2018. p. 111–124.

    Google Scholar 

  • Armstrong C, Johnston C, Burden D, Stevenson M. Localizing ectopic maxillary canines—horizontal or vertical parallax? Eur J Orthod. 2003;25(6):585–9.

    PubMed  Google Scholar 

  • Cochrane Effective Practice and Organisation of Care (EPOC). https://methods.cochrane.org/sites/methods.cochrane.org.bias/files/public/uploads/EPOC%20Data%20Collection%20Checklist.pdf. Accessed 29 July 2019.

  • Cohenca N, Silberman A. Contemporary imaging for the diagnosis and treatment of traumatic dental injuries. A review. Dent Traumatol. 2017;33(5):321–8.

    PubMed  Google Scholar 

  • Cortes A, Ekstrand KR, Gamboa LF, Gonzales L, Martignon S. Caries status in young Colombian children expressed by the ICCMSTM visual/radiographic combined caries staging system. Acta Odontol Scand. 2017;75(1):12–20. https://doi.org/10.1080/00016357.2016.1242154.

    Article  PubMed  Google Scholar 

  • Dean J. McDonald and Avery’s dentistry for the child and adolescent. 10th ed. St Louis: Elsevier; 2016 (ISBN 978-0-323-28745-6).

    Google Scholar 

  • DiAngelis AJ, Andreasen JO, Ebeleseder KA, Kenny DJ, Trope M, Sigurdsson A, Andersson L, Bourguignon C, Flores MT, Hicks ML, Lenzi AR, Malmgren B, Moule AJ, Pohl Y, Tsukiboshi M. Guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth. Pediatr Dent. 2017;39(6):401–11. https://doi.org/10.1111/j.1600-9657.2011.01103.x.

    Article  PubMed  Google Scholar 

  • Elbay M, Tak O, Şermet Elbay Ü, Kaya C, Eryilmaz K. The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography. Lasers Med Sci. 2016;31(2):355–61.

    PubMed  Google Scholar 

  • Espelid I, Mejàre I, Weerheijm K, EAPD. EAPD guidelines for use of radiographs in children. Eur J Paediatr Dent. 2003;4(1):40–8.

    PubMed  Google Scholar 

  • European Commission. Radiation protection 136: European Guidelines on Radiation protection in Dental Radiology. Luxembourg: Publications Office of the European Union; 2004. https://ec.europa.eu/energy/nuclear/radioprotection/publication/doc/136_en.pdf. Accessed 1 July 2019.

  • Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making. 1991;11(2):88–94. https://doi.org/10.1177/0272989X9101100203.

    Article  PubMed  Google Scholar 

  • Goodson JM, Haffajee AD, Socransky SS. The relationship between attachment level loss and alveolar bone loss. J Clin Periodontol. 1984;11(5):348–59.

    PubMed  Google Scholar 

  • Goodwin TL, Devlin H, Glenny AM, O’Malley L, Horner K. Guidelines on the timing and frequency of bitewing radiography: a systematic review. Br Dent J. 2017;222(7):519–26.

    PubMed  Google Scholar 

  • Gowda S, Thomson WM, Foster Page LA, Croucher NA. What difference does using bitewing radiographs make to epidemiological estimates of dental caries prevalence and severity in a young adolescent population with high caries experience? Caries Res. 2009;43(6):436–41.

    PubMed  Google Scholar 

  • Greenstein G. Contemporary interpretation of probing depth assessments: diagnostic and therapeutic implications. A literature review. J Periodontol. 1997;68(12):1194–205.

    PubMed  Google Scholar 

  • Hamanaka EF, Poi WR, Salzedas LM, Alves LC, Panzarini SR, Sonoda CK, Martins CM. A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth; a case report. Dent Traumatol. 2013;29(2):121–6.

    PubMed  Google Scholar 

  • Haney E, Gansky SA, Lee JS, Johnson E, Maki K, Miller AJ, Huang JC. Comparative analysis of traditional radiographs and cone-beam computed tomography volumetric images in the diagnosis and treatment planning of maxillary impacted canines. Am J Orthod Dentofac Orthop. 2010;137(5):590–7.

    Google Scholar 

  • Harrison R, Richardson D. Bitewing radiographs of children taken with and without a film-holding device. Dentomaxillofac Radiol. 1989;18(3):97–9.

    PubMed  Google Scholar 

  • Herman HD, Ashkenazi M. Quality of bitewing radiographs in children in relation to the type of film holder used. Eur Arch Paediatr Dent. 2013;14(3):141–6.

    PubMed  Google Scholar 

  • Hietala-Lenkkeri A-M, Tolvanen M, Alananen P, Pienihakkinen K. The additional information of bitewing radiographs in the detection of established or severe dentinal decay in 14-year olds: a cross-sectional study in low-caries population. Sci World J. 2014;2014:175358. https://doi.org/10.1155/2014/175358.

    Article  Google Scholar 

  • Hintze H, Wenzel A. Clinically undetected dental caries assessed by bitewing screening in children with little caries experience. Dentomaxillofac Radiol. 1994;23(1):19–23.

    PubMed  Google Scholar 

  • Holan G, Yodko E. Radiographic evidence of traumatic injuries to primary incisors without accompanying clinical signs. Dent Traumatol. 2017;33(2):133–6.

    PubMed  Google Scholar 

  • Horner K. Radiographic selection criteria: new guidelines, old challenges. Br Dent J. 2013;214(4):201–3. https://doi.org/10.1038/sj.bdj.2013.158.

    Article  PubMed  Google Scholar 

  • Institute of Health Economics (IHE). Quality appraisal of case series studies checklist. Edmonton (AB): Institute of Health Economics; 2014. https://www.ihe.ca/research-programs/rmd/cssqac/cssqac-about. Accessed 29 July 2019.

  • ICRP. The 2007 recommendations of the International Commission on Radiological protection. ICRP Publication 103. Ann ICRP. 2007;37(2–4):1–332.

    Google Scholar 

  • Jacobs SG. Radiographic localization of unerupted mandibular anterior teeth. Am J Orthod Dentofac Orthop. 2000a;118(4):432–8.

    Google Scholar 

  • Jacobs SG. Radiographic localization of unerupted teeth: further findings about the vertical tube shift method and other localization techniques. Am J Orthod Dentofac Orthop. 2000b;118(4):439–47.

    Google Scholar 

  • Juni P, Holenstein F, Sterne J, Bartlett C, Egger M. Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol. 2002;31(1):115–23.

    PubMed  Google Scholar 

  • Kullman L, Al SM. Guidelines for dental radiography immediately after a dento-alveolar trauma, a systematic literature review. Dent Traumatol. 2012;28(3):193–9. https://doi.org/10.1111/j.1600-9657.2011.01099.x.

    Article  PubMed  Google Scholar 

  • Kronmiller JE, Nirschl RF, Close JM. Evaluation of bitewing intervals in children. ASDC J Dent Child. 1986;53(2):110–4.

    PubMed  Google Scholar 

  • Lith A, Lindstrand C, Gröndahl H-G. Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: 1. A study at the patient level. Dentomaxillofac Radiol. 2002;31(4):224–31.

    PubMed  Google Scholar 

  • Llena-Puy C, Forner L. A clinical and radiographic comparison of caries diagnosed in approximal surfaces of posterior teeth in a low-risk population of 14-year old children. Oral Health Prev Dent. 2005;3(1):47–52.

    PubMed  Google Scholar 

  • Machiulskiene V, Nyvad B, Baelum V. Comparison of diagnostic yields of clinical and radiographic caries examinations in children of different age. Eur J Paediatr Dent. 2004;5(3):157–62.

    PubMed  Google Scholar 

  • Mahiepala NA, Phan VL, Kieu KD, Koppen JPL, Hussain BH, Huang B. Influencing factors of paediatric dental anxiety levels in an undergraduate dental clinic. Eur J Paediatr Dent. 2015;16(2):159–62.

    PubMed  Google Scholar 

  • Malmgren B, Andreasen JO, Flores MT, Robertson A, DiAngelis AJ, Andersson L, Cavalleri G, Cohenca N, Day P, Hicks ML, Malmgren O, Moule AJ, Onetto J, Tsukiboshi M. Guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition. Pediatr Dent. 2016;38(6):377–85.

    PubMed  Google Scholar 

  • Mann J, Pettigrew J, Beideman R, Green P, Ship I. Investigation of the relationship between clinically detected loss of attachment and radiographic changes in early periodontal disease. J Clin Periodontol. 1985;12:247–53.

    PubMed  Google Scholar 

  • McDonald SP. A method to reduce interproximal overlapping and improve reproducibility of bitewing radiographs for use in clinical trials. Community Dent Oral Epidemiol. 1983;11(5):289–95.

    PubMed  Google Scholar 

  • Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, Perruolo E, Parati G, ESH Working Group on CV Risk in Low Resource Setting. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS ONE. 2016;11(1):e0147601. https://doi.org/10.1371/journal.pone.0147601.

    Article  PubMed  PubMed Central  Google Scholar 

  • Moher D, Pham B, Klassen TP, Schulz KF, Berlin JA, Jadad AR, Liberati A. What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol. 2000;53(9):964–72.

    PubMed  Google Scholar 

  • Myers DR, Barenie JT, Bell RA. Requirements for supplemental periapical radiographs following No. 0 and No. 2 bite-wings. Pediatr Dent. 1984;6(4):235–7.

    PubMed  Google Scholar 

  • National Radiological Protection Board (NRPB). Guidance notes for dental practitioners on the safe use of X-ray equipment. Chilton: NRPB; 2001.

    Google Scholar 

  • Newman ME, Friedman S. Extraoral radiographic technique: an alternative approach. J Endod. 2003;29(6):419–21.

    PubMed  Google Scholar 

  • Novaes TF, Matos R, Raggio DP, Braga MM, Mendes FM. Children’s discomfort in assessments using different methods for approximal caries detection. Braz Oral Res. 2012;26(2):93–9.

    PubMed  Google Scholar 

  • Novaes TF, Matos R, Raggio DP, Imparato JC, Braga MM, Mendes FM. Influence of the discomfort reported by children on the performance of approximal caries detection methods. Caries Res. 2010;44(5):465–71. https://doi.org/10.1159/000320266.

    Article  PubMed  Google Scholar 

  • Nowak AJ, Casamassimo PS. The handbook of pediatric dentistry. 5th Ed. Chicago: American Academy of Pediatric Dentistry; 2018. Caries Res. 2010;44(5):465–71. https://doi.org/10.1159/000320266.

    Article  Google Scholar 

  • Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B, on behalf of the DIMITRA Research Group, https://www.dimitra.be. Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 2018;48(3):308–16.

  • Parks ET, Aps JKM. Radiographic techniques. In: Dean JA, Jones JE, Walker Vinson LA, editors. McDonald and Avery’s dentistry for the child and adolescent. St Louis: Elsevier; 2016. p. 17–38.

    Google Scholar 

  • Pierro VS, Barcelos R, de Souza IP, Raymundo RJ. Pediatric bitewing film holder: preschooler’s acceptance and radiographs’ diagnostic quality. Pediatr Dent. 2008;30(4):342–7.

    PubMed  Google Scholar 

  • Poorterman JHG, Aartman IH, Kieft JA, Kalsbeek H. Value of bite-wing radiographs in a clinical epidemiological study and their effect on the DMFS index. Caries Res. 2000;34(2):159–63.

    PubMed  Google Scholar 

  • Poorterman JH, Vermaire EH, Hoogstraten J. Value of bitewing radiographs for detecting approximal caries in 6-year old children in the Netherlands. Int J Paediatr Dent. 2010;20(5):336–40.

    PubMed  Google Scholar 

  • Roeters FJ, Verdonschot EH, Bronkhorst EM, Hof MA. Prediction of the need for bitewing radiography in detecting caries in the primary dentition. Community Dent Oral Epidemiol. 1994;22(6):456–60.

    PubMed  Google Scholar 

  • Ruiken HM, Truin GJ, König KG. Feasibility of radiographical diagnosis in 8-year -old schoolchildren with low caries activity. Caries Res. 1982;16(5):398–403.

    PubMed  Google Scholar 

  • Sacal C, Echeverri EA, Keene H. Retrospective survey of dental anomalies and pathology detected on maxillary occlusal radiographs in children between 3 and 5 years of age. Pediatr Dent. 2001;23(4):347–50.

    PubMed  Google Scholar 

  • Schulze RK. Editorial: guidelines for oral and maxillofacial radiology. Dentomaxillofac Radiol. 2016;45(3):20160034. https://doi.org/10.1259/dmfr.20160034.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shrout MK, Hildebolt CF, Vannier MW. The effect of alignment errors on bitewing-based bone loss measurements. J Clin Periodontol. 1991;18(9):708–12.

    PubMed  Google Scholar 

  • Sköld UM, Klock B, Lindvall AM. Differences in caries recording with and without bitewing radiographs. A study on 5-year old children in the County of Bohuslän, Sweden. Swed Dent J. 1997;21(3):69–75.

    PubMed  Google Scholar 

  • Stecksén-Blicks C, Wahlin YB. Diagnosis of approximal caries in pre-school children. Swed Dent J. 1983;7(5):179–84.

    PubMed  Google Scholar 

  • Steiner M, Buelhmann S, Menghini G, Imfeld C, Imfeld T. Caries risk and appropriate intervals between bitewing X-ray examinations in schoolchildren. Schweiz Monatsschr Zahnmed. 2011;121(1):12–24.

    PubMed  Google Scholar 

  • Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;28(366):l4898.

    Google Scholar 

  • The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party*. Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation. The Joanna Briggs Institute 2014. https://joannabriggs.org/critical_appraisal_tools. Accessed 29 July 2019.

  • Torres MG, Santos Ada S, Neves FS, Arriaga ML, Campos PS, Crusoe-Rebello I. Assessment of enamel-dentin caries lesions detection using bitewing PSP digital images. J Appl Oral Sci. 2011;19(5):462–8.

    PubMed  PubMed Central  Google Scholar 

  • Townsend D. Detection of dentine caries using the oblique lateral radiograph. Int J Paediatr Dent. 2000;10(2):145–9.

    PubMed  Google Scholar 

  • Tsolakis AI, Kalavritinos M, Bitsanis E, Sanoudos M, Benetou V, Alexiou K, Tsiklakis K. Reliability of different radiographic methods for the localization of displaced maxillary canines. Am J Orthod Dentofac Orthop. 2018;153(2):308–14.

    Google Scholar 

  • Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 29 July 2019.

  • Whaites E, Drage N. Essentials of dental radiography and radiology. 5th ed. Edinburgh: Churchill Livingstone Elsevier; 2015.

    Google Scholar 

  • White SC, Atchinson KA, Hewlett ER, Flack VF. Efficacy of FDA guidelines for prescribing radiographs to detect dental and intraosseous conditions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80(1):108–14.

    PubMed  Google Scholar 

  • White SC, Pharoah MJ. Safety and protection. In: White SC, Pharoah MJ, editors. Oral radiology principles and interpretation. St. Louis: Elsevier Mosby; 2014. p. 29–40.

    Google Scholar 

  • Wolf DL, Lamster IB. Contemporary concepts in the diagnosis of periodontal disease. Dent Clin N Am. 2011;55(1):47–61. https://doi.org/10.1016/j.cden.2010.08.009.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank the participants of the EAPD meeting in Chania in May 2019, Greece, for their valuable contributions and suggestions, especially those who participated in the workshop that was held for this systematic review.

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Authors and Affiliations

  1. Division of Oral Diagnostic and Surgical Sciences, Discipline Lead Dentomaxillofacial Radiology, Dental School and Oral Health Centre of Western Australia, University of Western Australia, M512, 17 Monash Ave, Perth, Nedlands, WA, 6009, Australia

    J. K. M. Aps

  2. Oral and Maxillofacial Radiology, National University of Singapore, Singapore, Singapore

    L. Z. Lim

  3. Paediatric Dentistry, National University of Singapore, Singapore, Singapore

    H. J. Tong

  4. University of California San Francisco, San Francisco, USA

    B. Kalia

  5. National University of Singapore Libraries, Singapore, Singapore

    A. M. Chou

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Aps, J.K.M., Lim, L.Z., Tong, H.J. et al. Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review. Eur Arch Paediatr Dent 21, 429–462 (2020). https://doi.org/10.1007/s40368-020-00532-y

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