EVALUATION OF DIAGNOSTIC VALUES OF DENTAL RADIOGRAPHY IN THE MANAGEMENT OF DENTAL PATHOLOGIES (CASE STUDY OF FEDERAL MEDICAL CENTRE ASABA)

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  • Name: EVALUATION OF DIAGNOSTIC VALUES OF DENTAL RADIOGRAPHY IN THE MANAGEMENT OF DENTAL PATHOLOGIES (CASE STUDY OF FEDERAL MEDICAL CENTRE ASABA)
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ABSTRACT

This non-experimental restrospective study was aimed to obtain information on the diagnostic value of dental radiography in the assessment of dental pathologies. And also the findings when dental radiography is compared with clinical examinations. It was conducted at Federal Medical centre Asaba. A total of 130 dental cases were reviewed. The results of this research showed that dental radiography had more diagnostic yield than clinical evalution. It was found that clinical examination had more negative findings compared with negative radiographic findings in all the pathologies assessed. However, the agreement between radiographic and clinical findings was very high. This was contrasted in chronic pulpitis where the agreement between clinical and radiographic findings, and only clinically detected had equal rate of 22.2% compared to 55.5% of only radiographically detected (negative clinical findings).Also in pericoronitis, radiography alone detected highest 62.5%. When the dental cases were distributed according to sex, more females (51.5%) than males (48.5%) had dental pathologies. It also showed that the prevalence of dental pathologies was higher in age range of 21-30 years (23.1%) compared to others. In conclusion, dental radiography was found highly invaluable in the diagnosis of dental pathologies and should be recommended for accurate diagnosis.

 

TABLE OF CONTENTS

Title Page

Approval page

Certification

Dedication

Acknowledgement

List of tables

Table of contents

Abstract

Chapter One

1.0    Introduction

  • Background of Study
  • Statement of Problem
  • Objectives of Study –
  • Significance of Study

1.5     Scope of the Study

1.6   Literature Review

Chapter Two

2.0 Theoretical Background

2.1   Anatomy of the Teeth

2.1.1 Development and Eruption Teeth

2.1.2 Primary Dentition

2.1.3 Permanent Dentition

2.2 Dental numbering system and notation

2.2.1 Palmer Notation Method

2.2.2 FDI World Dental Federation Notation

2.2.3 Universal numbering System (dental)

2.3   Dental pathologies and intra-oral infections

2.3.1 Dental Caries

2.3.2 Periodontitis         –

2.3.3 Pulpitis

2.3.4 Tooth Abscess

2.3.5  Furcation Defect

2.3.6 Pericoronitis

2.3.7 Retained Tooth – Root

2.3.8 Cracked Tooth Syndrome

  • Gingivitis

2.3.10 Calculus

  • Dental Radiographic Views

2.4.1  Intra-oral radiographic views

2.4.2  Extra – oral radiographic view

 

Chapter Three:

3.0 Research  Methodology

3.1 Research Design

3.2 Target Population

3.3 Area of Study

3.4 Inclusion Criteria

3.5 Instruments of Data Collection

3.6 Methods of Data Analysis

Chapter Four:

4.0     Results

  • Presentation of tables

Chapter  Five:

5.0     Discussion, Summary, conclusion, and recommendation            

5.1     Discussion

5.2 Summary of Findings

5.3 Conclusion

5.4     Recommendation

5.5 Limitations of the Study

5.6  Areas for further Studies

References

 

CHAPTER ONE

  • INTRODUCTION

 

  • BACKGROUND OF STUDY

 

Dental radiography is the x-ray examination of the teeth and associated structures.  It is the most common radiographic procedure done in cases of dental and maxillofacial disorders.  Dental radiographs on the other hand are the x-ray images of the teeth, bones, and surrounding soft tissues to screen for and help identify pathologies in the teeth, mouth and jaw.  X-ray images can show cavities, cancerous or benign masses, hidden dental structures (such as wisdom teeth), and bone loss.

Dental radiography provides diagnostic information  on caries, plaque retention factor, furcation defects, subgingival calculus and other pathologies.  In diagnosing periodontal diseases, radiographs, play an important role since critical information such as alveolar bone level, widening of periodontal ligament, crestal bone height and irregularity and crown root ratio cannot be found in clinical examination1

Clinical and radiographic examinations play an integral role in the diagnosis of periodontal disorders as well as in the choice of treatment and in follow-up examination2. Features visualized are dependent on the radiographic view.  Bitewing and periapical radiography are both useful tools for this purpose3.  In addition to intra-oral radiography, panoramic radiography has been used as adjunct to the examination of marginal bone tissue4.  Panoramic radiography compares favourably with intra-oral radiography in the assessment of marginal bone level5.

Very few radiographic studies5 have elucidated the diagnostic yield on alveolar vertical bone defects and furcation involvements.

Caries epidemiological studies have traditionally been based on clinical examination alone6.  Several studies have confirmed that the prevalence of proximal carries is significantly under estimated when clinical data are compared with the radiographic information.  Dental radiography are claimed to be of great importance, particular for the detection of proximal caries in contacting posterior surfaces7.

Plague – induced periodontal diseases are mixed infections associated with relatively specific groups of indigeneous oral bacteria8.  Susceptibility to these diseases is highly variable and depends on host responses to periodontal pathogens9.  Although bacteria cause plague – induced inflammatory periodontal diseases, progression and clinical characteristics of these disease are influenced by both acquired and genetic factors that can modify susceptibility to infection10.

To arrive at a periodontal diagnosis, the dentist must rely upon such factors as:

  1. Presence or absence of clinical signs of inflammation (eg bleeding upon probing).
  2. Probing depts.;
  • Extent and pattern of loss of clinical attachment and bone.
  1. Patent’s medical and dental histories, and
  2. Presence or absence of miscellaneous signs and symptoms, including pain, ulceration and amount of observable plague and calculus

Plague – induced periodontal diseases have traditionally been divided into two general categories based on whether attachment loss has occurred: gingivitis and periodontitis.  Gingivitis is the presence of gingival inflammation without loss of connective tissue attachment.  Periodontitis can be defined as the presence of gingival inflammation at sites where there has been a pathological detachment of collagen fibers from cementum and the junctional epithelium has migrated apically.  In addition, inflammatory events associated with connective tissue attachment loss also lead to the resorption of coronal portions of tooth – supporting alveolar bone11.

This research is aimed at gathering information about the additional value of radiographic examination compared to clinical examination in assessing caries and other dental pathologies.  This will give information about the precise extent of underestimated pathologies when only clinical criteria is used.

  • STATEMENT OF PROBLEM
  1. There is sparse literature support on the diagnostic value of dental radiography in the assessment of dental pathologies.
  2. The impressions based on clinical examination and radiological outcomes in the diagnosis and management of dental pathologies have not been evaluated in the area under study.
    • OBJECTIVES OF STUDY
  3. To obtain information on the diagnostic value of dental radiography in the assessment of dental pathologies.
  4. To compare the impressions based on clinical examination with radiological outcomes in the diagnosis and management of dental pathologies in federal medical centre Asaba.
  • To determine the age and sex distribution of patients for dental clinical and radiographic exams in FMC Asaba
    • SIGNIFICANCE OF STUDY
  1. This will help dental surgeons in planning initial, corrective and supportive phases of therapy.
  2. The result of this study will help in the definitive management of patient with dental and maxillofacial disease.
    • SCOPE OF THE STUDY

The study surveyed dental radiography examinations in federal medical centre Asaba, Delta state.  It covers all patient’s dental records from 1st January 2011 – 1st March 2012.

1.6   LITERATURE REVIEW

RADIOGRAPHY IN THE ASSESSMENT OF DENTAL CARIES

Detection and diagnosis of the carious process are perhaps the most common reasons for dental radiography.However, with changes in the caries profiles within certain segments of the younger age groups12 and increases in the number of older dentate adult13 radiographs are now being obtained for many different reasons for patients in all age groups and at all levels of risk. Bader and others14 have produced an excellent review of all current systems for detecting dental caries, including radiography.

OCCLUSAL AND INTERPROXIMAL CARIES

Numerous studies have assessed the ability to diagnose occlusal caries from radiographs, both conventional and digital. In a recent study employing a receiver operating characteristics(ROC) analysis, occlusal and approximal surfaces were radiographed with 6 charged coupled device (ccd) sensor systems and 2 film-based systems.15 four trained observers interpreted the radiographs, and the caries were validated histologically. The systems yielded auc measurements ranging from 0.74 to 0.90, with the filmbased Systems scoring generally higher . Of interest is that using 4 rather than 2 films in bitewing examinations (overlapping films) appeared to add  little to the diagnostic value of the exam.16In another study, the ability of 276 dental practitioners to detect  interproximal demineralization using bitewing radiographs was contrasted with microradiographic assessment (the gold standard).17 Sensitivity (± standard deviation) was moderate (54% ± 14) and specificity was high (97% ± 5) (AUC of 0.88). Apparently, differences in incidence of caries in different age groups affected radiographic prescribing and the value of ordering such tests: bitewings prescribed for children under 12 years of age added little information to the decision-making process, but for children older than 12 this type of imaging was of value in detecting inter proximal lesions.18

SECONDARY CARIES

The foremost reason for replacement of restorations is the presence of secondary or recurrent decay. In a study appraising the performance of conventional radiography in detecting recurrent decay, 91% of the noncarious restored teeth were detected, but only 53% of the failed restorations were found.19 An ROC value of 0.78 was calculated, and the authors suggested that careful clinical assessment of existing restorations was required before a definitive diagnosis of recurrent decay could be made.

The ability to detect recurrent decay from radiographs was examined with Class II amalgam  restorations in an in vitro design.20 Seventy-seven teeth were grouped according to the state of the filling: fillings without failure (controls),fillings with secondary caries and fillings with only marginal defects. The teeth were examined  radiographically and clinically. A false-positive rate of 12% and a true positive rate of 47% were obtained for radiographic examination only. When a clinical examination was added to the diagnostic procedures, the false-positive rate was 3% and the true-positive rate 64%. The authors concluded that for secondary caries, radiographic diagnosis alone was insufficient to attain an acceptable degree of certainty and should always be supplemented by a thorough clinical examination.20 In a separate study, dentist were asked to examine 77 teeth radiographically, visually and with the aid of a probe and  indicate if they would replace the restoration in each tooth.21 Only 5% of the teeth with no secondary decay were considered as requiring restoration replacement, but 36% of the teeth with small secondary lesions were indicated for replacement. In that study,20 as in several others involving simulated clinical situations,21 there was a great deal of variation between and within the observers.