Article
Letter in response to “Bitewing radiography for caries diagnosis in children: when and why?”
I read with interest the above article published in Dental Update (Dent Update 2020; 47: 334–341). I wholeheartedly agree that bitewing radiographs are the gold standard for diagnosis of proximal caries in children.
I work in a large maxillofacial unit, which has a regional children's hospital and paediatric accident and emergency department. Frequently, children present acutely with swollen faces requiring acute admission and subsequently emergency theatre for multiple extractions. Automatically these children fall into the high-risk caries group. An orthopantomogram is the only available imaging modality to use during these admissions, particularly out of hours, to aid with extraction planning.
If timing allows prior to theatre, we can send patients to the dental hospital for intra-oral bitewings plus or minus treatment planning by paediatric dentists. Anecdotally, when this does happen and they return with intra-oral imaging and a treatment plan, there are generally far more teeth on the extraction plan than would otherwise be planned by a maxillofacial surgeon using an orthopantomogram.
When taking a history from a parent, it becomes apparent that many of these children have pre-existing general anaesthetic referrals in the system from their general dental practitioner, and I wonder how many of these children go on to require repeat general anaesthetics.
Whilst I appreciate that taking intra-oral imaging may be a challenge for radiographers not used to working in the mouth, dental core trainees have the ability to take their own radiographs. As Timms et al highlight, there is an improved diagnostic yield, reduced dose and therefore improved treatment planning for children. Are we doing children and their parents a disservice by not having readily available intra-oral imaging in emergency x-ray?