Correlation of panoramic radiographic findings and clinical findings of dental patients at Moi Teaching and Referral Hospital, Kenya

Abstract

Background: Oral health is an integral part of the general health of the human body. Radiographs can help the dental practitioner to evaluate and definitively diagnose many oral diseases and conditions. Panoramic radiography is a simplified extra-oral imaging modality which visualizes the entire maxillary and mandibular region on a single film. However, panoramic radiography exposes the patient to health risks by inducing genotoxic and cytotoxic effects to oral epithelial cells leading to cell death and hereditary disorders to the descendants. Therefore its use should be clinically justified to avoid unnecessary exposure to radiation and cost. Objective: To describe the panoramic and clinical examination findings, and to assess the level of agreement between the panoramic and clinical examination findings of dental patients at Moi Teaching and Referral Hospital (MTRH), Kenya. Methods: This was a hospital based cross sectional study conducted at the Radiology and Imaging department and dental department at Moi Teaching and Referral Hospital from September, 2019 to June, 2020. A total of 93 consented patients were enrolled using systematic random sampling. A chart review forms were administered, and findings documented. Panoramic radiograph findings were then discussed with a consultant radiologist and a dentist before findings recorded on the form. Clinical examination findings were recorded from the electronic clinical records in the directorate of dentistry, MTRH. Descriptive statistics were carried out. Categorical variables were summarized as frequencies and proportions, and reported in tables. Numerical variables were summarized as median and interquartile ranges. Cross tabulation was done to compare clinical examination and panoramic radiograph findings where percent agreement was reported as proportions. Chi-square and Fishers exact test were used as statistical tests for the study. Results: 93 patients whose ages ranged from 5-73 years with a mean of 29 years were included into the study. Radiographic features of dental caries were present in 54% of panoramic radiographs compared to clinical examination (50.5%) while 23.7% of radiographs revealed impacted teeth compared to clinical examination (19.4%). Radiographic features of periodontitis were observed in 14% compared to clinical examination (16.1%). Fractures (12.9%) were observed radiographically compared to (10.7%) clinically. Periapical lesions (8.6%) were observed radiographically compared to clinical examination (6.4%). Temporo-mandibular disorders (6.5%) were observed both on radiographs and clinical examination. Radiographic features of missing teeth (3.2%) were observed compared to clinical examination (1.1%) while only 1.1% of malpositioned teeth were observed radiographically compared to clinical examination (2.2%). Notably, mandibular lesions (3.2%) and nasal congestion (14%) were only discovered radiographically. The overall percent agreement between panoramic radiograph and clinical examination was 75.3% (70/93) with a p value of less than 0.001. Conclusions: The level of agreement between panoramic radiographs findings and the clinical examination findings for dental conditions in MTRH was high (75.3%) and statistically significant. However, radiographs did reveal slightly more cases for most of the conditions than had been diagnosed clinically, with the exception of periodontitis. Notably, some of the conditions were only discovered following radiographic examination. Recommendation: Clinical examination is sufficient in most of the cases at MTRH. Therefore, panoramic radiography should be indicated only for specific cases to protect patients from unnecessary radiation and cost.