dc.description.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. |
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