Pakbaznejad Esmaeili, Elmira
(Helsingin yliopisto, 2017)
Orthodontic treatment is common especially among children and adolescents. A dental panoramic tomograph (DPT) and a lateral cephalometric radiograph (LCR) are the main radiographic tools for orthodontic treatment planning. Children own higher radiosensitivity than adults, because of their developmental and physiological status. Therefore, during dental extra-oral radiography of children, implementation of the two first principles of radiation protection, the principles of justification and optimization, should be highlighted. Notably, however, qualitative assessments of orthodontic radiography had not been published before the present study.
The study subjects were a random sample of 7- to 12-year-olds of whom a DPT and/or an LCR had been taken in the Oral Healthcare Department of the City of Helsinki in 2010. For DPTs, the sampling was repeated in 2013-2014 after an intervention.
Retrospective analysis of the sample from 2010 revealed that 1) the vast majority of DPTs and all LCRs were ordered for orthodontic diagnostics, 2) the referrals were inadequate for nearly one-third of the images, 3) an adult program was used for taking most of the DPTs, 4) segmented DPT was never used, 5) most of the DPTs and LCRs displayed too extended field-size, 6) the number of repeated radiographs was almost at the permitted level, 7) almost one-third of the images lacked radiographic interpretation and cephalometric analysis, and 8) general and developmental pathologic findings were observed in the area of the dentition only.
These results gave reason for an educational intervention program that particularly aimed at more appropriate DPT program selection in children. Its power was analysed by prospective evaluation of DPTs in 2013-2014, and a notable increase became evident in application of both segmented and child panoramic programs.
This work disclosed deficiencies throughout the process of dental extra-oral radiography of children. It emerged that further need for continuing education in radiation protection exists for the whole dental team, especially the orthodontists and practitioners involved in orthodontics. Education was proven to positively affect the optimization process. In addition, the results endorse development of DPT- and LCR-device towards enhanced field limitation options for patients of different age and size and indications for dental extra-oral radiography.