Optimising radiographic bitewing examination to adult and juvenile patients through the use of anthropomorphic phantoms.

Four anthropomorphic phantoms (an adult male, an adult female, a 10-y-old child and a 5-y-old child) were exposed to bitewing radiographs at film and digital settings using both rectangular and round collimation. Optically stimulated dosemeters were used. For children, average organ doses were <40 µGy and the organs with the highest doses were the salivary glands, parotid, oral mucosa, skin and extrathoracic airway. For adults, average organ doses were <200 µGy. Highest adult doses were to the salivary glands, oral mucosa and skin. Effective doses ranged from 1.5 to 1.8 µSv for children and from 2.6 to 3.6 µSv for adults when optimised technique factors were employed, including digital receptors, rectangular collimation, size-appropriate exposure times and proper clinical judgment. Optimised doses were a fraction of the natural daily background exposure. Therefore, predictions of hypothetical cancer incidence or detriment in patient populations exposed to such low doses are highly speculative and should be discouraged.

Comparison of adult and child radiation equivalent doses from 2 dental cone-beam computed tomography units.

INTRODUCTION: With the advent of cone-beam computed tomography (CBCT) scans, there has been a transition toward these scans' replacing traditional radiographs for orthodontic diagnosis and treatment planning. Children represent a significant proportion of orthodontic patients. Similar CBCT exposure settings are predicted to result in higher equivalent doses to the head and neck organs in children than in adults. The purpose of this study was to measure the difference in equivalent organ doses from different scanners under similar settings in children compared with adults. METHODS: Two phantom heads were used, representing a 33-year-old woman and a 5-year-old boy. Optically stimulated dosimeters were placed at 8 key head and neck organs, and equivalent doses to these organs were calculated after scanning. The manufacturers' predefined exposure settings were used. RESULTS: One scanner had a pediatric preset option; the other did not. Scanning the child's phantom head with the adult settings resulted in significantly higher equivalent radiation doses to children compared with adults, ranging from a 117% average ratio of equivalent dose to 341%. Readings at the cervical spine level were decreased significantly, down to 30% of the adult equivalent dose. When the pediatric preset was used for the scans, there was a decrease in the ratio of equivalent dose to the child mandible and thyroid. CONCLUSIONS: CBCT scans with adult settings on both phantom heads resulted in higher radiation doses to the head and neck organs in the child compared with the adult. In practice, this might result in excessive radiation to children scanned with default adult settings. Collimation should be used when possible to reduce the radiation dose to the patient. While CBCT scans offer a valuable tool, use of CBCT scans should be justified on a specific case-by-case basis.

Evaluation of radiation exposure with Tru-Align intraoral rectangular collimation system using OSL dosimeters.

A pilot study to compare radiation exposure with the Tru-Align rectangular collimation system to round collimation exposures was undertaken. Radiation exposure at various points within the cross sections of the collimators and entrance, intraoral and exit dose measurements were measured using InLight OSL dosimeters. Overall dose reduction with the use of the rectangular collimation system was estimated by taking into account the ratios of collimator openings and the average radiation exposure at the measurement points. Use of the Tru-Align system resulted in an average radiation exposure within the perimeter of the projected outline of the rectangular collimator of 36.1 mR, compared to 148.5 mR with the round collimator. Our calculations indicate a dose reduction by a factor of approximately 3.2 in the case of the Tru-Align system compared to round collimation. The Tru-Align system was easy to use, but in some situations failed to allow Xray coverage of the entire surface of the image receptor, leading to cone cuts.

Evolution of a humanitarian dental mission to Madagascar from 1999 to 2008.

In this article, we report on the evolution of a series of dental outreach missions sponsored by Stony Brook University to remote areas of Madagascar over a nine-year period. The project evolved from one dental resident performing only dental extractions in 1999 to a team comprised of two dentists, six third-year dental students, and two dental assistants performing dental restorations, extractions, and endodontic procedures using digital radiographic equipment in 2008. The ability during the latest mission to utilize digital radiography in remote areas lacking running water, electricity, and dental facilities significantly enhanced the range and efficacy of dental procedures. This long-term project offered senior dental students and residents from Stony Brook University's School of Dental Medicine an educationally valuable opportunity to engage in international dental outreach and to make a significant contribution to the improvement of oral health in the underserved rural communities of Madagascar.

Comparison of the efficacy and technical accuracy of different rectangular collimators for intraoral radiography.

OBJECTIVE: The objective of this study was to compare the operating efficiency and technical accuracy of 3 different rectangular collimators. STUDY DESIGN: A full-mouth intraoral radiographic series excluding central incisor views were taken on training manikins by 2 groups of undergraduate dental and dental hygiene students. Three types of rectangular collimator were used: Type I ("free-hand"), Type II (mechanical interlocking), and Type III (magnetic collimator). Eighteen students exposed one side of the manikin with a Type I collimator and the other side with a Type II. Another 15 students exposed the manikin with Type I and Type III respectively. Type I is currently used for teaching and patient care at our institution and was considered as the control to which both Types II and III were compared. The time necessary to perform the procedure, subjective user friendliness, and the number of technique errors (placement, projection, and cone cut errors) were assessed. The Student t test or signed rank test was used to determine statistical difference (P

Pilot study: digital subtraction radiography as a tool to assess alveolar bone changes in periodontitis patients under treatment with subantimicrobial doses of doxycycline.

BACKGROUND: Subtle changes in marginal alveolar bone level can be demonstrated using digital subtraction of sequential radiographs. OBJECTIVE: We aimed to evaluate the practical application of geometrically corrected digital subtraction in a clinical study of alveolar bone response to a drug previously shown to inhibit alveolar bone loss. STUDY DESIGN: Selected periapical radiographs were acquired with projective standardization of patients with clinical marginal alveolar bone loss. Subsequently, patients received a 6-month regimen of subantimicrobial doxycycline or placebo. Standardized radiographs of the same alveolar regions were acquired after 3 and 6 months, and baseline radiographs were subtracted from these images. RESULTS: Blinded digital subtraction analysis indicated various levels of marginal bone gain in 3 of the 6 patients in the experimental group, whereas in 3 of the 5 placebo patients the method showed bone loss. CONCLUSION: These results suggest that geometrically corrected digital subtraction possibly agrees with clinical predictors of bone loss severity.

Subantimicrobial dose doxycycline effects on alveolar bone loss in post-menopausal women.

AIM: Determine the efficacy of 2-year continuous subantimicrobial dose doxycycline (SDD; 20 mg bid) on alveolar bone in post-menopausal osteopenic, oestrogen-deficient women undergoing periodontal maintenance in a 2-year double-blind, placebo-controlled, randomized clinical trial. MATERIAL AND METHODS: One-hundred and twenty-eight subjects randomized to SDD or placebo (n=64 each). Posterior vertical bite wings taken at baseline, 1 and 2 years for alveolar bone density (ABD), using radiographic absorptiometry (RA) and computer-assisted densitometric image analysis (CADIA), and alveolar bone height (ABH). Statistical analyses utilized generalized estimating equations; primary analyses were intent to treat (ITT). Results are presented as SDD versus placebo. RESULTS: Under ITT, there was no statistically significant effect of SDD on ABD loss (RA: p=0.8; CADIA: p=0.2) or ABH loss (p=0.2). Most sites (81-95%) were inactive. For subgroup analyses, mean CADIA was higher with SDD for non-smokers (p=0.05) and baseline probing depths > or =5 mm (p=0.003). SDD was associated with 29% lower odds of more progressive ABH loss in women >5 years post-menopausal (p=0.05) and 36% lower among protocol-adherent subjects (p=0.03). CONCLUSIONS: In post-menopausal osteopenic women with periodontitis, SDD did not differ overall from placebo. Based on exploratory subgroup analyses, additional research is needed to determine the usefulness of SDD in non-smokers, subjects >5 years post-menopausal and in deeper pockets. Protocol registered at (ClinicalTrials.gov). Identifier: NCT00066027.