Practice Protocols and Selection Criteria for Prescribing Dental Radiographs

Objectives: Determine the protocols used and assess the influence of selection criteria on prescribing radiographs. Methods: Mail survey of a national random sample of 3518 general dentists from the ADA Dentist Masterfile. Respondents indicated which of three protocols reflected their practice and described how often (always, frequently, sometimes, never) 11 selection criteria influenced their prescribing of initial and recall radiographs. Results: Of 3409 eligible respondents, 1709 returned the questionnaire (50%). For initial examinations, radiographs were obtained before the dentist conducted any type of clinical examination (46%), after a preliminary screening examination but before a complete clinical examination (44%), and after a complete clinical examination (10%). For recall examinations, the percentages were 76, 17, and 8, respectively. There was a significant difference in the protocols used for the initial and recall examinations (chi-square, p<0.01). The percentages of respondents who “always or frequently” considered a selection criterion for the initial/recall examinations were: periodontal disease (90/92), caries (90/94), time since last radiographs (89/91), pregnancy (82/82), oral hygiene (77/79), patient's age (61/57), past radiation therapy (59/60), systemic diseases (58/56), current medications (22/25), fluoride exposure (22/22), and insurance coverage (17/20). The responses were significantly different across all four levels (always, frequently, sometimes, never) for the initial and recall examinations for six of the selection criteria: periodontal disease,* caries,* oral hygiene,* patient's age,** systemic diseases,* and insurance coverage* (chi-square, *p<0.01, **p<0.05). Conclusion: Obtaining radiographs before the clinical examination was common practice although it is contrary to professional guidelines and recommendations. Periodontal disease, caries, time since the last radiographs, and pregnancy were commonly considered (>80%) when prescribing radiographs. It is difficult, however, to reconcile the reported high use of clinical findings (i.e., caries, periodontal disease, oral hygiene) to make decisions about taking radiographs when a high percentage of respondents obtained radiographs before conducting a clinical examination.