Frequency of Radiographic Evaluation for Patients with Special Needs

Objective: This study evaluated the frequency of radiographic assessment of patients with special health care needs (SHCN) seen at the University of Iowa Pediatric Dentistry Clinic and compared this to American Dental Association (ADA)/Food and Drug Administration (FDA) dental radiographic guidelines. Patients with SHCN are considered at high risk for dental diseases, particularly caries, suggesting the need for strict adherence to guidelines that aid in diagnosis and management of dental disease. Frequently, due to behavioral challenges, it is not possible to make radiographs in the traditional dental setting. Methods: A comprehensive chart review of 553 patients having a diagnosis characterizing them as SHCN was performed. Data including dates of: initial visit, radiographs and final visit were recorded from the electronic health record. Patients were assigned to one of eight medical categories based on disease severity. Statistical analysis utilized the Wilcoxon Rank-Sum and Kruskal-Wallis tests to assess whether the medians of radiograph frequency differed among gender, age groups or medical diagnosis severity. Results: In this study the median frequency of radiographs was every two years, with a significant difference among age groups (p=0.0027). Patients over 18 years of age had the lowest median radiographic frequency (once every four years) compared to 7-18 year olds who had a median frequency of once every two years. The radiographic frequency based on severity of medical diagnosis differed significantly; patients with healthy/acute conditions received more than one radiographic exposure yearly while patients with significant chronic conditions affecting multiple systems had the lowest frequency (once every five years). There was no significant difference in radiographic frequency between genders. Conclusions: The ADA/FDA suggests making radiographs on high risk patients every 6-12 months. This study suggests older patients or those with more significant SHCN may not receive radiographs at recommended rates.