What difference does using bitewing radiographs make to epidemiological estimates of dental caries prevalence and...

The study aimed to determine the relative contributions of bitewing radiography and clinical examination to caries estimates for a New Zealand child population with high caries experience. An epidemiological survey was conducted of 171 12- and 13-year-old children attending schools in five communities. Examinations were conducted in dental clinics. Bitewing radiographs were taken at the time of the clinical examination. These were developed and read later, and the data from those were used at the analysis stage to adjust the caries diagnosis for the mesial, occlusal and distal surfaces of the posterior teeth. For almost all parameters, the use of radiographs resulted in higher estimates, although at the whole-mouth prevalence level the difference was not great. The percent difference between the estimates ranged from -0.1 to 166.7%. There were moderate differences between the clinical-only and radiographically adjusted whole-mouth estimates for mean DMFT, DT, DMFS and DS, but only a minor difference in caries prevalence. With the mesial and distal surfaces only, the prevalence and severity estimates were significantly greater, with a one-surface difference (on average) in mean DS being the largest difference observed, at 166.7%. The diagnostic discrepancy was much greater for approximal than occlusal surfaces. These findings support but also build upon earlier findings and again underline the need for bitewing radiographs to be a routine part of oral epidemiological surveys wherever logistics and funding permit.