title: Efficacy of the FDA selection criteria for radiographic assessment of the periodontium.
abstract: The diagnosis of periodontitis is generally made on the basis of a clinical examination supported by radiographic evidence of bone loss. Recent guidelines promulgated by the US Food and Drug Administration recommend that periapical radiographs be ordered on the basis of clinical signs and symptoms indicating the probable presence of disease. This study evaluated the effectiveness of the FDA Guidelines for ordering radiographs for new adult dental patients as related to assessment of the periodontal condition of the patient. We examined 490 patients and determined the periapicals needed to supplement the posterior bitewings based upon the patient's clinical findings. We measured the reduction in the number of radiographs ordered as well as the extent of missed alveolar and furcation bone loss resulting from the use of the selected set of radiographs compared with a complete set. Four hundred thirty-three subjects had at least one clinical sign of periodontitis present in their mouths, and 264 demonstrated radiographic evidence of alveolar bone loss. Of the 460 subjects on whom periodontal probing was conducted, two-thirds demonstrated periodontal probing depths in excess of 3 mm; almost half showed evidence of bleeding upon probing. Individuals with clinical signs of periodontitis had, on average, 10 periapicals ordered--more than twice the number as those with no sign of periodontitis. Of the 2,415 teeth with radiographic findings of proximal or furcal bone loss, 152 sites of bone loss (6%) were missed when the selected set of films plus the posterior bitewings was used.
authors.affiliation: UCLA School of Dentistry 90095-1668, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Atchison
authors.forename: S C
authors.initials: SC
authors.lastname: White
authors.forename: V F
authors.initials: VF
authors.lastname: Flack
authors.forename: E R
authors.initials: ER
authors.lastname: Hewlett
authors.forename: S A
authors.initials: SA
authors.lastname: Kinder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging; D005260:Female; D005889:Gingival Recession / Q000000981:diagnostic imaging; D005891:Gingivitis / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000000981:diagnostic imaging; D010519:Periodontium / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D011861:Radiography, Dental / Q000592:standards* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States; D014486:United States Food and Drug Administration