Comparison of bedside ultrasound and panorex radiography in the diagnosis of a dental abscess in the ED.
OBJECTIVE
The purpose of the study was to compare bedside ultrasound (US) and panorex radiography in the diagnosis of a dental abscess in emergency department (ED).


METHODS
A retrospective review of ED records of adult patients with atraumatic facial pain, swelling, and toothache who received a panorex x-ray and bedside US was performed. Medical records were reviewed for ED evaluation and disposition. Sensitivity and specificity of US and panorex x-ray were calculated to determine the clinical utility of the 2 tests.


RESULTS
A total of 19 patients were identified. No periapical abscess was reported on panorex x-rays in 7 (37%) of 19 patients. Ultrasound agreed with panorex x-rays in 6 (86%) of 7 cases. One case where US disagreed with x-rays was evaluated by dentistry consultants; and incision and drainage were performed, confirming the presence of an abscess. An x-ray diagnosis of periapical abscess was made in 12 (63%) of 19 patients. Ultrasound agreed with panorex x-ray in 10 (83%) of 12 cases. In 1 of the 2 cases where US disagreed with panorex x-rays, x-ray abnormalities were reported on the nonsymptomatic side. The other patient was given antibiotics and recommended outpatient follow-up. Follow-up information was not available to further confirm the presence of an abscess. Assuming that the patient who was lost to follow-up had dental abscess, the sensitivity and specificity of US in diagnosing a dental abscess were 92% and 100%, respectively.


CONCLUSIONS
Bedside US is nonionizing, is readily available, and can provide an alternative to panorex x-rays in the evaluation of a dental abscess in ED.
Adhikari
Srikar
S
Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198-1150, USA. sriadhikari@aol.com
Blaivas
Michael
M
Lander
Lina
L
D000038:Abscess / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009059:Mouth Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011862:Radiography, Panoramic; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography