title: Economic and health implications of routine CBCT examination before surgical removal of the mandibular third molar in the Danish population.
abstract: OBJECTIVE
  This epidemiological study aimed to analyse economical and societal consequences in Denmark if CBCT is used routinely as a diagnostic method before removal of the mandibular third molar. Furthermore, the aim was to calculate the excess cancer incidence from this practice.
  
  
  METHODS
  17 representative dental clinics in the regions of Denmark were visited by two observers, who registered the total number of patients in each clinic, the number of removed mandibular third molars from patients' files together with the age and gender of these patients. The data were collected from 2008 to 2014. The total number of removed mandibular third molars in Denmark each year was derived from the collected data and information on patients' contacts with dentists from Statistics Denmark as a sum of contributions from each region. The contribution of a region was obtained as the number of removed mandibular third molars in the selected clinics in the region times the ratio of the number of patients in the selected clinics in the region to the total number of patients with contact to a general practitioner in the region in 2011. Existing knowledge on the costs for panoramic and CBCT imaging was used to calculate total costs. The cancer incidence was calculated from lifetime attributable risk curves based on linear risk assumptions.
  
  
  RESULTS
  The selected clinics included 109,686 patients, and 1369 mandibular third molars had been surgically removed. Using data from Statistics Denmark gave an estimated annual number of removed mandibular third molars of 36,882 at a total cost of €6,633,400. The additional cancer incidence was estimated to be approximately 0.46 per year.
  
  
  CONCLUSIONS
  The data should be used in a cost-effectiveness analysis of the clinical efficacy of CBCT imaging before removal of mandibular third molars.
authors.affiliation: 1 Section for Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark.
authors.forename: L B
authors.initials: LB
authors.lastname: Petersen
authors.affiliation: 2 Department of Business and Economy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
authors.forename: K R
authors.initials: KR
authors.lastname: Olsen
authors.affiliation: 1 Section for Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark.
authors.forename: L H
authors.initials: LH
authors.lastname: Matzen
authors.affiliation: 3 Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Vaeth
authors.affiliation: 1 Section for Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Wenzel
mesh_terms: D000328:Adult; D054893:Cone-Beam Computed Tomography / Q000009:adverse effects / Q000191:economics*; D003718:Denmark / Q000453:epidemiology; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008964:Molar, Third / Q000000981:diagnostic imaging* / Q000601:surgery*; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: CBCT scanning; cancer incidence; costs; mandibular third molar; panoramic imaging