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The value of bitewing radiographs in the management of carious primary molars


Introduction Bitewing radiographs (BWs) are under-utilised for children, and reliance on visual diagnosis alone is likely to under-diagnose caries. Quantification of the level of the under-reporting of caries and the vital role of BWs would be beneficial when providing dental care to the paediatric population.

Aim To quantify the diagnostic value of bitewings in the management of proximal caries in primary molars.

Design Cross-sectional study.

Materials and methods Thirty children (mean age 6.2 ± 1.3 years) were recruited. A visual inspection (VI) of the primary molars was carried out and bitewings were taken. Radiographic assessment (RA) for primary molar proximal caries was completed separately. VI and RA were compared statistically against three caries thresholds, using the Fisher's exact test. A p value <0.05 was considered statistically significant. Sensitivity and specificity analyses were performed.

Results A total of 480 proximal surfaces were assessed. Bitewings detected 44.6% of additional proximal carious lesions (p <0.0001). At d3 threshold, VI under-reported 51.2% proximal caries (p <0.0001) and 34.1% dentinal proximal caries (p = 0.0012). VI showed high specificity (99%) and low sensitivity (53%).

Conclusion Bitewings play a vital role in proximal caries diagnoses of primary molars.

Key points

  • Highlights the importance of bitewing radiographs in assessment of carious primary molars.

  • Discusses the prevalence of under-reported proximal caries at the d3 threshold.

  • Describes the role of bitewing radiographs in detecting 'hidden proximal caries'.

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We would like to thank the staff of the Department of Radiology and Department of Paediatric Dentistry, Edinburgh Dental Institute along with participating patients and their parents for all their help and contribution to the study. We would also like to thank Mr Donald J. Thompson, Consultant Oral and Maxillofacial Radiologist, for his assistance in the study.

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Correspondence to Aneeka Anwar.

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Anwar, A., Keightley, A., Roebuck, E. et al. The value of bitewing radiographs in the management of carious primary molars. Br Dent J 231, 575–579 (2021).

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