Letters to the Editor

I read with interest the above article published in Dental Update (Dent Update 2020; 47: 334–341). I wholeheartedly agree that bitewing radiographs are the gold standard for diagnosis of proximal caries in children.

I work in a large maxillofacial unit, which has a regional children's hospital and paediatric accident and emergency department. Frequently, children present acutely with swollen faces requiring acute admission and subsequently emergency theatre for multiple extractions. Automatically these children fall into the high-risk caries group. An orthopantomogram is the only available imaging modality to use during these admissions, particularly out of hours, to aid with extraction planning.

If timing allows prior to theatre, we can send patients to the dental hospital for intra-oral bitewings plus or minus treatment planning by paediatric dentists. Anecdotally, when this does happen and they return with intra-oral imaging and a treatment plan, there are generally far more teeth on the extraction plan than would otherwise be planned by a maxillofacial surgeon using an orthopantomogram.