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All relevant ‘dental’ radiographic anomalies require a report, be they related to the teeth, mandible, maxillary sinuses, temporomandibular joints or soft tissues. However, non-dental incidental findings are often present on dental radiographs, some of which may be due to systemic disease: these should also be assessed. We compare the confidence at diagnosing, and subsequent management of, three such incidental findings between specialist dental and maxillofacial radiologists and recently qualified dentists. The imaging features and clinical implications of dense bone islands, carotid artery calcification and osteoporosis are described.
CPD/Clinical Relevance: Dental panoramic radiographs cover structures not confined to the tooth-bearing areas and incidental findings in these regions should be recognized and appropriately reported, in line with IR(ME)R legislation.
Article
Dental panoramic tomograms (DPTs) are widely used to support dental treatment. The DPT image is not confined to the tooth-bearing area and includes the surrounding anatomical structures, including the mandibular and maxillary bone and the soft tissue structures of the neck. Incidental findings not related to the ‘dentition’ may be detected and, under IR(ME)R legislation, should be recorded in the radiographic report. In the last few years, it has been suggested that three such incidental findings may have implications in systemic disease, such as dense bone islands (DBI), carotid artery calcification (CAC) and osteoporosis, could be picked up by the dentist from DPTs taken for other reasons. Dense bone islands have been implicated in Gardner's syndrome (multiple osteomas and polyposis coli), carotid artery calcification in increased risk of stroke, and osteoporosis in increased risk of fractures. The authors are aware that clinicians can struggle to identify findings not related to the dentition reliably, and that most of the publications have been in specialist dentomaxillofacial journals. They therefore wanted to compare the confidence of diagnosis of such lesions between specialist dental radiologists and newly qualified dentists and to see whether there were differences in their subsequent recommendation of management of the patient so that areas where specific training needs were required could be identified.
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