Dissertation Abstract

Use of radiology practice guidelines by general dentists in the United States

Dentists are expected to prescribe diagnostic radiographs according to the patient's needs based on a clinical examination and the dental and medical histories, a practice known as selective radiography. In 1987, the U.S. Food and Drug Administration (FDA) developed selection criteria and issued guidelines for the radiographic examination to facilitate selective radiography in dental practice. This study assessed dentists' use of selective radiography for the assessment of new and established patients and attempted to identify potential predictors, or risk factors for its use.

The study surveyed 3518 dentists selected from the 2001 American Dental Association "Dentist Masterfile," providing a national random sample of general dentists in private practice in the United States in the fall of 2004. The sample size anticipated a 50% response rate, thus yielding a 95% confidence interval of ±2.5 percentage points. The questionnaire included eight case scenarios that were likely to be seen in practice and covered by the FDA guidelines. Respondents were asked to prescribe radiographs as though they were seeing these patients in their offices. They were also queried about radiographic practice protocols, the extent to which selection criteria influenced their decision to obtain radiographs, and their demographic and professional characteristics. A Delphi panel of five oral and maxillofacial radiology experts generated the "gold standard" for the survey responses. Bivariate and multivariate analyses assessed predictors of selective radiography.

The response rate was 50.1% (n=1709); 46% percent of respondents prescribed radiographs for a new patient before conducting a clinical examination and 76% did so for the established patient at a recall appointment. At least 90% of the respondents regularly considered caries and periodontal disease activity when prescribing radiographs for both new and established patients. Against the experts' benchmark, 52% of respondents practiced selective radiography. These practitioners were more likely to be non-Hispanic, white men less than 70 years old compared with those who were not selective radiography practitioners. These results suggest that approximately half of U.S. general dentists are not taking advantage of the dose-sparing benefits of selective radiography.

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