oral surgery oral medicine oral pathology

with srctior~.~ on oral und maxillofacial radiology and endodontics

EDITORIAL

A research agenda to address challenges facing oral and maxillofacial radiology

Current practices and standards in oral and max- illofacial radiology are being challenged by the recsent technical advancements in dental imaging (digital radiography, tomography, CT, MRI, digital subtrac- tion) that impact on clinical practice and the demands of dentists and patients for more accurate, more efli- cient, and less expensive diagnostic radiology.

The three components of radiology practice in den- tistry are the same as those in medical radiology: the prescription of radiographs, the acquisition of images on film or in digital form, and the interpretation of the images. The purposes of this editorial are to describe contemporary challenges for oral and maxillofacial radiology and to identify a research agenda for this field.

National guidelines for the prescription of radio- graphs for general dentistry, periodontics, and pedi- atric dentistry were published by the FDA in 1988, they have been disseminated to the profession, and their introduction into dental schools has begun. The objective is to provide clinical decision guidelines for radiograph prescription for initial and continuing comprehensive care for patients. The status of incor- poration of the guidelines into clinical practice na- tionally is essentially unknown. Research is needed in three areas: first, to keep guidelines current, second, to identify cost-effective methods to disseminate the guidelines and encourage their use in clinical den- tistry, and third, to develop patient selection criteria for patients who require specialized radiographic ex- aminations.

Image acquisition is becoming more complex as direct intraoral radiography, digital subtraction, CT, MRI, nuclear medicine, and tomography are being applied to dental diagnostic problems. Oral and max- illofacial radiologists at dental schools and in private practice have organized mechanisms to facilitate the acquisition of these advanced imaging procedures for dental patients. There is a need for increased sophis-

ticated information that requires the use of advanced imaging modalities even though the efficacy of some of these approaches is not clearly documented.

The recent introduction of intraoral radiographic digital imaging systems signals the entry of direct digital radiographic imaging into dental offices. Film- less radiographic systems will be developed that gain acceptance by clinicians. Digital radiology will en- hance dentists’ ability to use image analysis methods to quantify anatomic relationships and to detect bone density changes. Research is needed to evaluate new digital technology, to develop new diagnostic tech- niques using digital information, and to develop im- proved systems.

Lastly, once appropriate images have been ob- tained, the clinician and radiologist are responsible for accurate radiographic interpretation. Diagnostic decisions made from radiographs depend upon the ability of the dentist to interpret the film once the im- age has been made. Research is needed to establish the most effective educational strategies for instruc- tion for dental students and experienced practitioners in radiographic diagnosis.

The challenge for the future is to obtain scientific verification for all aspects of radiology practice in dentistry: the continued development and increased use of radiograph prescription guidelines; develop- ment, testing, and cost effectiveness of new imaging modalities; educational approaches for learning ra- diographic diagnosis, and the development of decision support programs to enhance the quality of radio- graphic diagnosis. Clinicians and researchers must work together to reach these goals in the behalf of dental patients in the future.

Stephen R. Matteson. DDS San Antonio, Texas 1992- 1993 President

American Academy qf Oral and Maxillqfacial Radiolog.v

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