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The Value of the Roentgen Ray in Oral Diagnosis*
THE VALUE OF THE ROENTGEN RAY IN ORAL DIAGNOSIS* B y C L A R E N C E O . S I M P S O N , D .D .S ., St. Louis, M issouri
NY diagnostic aid is best appraised by a quantitative comparison of its contribution with that of other methods, by estimating the relative im portance of the information supplied in promoting an accurate diagnosis, by canvassing the possibilities of equitably substituting other methods, and by as certaining the proportion of positive findings which it gives. In oral diag nosis, the data are obtained by various combinations of the following means: 1. The objective symptoms, includ ing swelling, deformity, motor derange ments and circulatory, changes. 2. The subjective symptoms, in ascertaining the character and degree of pain, and the location of the dis turbance. 3. The history in reference to the manifestations and duration of the dis order, previous dental operations, the nature of and the response to treatment, the age and the physical condition. 4. Ocular inspection, to observe superficial tissue changes, dental anom alies, caries and discharging sinuses. 5. Instrumental examination, to explore sinuses, carious openings and pulp canals; to test the mobility of teeth, and to apply percussion. A
* R e ad b e fo re th e Section on E x o d o n tia , A nesthesia a n d R o e n tg e n o lo g y a t the Seventh In te rn a tio n a l D e n ta l C ongress, P h ila d e lp h ia , P a., A u g . 25., 1926. Jo u r. A . D . A . , N o v e m b e r, 1927
2025
6. Palpation, to locate tenderness, and to distinguish fluctuation and crepitus. 7. Transillumination, to observe gross opacities and the translucence of teeth. 8. Vitality tests, to determine the response of pulps to thermal changes or electric stimulus. 9. Microscopic and bacteriologic examinations, to determine the nature of suppurative processes and neoplasms, and to study the blood. None of these methods reveals the proximal surfaces of teeth in contact, the relation of caries or restorations to the pulp, the number and form of roots, the relative amount of the roots exposed by marginal destruction, the changes in periapical structures, un erupted teeth, unexposed foreign bodies, the early stages of destructive processes in the maxillary bones or the nature of fractures. Since most of the serious dental disorders occur in the pulp and investing tissues, the extent and impor tance of radiography’s contribution is greater than that of any other diag nostic aid and in value approximates that of all other methods of examina tion combined. Excepting the acute manifestations, radiographic evidence is the most dependable guide to the effect of disease in bone, and no other pre operative method of examination can be advantageously substituted for it.
2026
The Journal of the American Dental Association
The proportion of positive findings from radiodontic examinations is ex ceedingly high, and, in adults, an ex amination rarely fails to disclose unsuspected disorders requiring correc tion. The most significant revelations of radiography in prophylactic service are caries in the proximal surfaces of teeth and incipient marginal destruction. The consequence of this information is evident when the results of ignoring it are considered. Caries in the proximal surfaces of teeth is likely to endanger the pulp before producing pain or being discovered by the customary instru mental examination. The prompt re pair of teeth attacked by caries will eliminate the pulpless tooth problem, with its operative difficulties and health risk, and radiography offers the most efficient means of investigating the in accessible and susceptible proximal sur faces. Pyorrhea alveolaris causes the loss of more teeth than all other dis turbances, and the early discovery and correction of the etiologic factors is the most effective treatment. Localized periodontal lesions, the usual origin of pyorrhea alveolaris, are demonstrable in an incipient stage by systemic radio dontic examinations. In periodic ex aminations for prophylactic service, these degenerative changes are readily observed, and often the primary cause, which may be a defective restoration, lack of proximal contact, calcareous deposits or abnormal occlusal stress, is radiographically evident. The most spectacular and vital serv ice of oral radiography is in disclosing periapical involvement from septic teeth without subjective and objective symp toms. The prevalence of pulpless teeth, and the tendency of such teeth to be
come septic foci, render accurate diag nosis essential in determining the probability of infection of dental origin. Obtaining the evidence to re veal or exclude the indications of periapical infection is the most exacting phase of oral radiography. The usual radiodontic examination is grossly in adequate for the purpose of deciding the individual status of teeth, and the value of radiography in this connection can not be judged by the prevailing inferior standard of radiodontic practice. Until there is an insistent demand for a thor ough radiographic examination of the teeth and investing structures, instead of the customary pretense which is de ceptively called “x-raying the teeth,” the diagnosis of periapical disease will be merely conjecture, with a high pro portion of error. When the radiographic data are confined to crudelydistorted images of the teeth, traces of canal operations and extreme dis parities in radiability, accurate interpre tation is precluded. Mathematical precision cannot be expected in periapical diagnosis, but radiographic evidence is the most reli able index of structural changes, and, when fully utilized, it compares favorably with the efficiency of other dental and medical diagnostic methods. The study of periapical abnormalities is of paramount importance to investi gators who endeavor to determine the pathogenic potentiality of teeth rather than radically condemning all pulpless teeth. Instead of questioning or de preciating the value of radiography in locating oral foci, we should direct intensive efforts toward gaining all the information obtainable by this means and correctly interpreting the evidence for a rational diagnosis.
NY diagnostic aid is best appraised by a quantitative comparison of its contribution with that of other methods, by estimating the relative im portance of the information supplied in promoting an accurate diagnosis, by canvassing the possibilities of equitably substituting other methods, and by as certaining the proportion of positive findings which it gives. In oral diag nosis, the data are obtained by various combinations of the following means: 1. The objective symptoms, includ ing swelling, deformity, motor derange ments and circulatory, changes. 2. The subjective symptoms, in ascertaining the character and degree of pain, and the location of the dis turbance. 3. The history in reference to the manifestations and duration of the dis order, previous dental operations, the nature of and the response to treatment, the age and the physical condition. 4. Ocular inspection, to observe superficial tissue changes, dental anom alies, caries and discharging sinuses. 5. Instrumental examination, to explore sinuses, carious openings and pulp canals; to test the mobility of teeth, and to apply percussion. A
* R e ad b e fo re th e Section on E x o d o n tia , A nesthesia a n d R o e n tg e n o lo g y a t the Seventh In te rn a tio n a l D e n ta l C ongress, P h ila d e lp h ia , P a., A u g . 25., 1926. Jo u r. A . D . A . , N o v e m b e r, 1927
2025
6. Palpation, to locate tenderness, and to distinguish fluctuation and crepitus. 7. Transillumination, to observe gross opacities and the translucence of teeth. 8. Vitality tests, to determine the response of pulps to thermal changes or electric stimulus. 9. Microscopic and bacteriologic examinations, to determine the nature of suppurative processes and neoplasms, and to study the blood. None of these methods reveals the proximal surfaces of teeth in contact, the relation of caries or restorations to the pulp, the number and form of roots, the relative amount of the roots exposed by marginal destruction, the changes in periapical structures, un erupted teeth, unexposed foreign bodies, the early stages of destructive processes in the maxillary bones or the nature of fractures. Since most of the serious dental disorders occur in the pulp and investing tissues, the extent and impor tance of radiography’s contribution is greater than that of any other diag nostic aid and in value approximates that of all other methods of examina tion combined. Excepting the acute manifestations, radiographic evidence is the most dependable guide to the effect of disease in bone, and no other pre operative method of examination can be advantageously substituted for it.
2026
The Journal of the American Dental Association
The proportion of positive findings from radiodontic examinations is ex ceedingly high, and, in adults, an ex amination rarely fails to disclose unsuspected disorders requiring correc tion. The most significant revelations of radiography in prophylactic service are caries in the proximal surfaces of teeth and incipient marginal destruction. The consequence of this information is evident when the results of ignoring it are considered. Caries in the proximal surfaces of teeth is likely to endanger the pulp before producing pain or being discovered by the customary instru mental examination. The prompt re pair of teeth attacked by caries will eliminate the pulpless tooth problem, with its operative difficulties and health risk, and radiography offers the most efficient means of investigating the in accessible and susceptible proximal sur faces. Pyorrhea alveolaris causes the loss of more teeth than all other dis turbances, and the early discovery and correction of the etiologic factors is the most effective treatment. Localized periodontal lesions, the usual origin of pyorrhea alveolaris, are demonstrable in an incipient stage by systemic radio dontic examinations. In periodic ex aminations for prophylactic service, these degenerative changes are readily observed, and often the primary cause, which may be a defective restoration, lack of proximal contact, calcareous deposits or abnormal occlusal stress, is radiographically evident. The most spectacular and vital serv ice of oral radiography is in disclosing periapical involvement from septic teeth without subjective and objective symp toms. The prevalence of pulpless teeth, and the tendency of such teeth to be
come septic foci, render accurate diag nosis essential in determining the probability of infection of dental origin. Obtaining the evidence to re veal or exclude the indications of periapical infection is the most exacting phase of oral radiography. The usual radiodontic examination is grossly in adequate for the purpose of deciding the individual status of teeth, and the value of radiography in this connection can not be judged by the prevailing inferior standard of radiodontic practice. Until there is an insistent demand for a thor ough radiographic examination of the teeth and investing structures, instead of the customary pretense which is de ceptively called “x-raying the teeth,” the diagnosis of periapical disease will be merely conjecture, with a high pro portion of error. When the radiographic data are confined to crudelydistorted images of the teeth, traces of canal operations and extreme dis parities in radiability, accurate interpre tation is precluded. Mathematical precision cannot be expected in periapical diagnosis, but radiographic evidence is the most reli able index of structural changes, and, when fully utilized, it compares favorably with the efficiency of other dental and medical diagnostic methods. The study of periapical abnormalities is of paramount importance to investi gators who endeavor to determine the pathogenic potentiality of teeth rather than radically condemning all pulpless teeth. Instead of questioning or de preciating the value of radiography in locating oral foci, we should direct intensive efforts toward gaining all the information obtainable by this means and correctly interpreting the evidence for a rational diagnosis.