An audit and service evaluation of the use of cone beam computed tomography (CBCT) in a paediatric dentistry department

Abstract

Objectives: CBCT exposes the paediatric patient to a higher X-ray dose and risk than normal dental radiographs. This study has two components: an audit and service evaluation. The audit aims to assess whether the use of CBCT in a Paediatric Dentistry department at a London hospital complies with European guidelines (SEDENTEXCT). The service evaluation aims to explore the influence of CBCT on treatment planning. Methods: Two 6 month audit cycles were completed, where CBCT requests were audited to check whether image justifications comply with SEDENTEXCT. For the service evaluation, a total of 50 patient records were examined for the effect of CBCT on definitive treatment plans. Results: The first audit demonstrated 94% compliance with SEDENTEXCT. After instituting staff training in CBCT, compliance improved to 100%. In the service evaluation, 100% of CBCTs were found to provide information that impacted on the clinicians’ treatment planning, diagnosis and/or management. Of most significance, 44% of treatment plans were changed because of new information provided by CBCT. Conclusions: There are few studies investigating the use of CBCT in paediatric dentistry and the impact of this investigation. This service evaluation shows that CBCT can play an important role in optimising paediatric patient outcomes. The need for robust staff training in CBCT referrals to prevent over prescription is demonstrated in the audit cycles.

Trends in CBCT current practice within three UK paediatric dental departments

“…This study supports the findings from a (single unit) similar service evaluation by Mizban et al ( 2019 ) who found that CBCT can significantly change the diagnoses and opinions in teeth with dental trauma and pathology associated with developmental anomalies. The impact that CBCT has on treatment planning also supports a statement by IATD ( 2012 ) on CBCT: it provides improved visualisation of traumatic dental injuries, particularly root fractures and lateral luxation injuries, monitoring of healing, and complications.…”

“…The most common indication for requesting a CBCT was to investigate the local developing dentition and when examined within age group categories, this remained consistent in all age groups 4–6, 7–12 and 13–16 years (50%, 73%, 62%) and was succinct with the findings from other studies (Barba et al 2018 ; Mizban et al 2019 ). The divison of clinical indications was further divided into different groups for these studies whereby in the present study assessment of the localised developing dentiton group included teeth with root resoption unrelated to dental trauma, bony pathology, supernumeries and unerupted teeth.…”

“…A recent service evaluation at a London-based dental hospital also only included CBCTs requested by paediatric dental specialists and found that the mean age of subjects was 11.5 years and the most common clinical indication for the CBCT examinations was the assessment of unerupted teeth (Mizban et al 2019 ). This supports the findings of the present study and echoes the authors’ comment when comparing another UK-based service evaluation (Hidalgo-Rivas et al 2014 ) which assessed CBCT in paediatric patients.…”

“…Giray et al ( 2019 ) conducted a cross-sectional questionnaire concluding that about a third of the paediatric dentists who responded had no knowledge of CBCT. Those who did use CBCT imaging, cited their most common reason for use was for pathology of the jaw; whereas Mizban et al ( 2019 ) found the most common reason for a paediatric dentistry consultant to request a CBCT was for unerupted teeth. There are no other studies to our knowledge that investigate the trends of paediatric dentists using CBCT.…”

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety

“…In 73.5% of records (147/200), investigations required following the occurrence of events were reported, with the most frequently applied instrumental investigations (42.2% of cases). These assessments, as easily understood, determine an important investment of human and economic resources, precluding the possibility of being able to allocate them elsewhere [ 20 ].…”