If there’s some question about which tooth is bothering them, etc, I’ll see them prior to ordering films.

Scenario 1 above takes into account the fact that I can’t do my job without a film of the tooth in question and that I already know that I’ll need another film after seeing the one that was sent from the other office.

That’s my rationale anyway.

Charging for IO pics is like charging for local anesthetic for a filling.

So basically I can provide no concrete evidence to back up my statement. Now that is bad evidence based dentistry.

So how can I justify my support for regular “screening” OPG’s? The answer is, from a frank cost-benefit analysis, I can’t. Actually, even from a clinical usefulness perspective the evience supporting OPG’s is not particularly strong.

This however reminds me alot of an argument I’ve had with a pathology Professor in the local faculty. This professor has the firm belief that the soft tissue of ALL periapical radiolucencies should be submitted for histopathological examination if an extraction is carried out. Read that carefully. All. Periapical. Radiolucencies. Even the ones we are convinced are just periapical granulomas. I’ve always argued with him that this is an absolutely unworkable idea. The cost in terms of funding and manpower is just prohibitive. However his argument is to dispense with a cost-benefit analysis. In the span of a single year when he *was* able to institute this rule, histopath screening revealed four malignant neoplasms that had been mistaken for periapical infections. Now, the expense of all those screening to the institution? Probably huge. But the benefit to those four single patients of catching pathology earlier? Priceless.

But hey, even I can see that that is weak, anecdotal evidence and let’s face it, practices have to be run economically and efficiently.

So I’ll just say that currently, I am in a position to provide regular screening for patients at very little cost to them, so I see no reason why it shouldn’t be done. I would not necessarily expect the procedures to be adopted in all cases.

Actually, I will just say one last thing which I probably should have said earlier. Dentists have a tendency to concentrate too much on the teeth. The days where that was our sole responsibility are numbered. It is our responsibility to provide care, or at least screening, for the enitre oral milieu, and this includes the mandibular and maxillary bones as well as the sinuses and the orophayrnx. As an adjunct to clinical exam, I can’t think of a faster, easier way to image these areas than an OPG.

radiographs shold be prescribed by a physician or dentist and like any drug or agent that is dispensed, should be tailored to the individual patient. the likelihood of “missing something” like a tumor or problem by NOT routinely radiographing the entire mouth is very slim and failure to take a “screening” FMS or a PAN on a completely virgin dentition that develops, say, a traumatic bone cyst would not hold up in court because routine “screening” panoramics are NOT the standard of care. neither is an FMS. a panoramic for pain in the jaw or clicking and popping of the TMJ, or evaluating eruption patterns on a mixed dentition is. i save the full mouth series for extreme perio and implant cases or if there’s multiple extractions or extensive pathology. unfortunately, when we were in dental school every patient got an FMS, mostly because us low-lifes needed to learn how to take rads, but as you all know dental schools are pretty much exempt from these things.

i think what was missing in this case was a lack of communication between this dentist and the patient. he or she should have told this woman what he was going to do and explained its purpose before executing it. and no patient should receive radiographs without first being examined by the treating dentist.

and btw, i would never charge for intraoral camera films. it’s like me charging extra for using rotary endo.

The conversation brings up one more point of interest (which I’m guilty of doing). And that is ordering xrays without first doing an IO exam (or even seeing the patient)…

These days I order a new OPG and bitewings if a patient hasn’t had them for more than 12 months – many dentists would find this to be wildly extravangant however I think it is justified since a) I work exclusively in public health so the patient isn’t footing the bill and b) our ability to recall patients in the public system is functionally nonexistent so I think every chance should be taken to screen for new pathology. Note these are economic reasons – I believe there is adequate justification for taking radiographs this often for clinical and diagnostic reasons, too.

The question about being charged for unrequested photos I’d leave for wiser minds than mine (minds belonging to people with more private experience as well). BUT, I will say that if they were unrequested and the fact that they would cost had not been discussed before hand, I personally wouldn’t feel under obligation to pay for them. Alot of digital systems these days can be displayed to the patient on in-house computer or tv screens and are excellent patient education tools – excellent and free. If a patient asks for a hardcopy or CD, however, I think attaching a cost-price is absolutely acceptable.