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Supporting Your Practice

Radiography Prescription Practices of Dentists in Ontario

Dr. Ernie Lam
Professor of Oral and Maxillofacial Radiology
University of Toronto

Prescription radiography is a concept that emerged in the 1980s as an attempt to better understand what clinical signs and symptoms were important in prescribing imaging to patients. Yet, despite the subsequent publication of guidelines and a gathering of evidence to support those guidelines, a recent study co-authored by Dr. Ernie Lam, U of T Professor of oral and maxillofacial radiology, shows that the uptake of prescription radiography by dentists across Ontario remains low.

In this episode of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. Lam to present his findings from the study and give his recommendations on best practices for general dentists.

Here are some of the highlights from the conversation:

Prescription Radiography vs Protocol Radiography

  • Protocol radiography refers to the ordering of imaging as part of a routine diagnostic process. It is not very patient centered.
  • Prescription radiography is a more patient-centered approach that focusses on the specific reason why a radiograph might be useful in supporting a diagnosis.

 The Study

  • The study surveyed the current radiographic practices of general dentists in Ontario by presenting them with 3 fictional clinical scenarios and asking them what kind of imaging they would order in each scenario.
  • The same scenarios were sent to oral and maxillofacial radiologists across Canada for their input as a ‘gold standard’. Survey results were then compared to the ‘gold standard’ results.

Findings

  • The majority of dentists in Ontario still favor a protocol radiography approach over prescription radiography.
  • Dentists using protocol radiography were more likely to overprescribe imaging in the three scenarios presented.
  • Despite ample time and opportunity over the last 25 years to develop an evidence base for prescription radiography, there is little change in the number of respondents who have taken up prescription radiography.
  • Guidelines should not be seen as something that tie the hands of the dentist or supersede professional opinion. They are a broad set of evidence-based ideas that support dentists’ decision-making practices.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team

Further Resources

Full Conversation (13.46")

1 Comment

  1. SHAN A SHANMUGAVADIVEL July 31, 2021

    I have not seen the questionnaire given to the dentists . I would like that shared with the dentists. I order radiographs only after clinical examination and seeing the previous radiographs. My hygienists see patient after I finish the exam, not before. Repeat PAN rays are ordered only if there is a need for it.

    Reply

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