Fig. 3.22 Failure of eruption of maxillary left central incisor: time to be concerned!
3.5 FURTHER INVESTIGATIONS
3.5.0 Introduction
Having carried out a thorough extra- and intraoral examination as described above,
the clinician may feel that further investigations are indicated for diagnostic purposes.
Table 3.2 highlights the range of dental (and more general) investigations that may be
employed to aid diagnosis of the presenting complaint. The use of radiographs is more
fully described in the following section.
3.5.1 Radiographs
Key Point
Since patients should not be over-exposed to ionizing radiation, every radiographic
investigation should be clinically justified and have a clear diagnostic purpose.
Comprehensive clinical guidelines for radiographic assessment of children have been
proposed by the European Academy of Paediatric Dentistry (2003). 'Routine'
radiographic screening is certainly not indicated for children. However, radiographs
may be indicated in order to facilitate:
- caries diagnosis;
- trauma diagnosis;
- orthodontic treatment planning;
- identification of any abnormalities in dental development;
- detection of any bony or dental pathology.
Caries diagnosis
Bitewing radiographs are invaluable for the detection of early interproximal carious
lesions (Fig. 3.23), or occult occlusal lesions. Indeed, bitewing radiography will
increase the identification of interproximal lesions by a factor of between 2 and 8,
compared to visual assessment alone. Bitewing radiographs are usually recommended
for all new patients, especially high caries risk individuals, to provide a baseline
caries assessment. However, they may not be necessary for very young patients with
open primary molar contacts.