PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
PROSTHODONTICS - American College of Prosthodontists
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SignificantclinicalfindingsAthoroughdescription<strong>of</strong>thechangesincolor,contour,consistency,andfunctionthatarerepresentative<strong>of</strong>malignanciesins<strong>of</strong>ttissueshasbeenprovidedelsewhereinthispublication.CTandMRIare<strong>of</strong>tenperformedtodeterminethenatureandextent<strong>of</strong>theselesions.Butitshouldbekeptinmindthatmalignanciesthatoriginateins<strong>of</strong>ttissuescanextendormetastasizetobone,sodentistsshouldconsiderradiographicexamination<strong>of</strong>thejawsifsuspicionsariseaboutboneinvolvementwiths<strong>of</strong>ttissuetumors.Varioussignsandsymptomsmayrepresentlesionscentrallylocatedinthejawsandwouldleadtotheexposure<strong>of</strong>radiographs.Shiftingorloosening<strong>of</strong>teethorexpansion<strong>of</strong>thejawsintheabsence<strong>of</strong>inflammatorydisease,jawpainorparaesthesia<strong>of</strong>thelip,andclinicalevidence<strong>of</strong>non‐inflammatoryandnon‐reactivemaxillarysinusdiseaseareamongtheominousfindingsthatshouldalertthedentisttotheneedforradiographs.Shouldradiographsbeexposedroutinelytoscreenpatientsforcancer?Isitwisetoroutinelyorderradiographstohuntforoccultdiseaseintheabsence<strong>of</strong>suggestivehistoricalorexaminationfindings?Evidencesuggeststhatthepresence<strong>of</strong>malignantdiseaseisusuallyaccompaniedbysignsandsymptomsthatwouldwarrantradiographicexamination(BrooksSL,AtchisonKA.Guidelinesforprescribingdentalradiographs.In:WhiteSC,PharoahMJ.OralRadiology,5thed.St.Louis,Mosby,2003,pp265‐80).Whileunsuspectedabnormalitieshavebeendetectedonradiographsexposedwithoutsuspiciousfindings,theyarealmostalwaysinsignificant,andthechance<strong>of</strong>findingevidence<strong>of</strong>anunsuspectedmalignancyonaradiographisextremelysmall(StephensRG,KogonSL,SpeechleyMR,DunnWJ.Acriticalview<strong>of</strong>therationaleforroutine,initialandperiodicradiographicsurveys.JCanDentAssoc1992;58(10):825‐8,831‐2,835‐7).Thisisprobablyduetotherelativelylowsensitivity<strong>of</strong>radiographyinvisualizingverysubtlechangesintissue.Prevailingopiniondoesnotfavorroutinescreeningradiographsinthesearchformalignantdisease.HowcanIdecidewhichradiographictechniquestouse?Oncethedecisionhasbeenmadetoperformorrequestaradiographicexamination,thedentistmustselectthetechniquesthatwillmosteffectivelyvisualizethestructureinquestion.Very<strong>of</strong>ten,morethanonetype<strong>of</strong>imagingshouldbeusedtotakeadvantages<strong>of</strong>thebenefits<strong>of</strong>differentprojections.1. Periapicalradiographshaveahighdegree<strong>of</strong>spatialresolutionthatenablesdetection<strong>of</strong>subtlechangesinboneoralterations<strong>of</strong>thedentalsupportingstructures.AdentistmightchooseaPAtovisualizealterationsinthePDLortoseefinedetails<strong>of</strong>changeinthealveolarprocess.However,theseradiographsarelimitedintheirarea<strong>of</strong>coverage.2. Occlusalradiographsprovidethesamehighresolutionasperiapicals,andcoverlargeramounts<strong>of</strong>tissue.Theyaregoodchoicestoexaminethepalate,ortomorecompletelydepictanabnormalitythatispartiallyrevealedonPAradiographs.Occlusalscanalsohelpidentifybuccal‐lingualexpansion<strong>of</strong>thejaws,providingtherightangleviewsneededtolocalizeabnormalitiesinthreeplanes<strong>of</strong>space.3. Panoramicradiographsallowvisualization<strong>of</strong>largerareas<strong>of</strong>thedentoalveolarcomplexandsurroundingstructures.Thisisagoodoptiontorevealthefullextent<strong>of</strong>largelesionsandtheirinternalandexternalradiographiccharacteristics.Panoramicsalsorevealotherfeatures,suchastoothdisplacementorresorption, 222010 CDEL Re-recognition <strong>of</strong> the Specialty Report 206 <strong>of</strong> 279
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