Prescription of Bitewing and Panoramic Radiographs in Pediatric Dental Patients: An Assessment of Current Trends and Provider Compliance

Purpose: To evaluate prescription patterns for bitewing and panoramic radiographs (PR) for pediatric and adolescent dental patients following the implementation of the most recent ADA/FDA guidelines. Methods: Paid insurance claims data for all 50 states were accessed from January 1, 2013 to June 30, 2019 for patients age 18 years and younger; a 5% random sample population was extracted. Statistical analyses were performed to evaluate various imaging metrics for pediatric dentists (PD) and general practitioners (GP). Results: A total of 2,123,735 bitewing images were prescribed during 4,734,249 office visits. The average time interval between bitewing exams ordered by GPs was 13.9 (± 7.4) months, and for PDs this average was 13.0 (± 6.7) months (p<.0001). When divided by age group, 3.5% of all bitewings were taken on patients age 0-4 years. For PRs, 286,824 images were included in the present study. The average time interval between PRs ordered for the same patient was 3.4 (± 1.3) years for PDs and 3.3 (± 1.4) years for GPs. One percent of all PRs were prescribed for patients age 0-4, with 403 images attributed to PDs and 2348 to GPs. Conclusions: PDs were more likely to comply with the guidelines on radiograph prescriptions for pediatric and adolescent patients than GPs. Practical Implications: Inclusion of individual caries risk with insurance claims data should be considered for more appropriate administration of dental radiography. Future guidelines should be developed to include more explicit recommendations for prescribing PRs