FDC2022 | SPEAKER preview
The Dentist as Diagnostician: WhAT you don’t see might hurt you By Dale A. Miles DDS, MS, FRCD(C) Diplomate, American Board of Oral Maxillofacial Radiology
Today, the average patient in the dental office is not young, healthy and suffering from dental caries and periodontal disease. They are more likely to be middle-aged, prescribed multiple medications and have systemic issues that can complicate dental care. The introduction of the radiology modality (CBCT) to the dental profession has been a very disruptive technology with both advantages and potential liabilities. It is an extremely useful tool for dentists when it comes to most of the tasks they perform in their offices. However, the first reaction of a dentist upon capturing their first data set in cone beam CT is commonly, “These images are great! But…what am I looking at?” Unfortunately, the technology always precedes the education, so working towards complete comprehension is key to operating the technology competently and usefully. I, like every other dentist, have had to educate myself to look at the volume data in an expert fashion, despite my advanced training in oral maxillofacial radiology. There are three anatomic planes of section in the scans and hundreds of slices in each of the three planes. That’s a lot of data!
Because I was a dentist first and practiced for many years before my graduate training, I understand the complexities of practicing dentistry and am trying to help my colleagues understand the technology that they are adopting. You must examine all the data in your cone beam scans, or those systemic changes that you miss may come back to haunt you. Having examined over 35,000 CBCT scans, I feel quite competent interpreting changes in the nasal cavity, paranasal sinuses, airway and cranial vault to help my colleagues “stay out of trouble.” Think of me as your risk reduction professional! However, given that dentists have to look at all of their own data, it is essential that they “retool” themselves in anatomy, pathology and image processing so that they do not miss an important finding. It’s equally important that they learn how to use the tools in their cone beam software to enhance the features of the disease process to make a better clinical decision. This is part of being a competent dental professional. There is no way around it, you must get additional training to use the technology expertly. Recently, I have noticed that there are patterns of calcifications in the internal carotid arteries through the neck and head that are a potential marker of undiagnosed or uncontrolled Type II Diabetes Mellitus. Imagine being able to examine your cone beam data
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