Are Dental Radiographs a Necessary Component of Veterinary Dentistry?

Although dental radiographs are becoming increasingly common in general veterinary practices, there are still many practices that perform dental cleanings without the assistance of dental radiography. Is this a justifiable way to keep costs low for clients, or does it mean that your practice is falling below the standard of care? Read on to learn more.

Benefits of Dental Radiography

The primary benefit of dental radiography is that it allows the detection of dental lesions that would be missed on physical examination. In a study of 226 dogs, 28% of the dogs had clinically relevant abnormalities that would have gone undetected without dental radiography.¹ In a similar study of 115 cats, 42% of cats was found to have clinically relevant abnormalities that would have been undetected without dental radiography.¹ Both of these studies also looked at additional information that radiography provided about clinically abnormal teeth; radiographs of diseased teeth provided additional, clinically essential information in 23% of dogs and 32% of cats.^1,2 Not only does radiography allow the diagnosis of otherwise-undetectable lesions, but it can also provide useful information that will help you manage clinically diseased teeth.

Dental radiographs should be performed prior to any dental extractions. Small-breed dogs, in particular, often have marked weakening of the mandible due to periodontal disease. This not only affects the rostral mandible, but also the area around the molars.³ Pre-extraction radiographs can allow you to detect pathologic fractures present prior to extraction, as well as help you make educated decisions about the risk of iatrogenic fracture associated with extractions. This information will help you make better decisions for your patients and better advise clients.

In addition to pre-extraction radiographs, post-extraction radiographs should also be performed. This allows you to ensure that the extraction is complete. A 2004 study of over 100 patients found that 82% of canine patients and 93% of feline patients had evidence of retained root tip fragments after extraction.⁴ Finding and addressing these retained root tips prior to discharge can help ensure a better outcome for your patients.

Radiographs are essential in the diagnosis and management of feline odontoclastic resorptive lesions (FORLs). The management of these lesions is based largely on radiographic appearance. Extractions are typically required, but radiographs can help you determine whether or not you will need a flap for extraction. Additionally, if radiographs show significant, advanced ankylosis of the roots, a crown amputation may be necessary. Without radiographs, your treatment plan for a FORL is nothing more than an educated guess.

Periodontal and endodontic diseases are also frequently diagnosed on radiographs. While dental probing and visual information can provide some beneficial information, obtaining a radiographic image of the periodontal ligament space and the tooth roots is essential for guiding decisions related to diagnosis and treatment.

Cost of Dental Radiography

In general, you can expect to spend approximately $10,000-15,000 for the equipment needed to perform dental radiography in your practice. While that may seem expensive, it’s important to think about how you will recoup that cost. If you charge $100 for each set of dental radiographs, a $15,000 dental radiography unit will pay for itself after just 150 radiographs. In many practices, you would pay for your unit in as little as one year of use. Also, keep in mind that the additional pathology you find using dental radiographs will likely translate to performing more services on each of your dentistry patients, meaning that your unit may actually pay for itself in less time than expected.

There is another cost to dental radiography, however, and that is the cost of training yourself and your staff. Having a dental radiography unit is of little benefit unless you are able to efficiently obtain diagnostic images and interpret these images appropriately. Even if you opt to use a teleradiology service for interpretation, there is often a steep learning curve for the veterinary technicians who are taking dental radiographs. Allow time for staff training (which will likely be provided by the supplier of your radiography unit). Also, take into account that your dental procedures will likely take longer than expected during those initial months, as everyone becomes familiar with how to operate the new equipment. Factoring these costs into your purchase decision can help ensure that there are no surprises and that you are prepared to get the maximum benefit out of your dental radiography purchase.

Dental Radiography and Liability

The Summer 2015 issue of the AVMA Professional Liability newsletter highlights three separate claims related to veterinary dentistry, in which the veterinarian failed to recommend or offer dental radiography.⁵ Each of these three cases was settled with money paid to the pet owner because the veterinarians did not recommend radiographs and “the standard of care would be difficult to defend.” These cases suggest that a failure to perform dental radiography is potentially setting you up for liability risk. The newsletter states, “jaw fractures and retained tooth roots are some of the more common dental claims reported, and you can avoid both scenarios with dental radiography.”

A 2020 article in The Canadian Veterinary Journal, titled “Performing dental procedures in dogs and cats without dental radiographs: Malpractice?” explores this topic in more detail.⁶ While the article does not reach any definitive conclusions regarding liability, the author clearly outlines the importance of dental radiographs before calling upon veterinarians to “do no harm.” Clearly, dental radiographs are an essential component in quality dentistry, so the author argues that failing to perform them could be seen as shirking one’s professional responsibilities.

Changing Times

Fifteen or twenty years ago, dental radiographs were viewed as a nice, cutting-edge perk to have in a veterinary practice. As practice standards, and specific standards surrounding veterinary dentistry, have changed, however, dental radiography has become an increasingly essential tool for general practices that offer any veterinary dentistry services. After carefully considering the costs and benefits of dental radiography, you will likely find that a dental radiography unit can pay for itself quickly while improving your quality of medicine and protecting you and your team from liability.

References

1. Verstraete, F. J., Kass, P. H., & Terpak, C. H. (1998). Diagnostic value of full-mouth radiography in dogs. American journal of veterinary research, 59(6), 686–691.

2. Verstraete, F. J., Kass, P. H., & Terpak, C. H. (1998). Diagnostic value of full-mouth radiography in cats. American journal of veterinary research, 59(6), 692–695.

3. Niemec, B. (2015). Dental Radiology Series: The Importance of Dental Radiography. Today’s Veterinary Practice. Retrieved from: https://todaysveterinarypractice.com/dental-radiography-series-the-importance-of-dental-radiography/

4. Moore, J. I., & Niemiec, B. (2014). Evaluation of extraction sites for evidence of retained tooth roots and periapical pathology. Journal of the American Animal Hospital Association, 50(2), 77–82.

5. AVMA PLIT. (2015). Professional Liability. Retrieved from: im3vet.com/iM3US/media/Documents/professional_liability_Dental_X-ray.pdf

6. Thatcher G. (2020). Performing dental procedures in dogs and cats without dental radiographs: Malpractice?. The Canadian veterinary journal = La revue veterinaire canadienne, 61(2), 197–200. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973222/