Impact of dentists and equipment in the performing dental imaging examinations: a longitudinal analysis

Freire, Danielle Bianca de Lima; Celeste, Roger Keller; Vizzotto, Mariana Boessio; Nunes, Luciana Neves; Arús, Nádia Assein; Silveira, Heraldo Luís Dias da

doi:10.1590/1807-3107bor-2022.vol36.0047

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Original Research, Imaginology • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0047 copy

Impact of dentists and equipment in the performing dental imaging examinations: a longitudinal analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

In this study, we aimed to identify factors associated with performing dental imaging examinations in public health services. Brazilian data at the municipal level (n = 5,564) in two time periods, P0 (2005–2007) and P1 (2014–2016), were collated from health information systems. The increase in the municipal rates of intraoral and extraoral radiographic imaging procedures was the outcome. Changes in the use of clinical procedures and the rates of dentists and equipment were the main predictors. Multiple logistic regression analysis was performed to estimate the adjusted odds ratio (OR). Approximately 35.3% of the Brazilian municipalities increased the dental radiography equipment rate, 9.9% increased the fan-beam computed tomography (CT) equipment rate, and 5.9% increased the magnetic resonance imaging (MRI) equipment rate. In addition, 31.8% increased the periapical/interproximal radiography rate, 10.5% increased the CT rate, and 4.4% increased the MRI rate. Increases in the dental radiography, CT, and MRI rates were associated with higher chances of periapical/interproximal images (OR = 1.90, p < 0.01), face and neck images (OR =1 5.3, p < 0.01), and MR images (OR = 18.1, p < 0.01), respectively. Municipalities that increased the rates of endodontists increased the rates of periapical/interproximal (OR = 2.50, p < 0.01) and occlusal (OR = 1.60, p < 0.01) imaging procedures, and those that increased the rates of radiologists also increased the rates of occlusal (OR = 2.00, p < 0.01) and panoramic (OR = 1.70, p < 0.01) imaging procedures. The implementation of a secondary dental care center, Centro de Especialidades Odontológicas (CEO) was associated with an increase in the chances of performing periapical/interproximal and panoramic radiographic procedures in 1.5 and occlusal radiographic examinations in 2.0. The rates of dentists, equipment, specialized dental centers, and specific dental procedures were associated with the increased use of imaging procedures in dentistry in the Brazilian public health system.

Keywords:
Radiography; Dental; Public Health; Tomography Scanners; X-Ray Computed; Radiography

Variables		P0 mean (SD)	P1 mean (SD)	Mean difference (SD)	% Municipalities with increase
Independent variables		Equipment rates per 1 million inhabitants
	DR equipment	39.03 (100.08)	62.60 (122.38)	23.57 (94.39)	35.3
	CT equipment	1.16 (5.44)	2.94 (12.54)	1.78 (11.55)	9.9
	MRI equipment	0.15 (2.12)	0.77 (4.08)	0.62 (4.09)	5.9
Dependent variables		Rates of imaging procedures per 100,000 inhabitants
	Periapical/interproximal radiography	511.79 (1734.21)	753.38 (2174.54)	241.59 (2030.7)	31.8
	Occlusal radiography	21.24 (495.36)	12.92 (217.10)	−8.32 (516.5)	6.9
	Panoramic radiography	3.70 (61.97)	18.56 (208.32)	14.86 (206.2)	8.3
	Radiography of the TMJ	10.70 (61.07)	14.57 (108.63)	3.88 (108.5)	14.1
	Teleradiography	1.26 (62.43)	2.50 (80.34)	1.24 (101.4)	1.3
	Head and neck CT	2.70 (19.61)	13.59 (72.19)	10.9 (66.3)	10.5
	TMJ MRI	0.01 (0.16)	0.50 (18.40)	0.49 (18.4)	4.4
Independent variables		Rates of clinical procedures per 100,000 inhabitants
	Primary care	63,141.75 (61,800.68)	96,799.80 (299,680.80)	33,658.05 (300,758)	47.7
	Endodontics	2,862.28 (5,024.39)	10,253.49 (76,913.11)	7,391.21 (76,858.3)	71.9
	Periodontics	10,455.83 (14,410.69)	22,732.94 (123,449.37)	12,277.1 (123,005.1)	62.1
	Tooth extraction	5,620.64 (4,510.33)	8,981.15 (72,246.97)	3,360.52 (72,313.3)	36.2
Independent variables		Professional rates per 1 million inhabitants
	Oral and maxillofacial radiologist	1.30 (11.633)	1.06 (12.191)	−0.24 (16.5)	2.3
	Endodontist	3.97 (25.848)	2.18 (9.863)	−1.79 (16.8)	10.8
	Periodontist	1.26 (6.953)	3.35 (17.196)	2.09 (16.6)	10.2
	Oral and maxillofacial surgeon	1.38 (7.032)	2.74 (11.976)	1.37 (12.7)	9.9

Variable	Population size (thousands of inhabitants)			p-value
Variable	> 100,000	25,000-100,000	< 25,000	p-value
DR equipment rate	80.3	54.3	27.1	< 0.001
CT equipment rate	66.5	26.8	1.3	< 0.001
MRI equipment rate	62.8	11.8	0.2	< 0.001

Variable			Periapical	Occlusal	Panoramic	TMJ	Tele	MRI	CT
Imaging equipment type
	DR equipment
		No equipment	22.9	3.1	4.4	9.8	0.5
		Some equipment	48.1	13.8	15.3	22.0	2.8
	MRI equipment
		No equipment						0.9
		Some equipment						60.7
	CT equipment
		No equipment							3.3
		Some equipment							76.1
Dentists
	Oral and maxillofacial radiologist
		None	31.1	6.3	7.7	13.8	1.2	4.1	9.7
		At least one	59.8	29.9	31.5	26.8	8.7	20.5	44.1
	Endodontist
		None	27.0	4.8	7.2	12.4	1.0	3.8	8.3
		At least one	71.4	23.5	17.0	28.2	4.0	9.3	28.5
	Periodontist
		None	27.4	4.7	6.3	12.1	0.8	3.1	7.3
		At least one	70.4	25.4	25.6	32.1	6.1	16.1	38.2
	Oral and maxillofacial surgeon
		None	28.3	5.0	6.0	11.9	0.8	2.4	6.5
		At least one	63.7	23.8	28.5	34.7	6.7	23.0	46.6
	Secondary dental care centers
		None	25.3	3.4	4.7	10.5	0.3	1.4	4.5
		At least one	64.7	24.6	26.4	32.5	6.6	19.9	41.1

Clinical procedures		Increase in the rate of imaging procedures
Type of procedure	Increase in the rate of procedure	Periapical	Occlusal	Panoramic	TMJ	Tele	MRI	Face CT
Rate of primary care procedures	No	28.6	6.4	8.8	14.4	1.4	4.8	10.8
Rate of primary care procedures	Yes	35.2	7.3	7.6	13.8	1.3	4.0	10.1
Rate of endodontic procedures	No	20.9	4.3	7.5	12.9	0.3	3.2	8.9
Rate of endodontic procedures	Yes	36.0	7.9	8.5	14.6	1.7	4.9	11.1
Rate of periodontal procedures	No	24.6	5.4	8.2	12.2	1.1	4.6	9.7
Rate of periodontal procedures	Yes	36.2	7.8	8.3	15.3	1.5	4.3	11.0
Rate of permanent tooth surgeries	No	31.6	7.2	8.9	15.3	1.4	5.2	11.9
Rate of permanent tooth surgeries	Yes	32.1	6.2	7.1	12.0	1.2	3.0	8.0

Increased in rate			Periapical		Occlusal		Panoramic		TMJ		Tele		CT		MRI
Increased in rate			OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Imaging equipment
	DR equipment
		No	1		1		1		1
		Yes	1.90	(1.67–2.19)	2.00	(1.53–2.60)	1.60	(1.24–2.01)	1.40	(1.15–1.65)
	CT equipment
		No											1		1
		Yes											15.3	(11.1–21.3)	1.80	(1.12–2.74)
	MRI equipment
		No											1		1
		Yes											4.9	(3.15–7.59)	18.1	(11.5–29.1)
Dentists
	Oral and maxillofacial radiologist
		No			1		1
		Yes			2.00	(1.20–3.16)	1.70	(1.09–2.73)
	Endodontist
		No	1		1		1
		Yes	2.50	(1.99–3.25)	1.60	(1.19–2.21)	0.60	(0.46–0.87)
	Periodontist
		No	1
		Yes	1.50	(1.17–2.03)
	Oral and maxillofacial surgeon
		No	1				1		1				1
		Yes	1.30	(1.02–1.68)			1.50	(1.09–1.94)	1.30	(1.05–1.74)			1.5	(1.04–2.20)
Rates of clinical procedures
	Basics
		No
		Yes
	Endodontics
		No	1		1						1
		Yes	1.70	(1.43–1.97)	1.40	(1.02–1.90)					4.50	(1.87–13.2)
	Periodontal
		No	1						1
		Yes	1.30	(1.15–1.57)					1.30	(1.09–1.60)
	Permanent tooth surgery
		No							1						1
		Yes							0.80	(0.64–0.97)					0.60	(0.35–0.91)

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[1] Corresponding Author: Heraldo Luís Dias da Silveira, E-mail: heraldo.silveira@ufrgs.br