The Effect of Bitewing Radiography on Outcomes and Costs of Treating Caries in Permanent Teeth

Dentists commonly use bitewing radiographs (dental X-rays) together with a visual-tactile (clinical) examination to detect cavities between the back teeth. While bitewing radiography can identify some lesions that are not visible during a visual-tactile examination, it is unclear whether its use improves outcomes that are important to patients. Radiographs may lead to the detection and treatment of lesions that would not otherwise cause problems, resulting in additional costs and dental procedures. Despite the widespread use of bitewing radiography in adult dental care, its effects on treatment decisions, patient outcomes, and cost-effectiveness have not been evaluated in randomized controlled trials among adults. Therefore, the investigators aim to conduct a randomized controlled trial to compare two strategies for caries diagnosis in young adults: visual-tactile examination alone and visual-tactile examination supplemented with bitewing radiography. Participants will undergo a standardized oral examination and will be randomly assigned to one of the two diagnostic strategies. Treatment recommendations will be based on the findings obtained using the allocated diagnostic approach and will follow predefined treatment criteria. The investigators will compare the effects of these diagnostic strategies on patient-important outcomes, treatment decisions, resource use, examination time, and cost-effectiveness. The results of this study will provide evidence on whether including bitewing radiography in routine caries diagnostics offers benefits that justify its additional costs and radiation exposure in young adults.

Inclusion Criteria: I) More than 1 year since previous bitewing radiography II) At least two neighboring posterior teeth with approximal contact III) Based on clinical assessment, at least one of the following: 1. at least one caries lesion penetrating the enamel, 2. more than one active caries lesion, 3. more than one of the predefined risk factors for caries * inadequate tooth cleaning * less than twice daily use of fluoride toothpaste * frequent consumption of easily fermentable carbohydrates * plaque present on multiple caries-susceptible tooth surfaces * reduced salivary flow * extensive previous history of restorations * exposed root surfaces Exclusion Criteria: * Symptoms requiring radiographic examination for clinical care * Participants who miss two scheduled examination appointments before enrollment.