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. 2022 Jan;10(1):2.
doi: 10.21037/atm-21-2197.

Importance of bitewing radiographs for the early detection of interproximal carious lesions and the impact on healthcare expenditure in Japan

Peter Grieco  1 , Ashiana Jivraj  2 , John Da Silva  1 , Yukinori Kuwajima  3 , Yoshiki Ishida  4 , Kaho Ogawa  3 , Hiroe Ohyama  1 , Shigemi Ishikawa-Nagai  5
Affiliations

Importance of bitewing radiographs for the early detection of interproximal carious lesions and the impact on healthcare expenditure in Japan

Peter Grieco et al. Ann Transl Med. 2022 Jan.

Abstract

Background: Globally, the direct cost of dental caries is approximately $298B yearly, consuming 5-10% of national healthcare budgets. Bitewing radiographs (BWR) are the standard method of diagnosing interproximal dental caries. In Japan, bitewing radiographs are rarely used. This retrospective observational study was conducted to measure the potential economic impact of carious lesions left undiagnosed and untreated due to this omission of bitewing radiographs.

Methods: The total number of existing carious lesions, the number of undiagnosed lesions, and costs of treating these lesions were calculated from the national database of Ministry of Health, Labor and Wellness in Japan between June 2013 and 2017. The number of affected teeth was estimated using prevalence data and undiagnosed lesions were estimated. The expense associated with treating progressed lesions was calculated using the standard Japanese fee structure. BWR trends were assessed, and analyses were performed to understand the differences between states and populations over time.

Results: The average number of BWR taken monthly per office was 48.3±1.1 (average ± SD). It was calculated that an average of 6,429,155 lesions went undiagnosed per month, 93.5 teeth per practice, and 1.6 teeth per patient. The cost of treating lesions that went undiagnosed and then progressed into more invasive restorations was estimated to be between $57M-$218M more (difference between NaF varnish and class II restorations), and $150M-$443M more (difference between Class II restoration and crown or crown with RCT).

Conclusions: BWRs are crucial in diagnosing a significant number of carious lesions. There is considerable impact on health and cost to the national health system due to undiagnosed lesions. Practitioners need to be educated on reading and understanding BWR, and policy should be changed to cover BWR.

Keywords: Bitewings; cariology; health expenditures; prevention.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-2197). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The formula to calculate the numbers of teeth in which interproximal caries (IC) remain undiagnosed by not taking bitewing radiographs (BWR).
Figure 2
Figure 2
The formula to calculate the projected extra expenditure of treatments required for the undiagnosed IC after caries progression. E1: The expenditure of preventive care recommended. E2 and D1: The expenditure of class II restorations recommended. D2: The expenditure of extensive treatment recommended.
Figure 3
Figure 3
The total number of 3 types of radiographs taken in June 2013–2018 (published data by Japan’s Ministry of Health, Labor and Welfare: JMHLW).
Figure 4
Figure 4
The average number of bitewing radiographs (BWR) taken per practice per month in each of 47 states in year 2017.
Figure 5
Figure 5
Average projected extra expenditure of treatments required for undiagnosed interproximal caries (IC). (A) Enamel caries, (B) Shallow dentin caries.
See this image and copyright information in PMC

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