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  Discussion on Research Summary: Diagnosis of Infected Cheek Teeth Roots
Author Message
Moderator:
DrO

Posted on Thursday, Jul 7, 2011 - 12:55 pm:

Though often used there has been little study on the accuracy of radiography (xrays) to diagnose the presences of infected teeth at the roots. This study found that increase bone density (sclerosis), loss of bone (halo), and "clubbing" of the tooth roots were all strongly associated with infection and the more severe the changes the more likely infection was present.
DrO
Member:
paul303

Posted on Friday, Jul 8, 2011 - 1:23 am:

Is the research summary under Disorders of the Mouth and Teeth? Which, is a great article...having been in dentistry for 37 years, it shows how these teeth problems in horses, mirror human dental problems almost exactly. I'm only finding your comment, above, and I want to read about the x-ray studies.
Moderator:
DrO

Posted on Tuesday, Jul 12, 2011 - 6:38 am:

Hello Lee,
I don't have permission to publish the full article but here is the summary:

Equine Vet J. 2011 Mar;43(2):170-8.

Investigation of the sensitivity and specificity of radiological signs for diagnosis of periapical infection of equine cheek teeth.

Townsend NB, Hawkes CS, Rex R, Boden LA, Barakzai SZ.
Source

Division of Veterinary Clinical Science, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, UK.
Abstract
REASONS FOR PERFORMING STUDY:

Radiography is commonly used for the diagnosis of equine cheek teeth (CT) infection but, to our knowledge, no study to date has evaluated the relative values of individual specific radiographic signs when making a diagnosis.
OBJECTIVES:

To investigate the sensitivity and specificity of individual radiographic signs identified from the literature for the diagnosis of CT apical infection using a retrospective case-control study.
METHODS:

Cropped radiographs taken using computed radiography of 41 apically infected CT and 41 control CT were independently blindly evaluated by 3 clinicians for the presence of 12 predetermined radiographic signs associated with CT apical infection. A final diagnosis of either noninfected or infected was made. Sensitivity and specificity were calculated for the presence or absence of each radiographic sign for each clinician. Uni- and multivariable conditional logistic regression were used to determine strength of association of the 12 radiographic signs with apical infection.
RESULTS:

Median sensitivity and specificity for the diagnosis of CT apical infection were 76 and 90%, respectively. Periapical sclerosis, clubbing of one or 2 roots, degree of clubbing and periapical halo formation had the highest sensitivities (73-90%), with moderate specificity (61-63%). Multivariable conditional logistic regression revealed that severity of periapical sclerosis and extensive periapical halo were strongly associated with CT apical infection.
CONCLUSIONS:

The presence of periapical sclerosis and formation of a periapical halo were strongly associated with CT apical infection. Computed radiography appears to have a higher sensitivity but similar specificity to previously published results using film radiography to detect CT apical infection.
POTENTIAL RELEVANCE:

These findings may aid practitioners when interpreting radiographs of equine CT as to the relative significance of their findings.
Member:
paul303

Posted on Wednesday, Jul 13, 2011 - 10:58 pm:

Thank you Dr.O. I know over the years there have been a couple of postings here with x-rays of the mouth where the dental pathology has been incredibly apparent and crisp and clear. I've always wondered whether that quality would be obtainable in the field or only in a university or hospital setting...Do they lay the horse down to get these pictures? It would have to be difficult to get a crisp clear result with correct angulation. Definitely good to see the interest in it and the results.
Moderator:
DrO

Posted on Thursday, Jul 14, 2011 - 11:43 pm:

Lee, though it takes sedation, a set of stocks and a good sturdy ladder, quality radiographs of the mandible and maxilla and the teeth therein are obtainable in the field under sedation only.
DrO
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