Vol. 39, No. 4-Fall,
25 I
1979
June 5 , 1979 To the Editor: In the paper on “The Quality of Radiographs Used in the Pretreatment Review of Dental Claims” by Bailit et al. which appeared in the Spring 1979 issue of the Journal, reference is made to previous publications on the subject, including my A Guide f o r the Evaluation of Dental Care (UCLA School of Public Health, 1972). Bailit et al. stated that “with one exception these assessment systems have not been tested for reliability.” However, there is a second exception inasmuch as 1 compared the extent to which indirect evaluations can be used as a substitute for direct clinical examinations in a manner similar to the method used by Bailit’s group. The results of my study were published as an Appendix in the Guide under the heading of “The Accuracy of Indirect Evaluation of the Quality of Dental Care.” Bailit’s findings support my conclusion that there is a high degree of reliability utilizing indirect evaluation based on radiographs for purposes of dental insurance review. I wish to support Bailit’s conclusion that in general “the technical quality of radiographs in the sample is adequate.. . .” Despite the known fact that many individual films are unsatisfactory for diagnostic purposes, the radiographic series submitted for pretreatment review is usually-but not always-sufficient for the purpose. I d o not agree with the statement that “a panorex is a substitute for periapical films.” The panoramic radiograph is a n adjunctive film that has its value and its place. It is by no means an equivalent or substitute for periapical radiographs particularly of anterior and bicuspid teeth. Furthermore, the experience of reviewing thousands of radiographs over the past seven years leaves me with the clear impression that the panograph is abused even more so than conventional films. It is rare that one sees an excellent panograph, certainly nothing like the displays at the commercial exhibits. More often, they are blurred, indistinct and distorted, if not too light or too dark. Though acceptable as a broad screening film, whenever there is suspicion of pathosis the panographic film should be supplemented by periapical radiographs. Jay W . Friedman, D.D.S., M.P.H. 403 No. Oakhurst Dr. Beverly Hills, CA 90210 cc Howard Bailit
* * * * * * June 13, 1979 To the Editor: Enclosed please find my agitated response to the Journalqf Public Health Dentistry review of our book which I hope you will publish as a Letter to the Editor. Feel free to make selected editorial revisions, as necessary. Donald B. Giddon, D.M.D., Ph.D. Professor New York University 421 First Avenue New York, N Y 10010
25 I
1979
June 5 , 1979 To the Editor: In the paper on “The Quality of Radiographs Used in the Pretreatment Review of Dental Claims” by Bailit et al. which appeared in the Spring 1979 issue of the Journal, reference is made to previous publications on the subject, including my A Guide f o r the Evaluation of Dental Care (UCLA School of Public Health, 1972). Bailit et al. stated that “with one exception these assessment systems have not been tested for reliability.” However, there is a second exception inasmuch as 1 compared the extent to which indirect evaluations can be used as a substitute for direct clinical examinations in a manner similar to the method used by Bailit’s group. The results of my study were published as an Appendix in the Guide under the heading of “The Accuracy of Indirect Evaluation of the Quality of Dental Care.” Bailit’s findings support my conclusion that there is a high degree of reliability utilizing indirect evaluation based on radiographs for purposes of dental insurance review. I wish to support Bailit’s conclusion that in general “the technical quality of radiographs in the sample is adequate.. . .” Despite the known fact that many individual films are unsatisfactory for diagnostic purposes, the radiographic series submitted for pretreatment review is usually-but not always-sufficient for the purpose. I d o not agree with the statement that “a panorex is a substitute for periapical films.” The panoramic radiograph is a n adjunctive film that has its value and its place. It is by no means an equivalent or substitute for periapical radiographs particularly of anterior and bicuspid teeth. Furthermore, the experience of reviewing thousands of radiographs over the past seven years leaves me with the clear impression that the panograph is abused even more so than conventional films. It is rare that one sees an excellent panograph, certainly nothing like the displays at the commercial exhibits. More often, they are blurred, indistinct and distorted, if not too light or too dark. Though acceptable as a broad screening film, whenever there is suspicion of pathosis the panographic film should be supplemented by periapical radiographs. Jay W . Friedman, D.D.S., M.P.H. 403 No. Oakhurst Dr. Beverly Hills, CA 90210 cc Howard Bailit
* * * * * * June 13, 1979 To the Editor: Enclosed please find my agitated response to the Journalqf Public Health Dentistry review of our book which I hope you will publish as a Letter to the Editor. Feel free to make selected editorial revisions, as necessary. Donald B. Giddon, D.M.D., Ph.D. Professor New York University 421 First Avenue New York, N Y 10010
