Accuracy of Endodontists and General Dental Practitioners in Periapical Diagnosis

Objective: To investigate the ability of endodontists and general dental practitioners (GDPs) to interpret apical pathology.

Methods: A questionnaire was sent to 857 general dental practitioners and to 170 endodontists in the United Kingdom. The clinicians were asked to assess one specific tooth on each of twelve periapical radiographs. Each radiograph was presented as a high resolution photograph, replicating the size and the density and the contrast of the original F-speed periapical (size 2) film. The clinicians were asked to state whether or not there was evidence of early apical change affecting a specific tooth. Prior validation of the presence or absence of apical pathology had been reached using both clinical history and examination and consensus viewing of the film by two experienced dental radiologists. Information was also obtained on the effectiveness of the respondents' training in radiological interpretation at both undergraduate and postgraduate level.

Results: A total of 603 (70.4%) GDPs and 132 (77.6%) endodontists responded. The mean sensitivity and specificity for endodontists was 65% and 73% respectively. For GDPs, the mean sensitivity and specificity was 53% and 66% respectively. An analysis of variance found a significant difference (P<0.001) for both sensitivity and specificity between GDPs and endodontists. For both groups, values for sensitivity and specificity increased with age.

When undergraduate radiology training was considered, there was a difference between the two groups. For endodontists, the undergraduate training received in radiological interpretation had no significance on their ability to detect apical pathosis. The converse was found for GDPs (sensitivity P= 0.01; specificity P<0.001). Attending postgraduate radiology courses had no significance for endodontists. However, GDPs recorded a significant difference between continuing education courses in radiology and specificity (P=0.004).

Conclusions:

Endodontists were more able than GDPs in recognising apical pathology. Attending postgraduate courses in radiology interpretation increased the specificity of GDPs.