The aim of the authors was to evaluate prescription patterns for bite-wing and panoramic
radiographs (PRs) for pediatric and adolescent dental patients after the implementation
of the most recent guidelines from the American Dental Association and US Food and
The authors accessed paid insurance claims data for all 50 states from January 1,
2013, through June 30, 2019, for patients 18 years and younger and extracted a 5%
random sample population. The authors performed statistical analyses to evaluate various
imaging metrics for pediatric dentists (PDs) and general practitioners (GPs).
A total of 2,123,735 bite-wing images were ordered during 4,734,249 office visits.
The average (standard deviation [SD]) time interval between bite-wing examinations
ordered by GPs was 13.9 (7.4) months, and for PDs the average (SD) was 13.0 (6.7)
months (P < .0001). When divided by age group, 3.5% of all bite-wings were obtained from patients
aged 0 through 4 years. For PRs, the authors included 286,824 images in this study.
The average (SD) time interval between PRs ordered for the same patient was 3.4 (1.3)
years for PDs and 3.3 (1.4) years for GPs. One percent of all PRs were ordered for
patients aged 0 through 4 years, with 403 images attributed to PDs and 2,348 to GPs.
PDs were more likely to comply with the guidelines on radiograph prescriptions for
pediatric and adolescent patients than GPs.
Inclusion of patient caries risk with insurance claims data could be considered for
more appropriate administration of dental radiography. Future guidelines should be
developed to include more explicit recommendations for prescribing PRs.