Oral Health Group

A comment on the Viewpoint, Oral Health, October 2010, page 8

December 1, 2010
by Kenneth S. Serota, DDS,MMSc Mississauga, ON

I would like to thank Dr. Perschbacher for clarifying a diagnostic misstatement in the article ‘Small Focal Field Volumetric Cone Beam Tomography’. The authors made no pretense to be radiologists, rather the point at issue was that the use of cbCT, small FOV cbCT, at the very least made them aware of a pathologic entity that might otherwise have been overlooked using alternate diagnostic modalities. As blog editor, I have included entries sampling routine radiologic and cbCT images that demonstrate the incredible diagnostic distinction between both modalities.

A follow-up article on image dose and safety, which is an addendum to the first article that should illuminate all the other issues of concern Dr. Perschbacher is addressing, has been submitted to Oral Health. The issue of abuse of panoramic radiographs is however, mixing apples and oranges. Panoramic radiographs at no time represented the standard of care in diagnostic sophistication represented by cbCT, whether small, medium or large field. It offered oral surgeons and orthodontists a more efficient and less intrusive means for analysis and treatment planning; the abuse came from replacement of 2 dimensional full mouth series for decay, endodontic and periodontic assessment with a “pan” and two bite wings.


The argument that Dr. Barnett and I wish to put forward is simple. Certification is onerous and tedious and to do so in a class room setting is antedeluvian and retrograde. The implication that it is being done to protect the population is specious at best when medical scans with dose levels that are exponentially higher than small FOV cbCT machines with stitching software are pervasively used for “dental diagnosis” throughout the country and in Ontario specifically.

There is a wealth of evidence based science that demonstrates that online teaching of anatomy and radiology is superior to classroom settings as a learning technology. Create a certification and recertification website that dentists without advanced or masters training in radiology must use on a bi-annual basis. It is far superior to the honour system used by licensing bodies for mandatory continuing education; the answers would have to be accurate to avoid some type of remedial requirement to continue using the purchased equipment. The difference is that the the dentists’ moral and ethical standards and their ability to service their patients at optimal standards is not being challenged or diminished.

No distinction is made between the standard to which generalists and specialists are held by the RCDSO that I am aware of, particularly in endodontics. Why should generalists and endodontists and periodontists and by extension those that do implantology be restricted in the provision of the highest calibre standard of therapeutics?

A rising tide raises all ships and if there is real concern, then radiologists should open their diagnostic skills to virtual protection networks and scans should be sent to them for pay per service analysis when clarification is required. To create an obfuscatory system of training and certification when none exists in the other nine provinces of this country simply doesn’t suggest a “rallying point for sanity”, rather an expression of fear, although for whom or by whom remains uncertain.