Abstract
Objectives: Severely and profoundly mentally retarded and developmentally disabled (MR/DD) patients are unable to communicate disease symptoms, and radiographic examinations are often difficult to perform on non-sedated patients. This clinical trial evaluated the impact on dental treatment planning of radiographic mini-panels for MR/DD patients.
Methods: With Institutional Review Board approval and informed consent of the legal guardian of each patient, a digital series of six periapical radiographs was achieved without sedation on 72 MR/DD inpatients (the survey was attempted on 74 patients).
Results: The average number of teeth included in each mini-panel was 20.4 compared with 22.2 teeth found clinically and 22.7 teeth determined combining both clinical and radiographic findings. Individual mini-panel images were judged technically excellent in 65% of cases, diagnostically satisfactory in 26% of cases and suboptimal in 9%. The radiographic panels were judged to affect treatment planning for more than 60% of the patients included in the trial. In 32% the detected condition was one or more periapical radiolucency. Several radiographic findings indicated potentially painful conditions that perhaps explained patient actions previously attributed to behavioural problems. Potential sources of dental pain and sepsis were treated by endodontic therapy or dental extractions on a case-by-case basis with or without general anesthesia. The trial also demonstrated a need that has translated into increased state allocations for dental treatment of MR/DD patients resident in the Commonwealth of Kentucky.
Conclusions: Dental inspections of MR/DD patients are incomplete if radiographs are excluded. Whilst the mini-panel approach could be considered incomplete, it is better than no radiographs at all. 91% of images were excellent to satisfactory in diagnostic quality and a majority of patients' treatments were modified because of the radiographic information.
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