Elsevier

Journal of Dentistry

Volume 27, Issue 3, 15 March 1999, Pages 243-246
Journal of Dentistry

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Patient discomfort and cross-infection control in bitewing examination with a storage phosphor plate and a CCD-based sensor

https://doi.org/10.1016/S0300-5712(98)00063-3Get rights and content

Abstract

Objectives: the aim was to compare a CCD-based sensor and a storage phosphor plate with respect to patient discomfort and the efficacy of a simple cross-infection control procedure in connection with a posterior bitewing examination.

Methods: 130 patients accepted to have one posterior bitewing of the left and right side taken with two digital radiography systems, the Digora phosphor plate and the Trophy RVG XL, CCD-based sensor system. The patients assessed their feeling of discomfort after the examination on a 100-mm. Visual Analogue Scale (VAS). Microbiological samples were taken from the RVG sensor and cord and from the Digora envelope, plate and scanner during examination of 14 patients. The samples were plated and incubated anaerobically, and the colony-forming units counted.

Results: Median VAS score for discomfort was 20 min for Digora and 32 min for the RVG sensor (P<0.001). Median total counts of cultivable bacteria were low (<20), the majority being catalase-positive, Gram-positive cocci and Gram-positive rods, presumably skin bacteria. Only the samples taken from the enveloped Digora plate and the rubber tube coated RVG sensor immediately after exposure yielded large numbers of oral bacteria.

Conclusion: The phosphor plate was less unpleasant than the CCD sensor. Cross-contamination posed a minor problem for both systems when a simple, standard hygiene procedure was followed.

Introduction

Direct digital acquisition of intraoral radiographs has been possible in the past decade. Different concepts have been followed in the development of the digital imaging systems resulting in two basically different receptors: the CCD-based sensors and the storage phosphor plate. Several studies have shown that, theoretically, there are a number of advantages of digital radiography compared to conventional film [1], [2], [3]. However, most studies so far have only evaluated the performance of the systems in laboratory experiments [3]. Though they are sold worldwide, very little documentation exists on the efficacy of the systems in the clinic.

In comparison to the film, most digital receptors are stiff and cannot be bent in the mouth, and the CCD sensors are much thicker than film. The CCD sensors have not been optimal for bitewing examination in the clinic as the effective radiation field has been too small to image the tooth crowns in both jaws in the same exposure, not to mention marginal bone. A new CCD sensor with an effective image area almost as large as the size 2 film, has recently been developed. It has not been investigated whether this sensor size might facilitate bitewing examination, and if the use of the digital receptors is associated with discomfort for the patient.

Microbiological cross-contamination between patients may occur in association with intraoral radiographic examination and, in particular during development of disposable films [4], [5]. Protocols that aim at minimizing the risk of cross-contamination include wearing gloves when placing the film in the mouth and when unpacking the film in the dark room, disinfection of all surfaces or use of barriers, and sterilization of instruments and re-usable filmholders [6], [7]. Surface disinfection as well as enveloping of the films have been suggested and proved effective in minimizing this [8], [9]. In the digital radiography systems, the receptor is consecutively re-used and not sterilizable, which may cause a problem with regard to cross-infection control in the clinic. The phosphor plate may in particular pose a problem as it has to be placed in a scanner, resembling the conditions in the dark room. To our knowledge, no data to explore the extent of these potential problems have been published.

It was the aim of the present study to compare a CCD-based sensor and a storage phosphor plate with respect to patient discomfort and evaluate the efficacy of a simple cross-infection control procedure in connection with a posterior bitewing examination.

Section snippets

Materials and methods

Written informed consent was given by 130 patients (63 males and 67 females) after written and oral information regarding the study. One posterior bitewing (GX-1000 dental unit, 65 kV, 10 mA, f–f distance 40 cm, rectangular tube, exposure time 0.18–0.26 s (same exposure time used for both systems) was taken of the left and right side both with the Digora storage phosphor plate, 35×45 min external measures (Soredex/Orion Corp., Helsinki, Finland) and with the newly developed RVG XL sensor, 32×45×7.5 

Results

The evaluation of patient discomfort revealed that 58% of the patients preferred the Digora plate, 30% the RVG sensor, and 12% had no preference. Median VAS score for discomfort with the Digora was 20 mm (range 0–82) and 32 mm with the RVG (range 0–99). The difference was statistically significant (P<0.001).

From Table 1, Table 2 it can be seen that bacterial contamination was a minor problem in both radiographic procedures. Only the coated RVG sensor and the enveloped Digora plates retained large

Discussion

Patient discomfort was on average significantly lower with the Digora plate than with the RVG sensor; however, VAS scores were low with both systems for most patients. A few patients could not tolerate the RVG sensor. These were examined only by the Digora plate. The sensor is 12 mm at its thickest part near the cord and naturally more bulky than the phosphor plate. This is a concern, and a smaller size sensor must therefore also be available in the clinic. The RVG system offers an additional

Conclusion

The phosphor plate was less unpleasant than the CCD sensor for the majority of the patients. Crosscontamination posed a minor problem for both systems when simple hygiene procedures were followed, however, both equipments could benefit from further developments in this aspect.

References (11)

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