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Ultrasound Compared with Panoramic X-ray in the Diagnosis of Dental Abscess in the Hospital Emergency Department (ED) – Dental Implications

Ultrasound and color Doppler imaging are reproducible techniques that have demonstrated significant evaluative utility in Medicine. Although new to dentistry, they have the potential to supplement conventional Dental x-ray assessment in the evaluation of periapical lesions and dental abscess. The techniques are non-invasive and radiation-free and can provide specific information with regards to healing status at both the boney surgical site and also the overlying soft tissue. Some authors suggest that ultrasonography ‘may prove to be more effective in assessing bone micro-architecture, the onset of bone formation, and the surface topography of bone’ than x-ray techniques (Hans D, et al. Do ultrasound measurement on the os calcis reflect more the microarchitecture than the bone mass? A two-dimensional histomorphometric study. Bone 16:295-300, 1995; Hughs CW, et al, Ultrasound monitoring of distraction osteogenesis. Br J Oral Maxillofac Surg 41: 256-258, 2003; Lauria l, et al: Ultrasonography evaluation of bone lesions of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:351-357, 1996).

In an attempt to see if there were differences between bedside panoramic x-ray survey and bedside ultrasound in patients presenting with dental abscess in the Emergency Department, authors Edhikari S, Blaivas M, and Lander L, performed a retrospective study of ED records of adult patients with atraumatic facial pain associated with swelling and toothache where both procedures were performed at bedside in the Emergency Department of the University of Nebraska Medical Center, Omaha, Nebraska. They report their findings in the Am Journal of Emergency Medicine in 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20825898 - ahead of print).

Nineteen patients were identified from this pool. Every subject had experienced both panoramic x-ray and Ultrasound assessment. In those patients were no periapical abscess was reported on panoramic x-rays (7 of 19 patients), ultrasound agreed with the panoramic assessment in 6 of 7 cases. In this one case incision and drainage was performed confirming an abscess. In 12 of 19 patients there was x-ray confirmation of periapical abscess. Ultrasound agreed with the x-ray in 10 of 12 of these cases. In one of the two cases of disagreement an abnormality was found on the contralateral side which was not picked up by ultrasound.

The authors concluded that the sensitivity and specificity of Ultrasound compared with Panoramic x-ray survey (considered in this case as the gold standard) for diagnosing a dental abscess was 92% and 100% respectively. Given these values, they suggest that ultrasound can provide ‘an alternative to panorex x-rays in the evaluation of a dental abscess in the Emergency Department’ of Medical Centers.

Submitted by Jeff Burgess DDS MSD
Editor in chief Dental-Health Imaging Hub

Editor’s comment: An emerging literature suggests that ultrasound and color Doppler imaging may be useful non-radiologic imaging modalities for assessment of a number of soft and hard tissue problems in the facial region. Dentists may need to think seriously about educating themselves on these techniques.