The Ability to Identify Early Apical Pathology: A Comparison between UK's General Dental Practitioners and Endodontists

Objectives: To investigate the ability of endodontists and general dental practitioners (GDPs) to interpret early periapical pathology and to examine effect of age, undergraduate education and attendance at courses upon radiographic interpretation. The hypothesis was that there would be no significant difference between GDPs and endodontists. Methods: General dental practitioners (n=603) and endodontists (n=132) had access to high quality images of 12 periapical radiographs. The images had been previously scanned to obtain the same resolution as the original radiograph. Each was presented to observers as an exact replica of the size of a size 2 periapical film. Six radiographs demonstrated the presence of an early periapical lesion on a specific tooth whilst the remaining six radiographs showed normal periodontium. Each radiograph was printed on high quality paper. Each participant was asked to examine a specific tooth for the presence/absence of apical pathosis. Results: The mean sensitivity and specificity for the endodontists was 0.65 and 0.73 respectively and, for the GDPs, mean sensitivity was 0.53 and specificity 0.66. The independent T-test found a significant difference (p<0.001) for both sensitivity and specificity between GDPs and the endodontists. The study also found a significant difference between the sensitivity and specificity of GDPs and their undergraduate education (p-value of 0.01 and <0.001 respectively). GDPs also recorded a significant difference between attending continuing education courses in radiology and their specificity (p< 0.004). Conclusions: Endodontists were more able than GDPs in recognising apical pathology. Attending postgraduate courses in radiology interpretation increased the specificity of GDPs