Introduction: Limited field cone-beam computed tomography (CBCT) imaging has become a modality fr... more Introduction: Limited field cone-beam computed tomography (CBCT) imaging has become a modality frequently used by endodontists to evaluate the teeth and surrounding tissues of their patients. Accurate image interpretation is vital to obtain needed treatment information as well as to discern coincidental findings that could be present. The goal of this study was to determine the accuracy of CBCT volume interpretation when performed by endodontists and endodontic residents. Methods: Eighteen deidentified limited field CBCT scans were obtained and evaluated by an oral and maxillofacial radiologist and an endodontist experienced in reading CBCT images. Their collective findings were combined as the ''gold standard'' of interpretation for this investigation. Using standard CBCT software, 4 practicing endodontists and 5 second-year endodontic residents evaluated each scan and recorded any notable findings and whether or not each scan warranted referral to a radiology specialist. Their interpretations were then compared with the gold standard to determine accuracy and any significant differences among the groups. Results: The overall accuracy was 58.3% for endodontists and 64.3% for residents. Paired t tests showed no statistically significant differences in accuracy between the 2 groups for findings in teeth or in bone, but residents were significantly better for maxillary sinus findings. Endodontists agreed with the gold standard 38.9% of the time and residents 49.8% of the time on necessity of referral. The Cohen kappa coefficient showed moderate agreement between the groups. Conclusions: Endodontists and residents had similar accuracy in CBCT scan evaluation. More training and experience are warranted for both groups in order to maximize image assessment accuracy.
Journal of the International Clinical Dental Research Organization, 2010
Objectives: To determine the effect on caries diagnosis of exposure reduction on intraoral digita... more Objectives: To determine the effect on caries diagnosis of exposure reduction on intraoral digital radiographs compared with optimally exposed film images. Materials and Methods: F-speed film radiographs of 61 extracted molars and premolars were made with optimal exposure parameters. The teeth were radiographed using a complementary metal oxide semiconductor (CMOS) digital system with exposures equal to 50%, 30%, 20%, 10%, and 5% of the film exposure. Five observers, who were permitted to adjust brightness and contrast on the digital images, scored the proximal and occlusal surfaces for the presence of caries using a 5-point confidence scale. Areas under receiver operating characteristic (ROC) curves represented accuracy of caries detection. Sensitivity and specificity were also calculated. The significance level was P = 0.05. Results: All digital images resulted in lower diagnostic accuracy than film images for all lesions (P ≤ 0.036) and for caries in enamel only (P ≤ 0.030). With dentin caries, there were no significant differences between film and any digital radiographs (P ≥ 0.065) except the 5% exposures (P ≤ 0.034). Digital radiographs of 5% of the exposure of film were significantly poorer than all other exposure categories (P ≤ 0.014) except for the 10% exposures for accuracy for all lesion sizes and for dentin lesions only. Exposures at 10% and 20% resulted in lower sensitivity scores for enamel caries, while 50% exposures were associated with the poorest specificity. Conclusions: Exposures of 30% of optimal F-speed film exposure settings appear to balance acceptable levels of accuracy, sensitivity, and specificity for caries detection. Observer-controlled enhancements were ineffective at extremely high and low exposures.
Physicians often do not provide adequate information regarding patients' medical conditions when ... more Physicians often do not provide adequate information regarding patients' medical conditions when presented with consultation requests (CR) generated by dental students and their instructors about the students' patients. We hypothesized that a structured CR form, which requests specific information by providing a checklist and/or closed-ended questions for physicians to answer, would lead to better communication and improved responses. We also hypothesized that providing in-service education to clinical faculty on the conditions that require and don't require CRs would reduce the number of unwarranted CRs sent to physicians. We assessed the responses obtained with the new form and compared them to findings over a similar period using our older, unstructured CR forms. We also evaluated the numbers of CRs written unnecessarily during both time periods. Improvements in the appropriateness of information provided by physicians were noted with the new CR forms for diabetes mellitus, hypertension, heart murmur, and anticoagulant therapy. The number of CRs written for conditions that did not need a consultation was approximately the same after provision of instruction as before. We conclude that structured CR forms improve the flow of information between dentists and physicians and should enhance student knowledge and skills in soliciting relevant information. Greater efforts must be taken to inform clinical faculty about the indications for CRs.
X-ray exposure to dental patients has been significantly reduced by the introduction of speed gro... more X-ray exposure to dental patients has been significantly reduced by the introduction of speed group E intraoral film, rectangular beam limitation, long position indicating devices (PIDs), and rare-earth intensifying screens for extraoral radiography. Research indicates that many dentists do not use these techniques. However, schools of dentistry have implemented them to varying degrees for many years, so this investigation was conducted to determine the extent to which dental school faculty members use these materials and techniques in their own practices. Comparisons were made between full-and part-time instructors, those in practice for fifteen years or less and those in practice for more than fifteen years, and those with postgraduate education versus those with no formal education beyond dental school. The significance of differences was measured with chisquare analysis. The results indicate that dentists with faculty appointments utilize dose-reducing techniques to degrees that are comparable to or greater than reported usage by non-dental faculty practitioners. Faculty dentists in practice fifteen years or less are more likely than their older colleagues to use E-speed film (p = 0.001), whereas those in practice more than fifteen years are more likely to use longer PIDs (p = 0.049). Greater acceptance of these practices by faculty may lead to reinforcement of their use in the clinical education of dental students.
1. J Mich Dent Assoc. 2003 Dec;85(12):40, 42-3. Oral pathology quiz: an unusual pericoronal cyst.... more 1. J Mich Dent Assoc. 2003 Dec;85(12):40, 42-3. Oral pathology quiz: an unusual pericoronal cyst. The diagnosis was glandular odontogenic cyst, although focal areas consistent with dentigerous cyst were seen. Geist J, Gordon S, Wesley R. ...
This study compared images displayed on 1 desktop monitor, 1 laptop monitor, and 2 tablets for th... more This study compared images displayed on 1 desktop monitor, 1 laptop monitor, and 2 tablets for the detection of contrast and working length interpretation, with a null hypothesis of no differences between the devices. Three aluminum blocks, with milled circles of varying depth, were radiographed at various exposure levels to create 45 images of varying radiographic density. Six observers viewed the images on 4 devices: Lenovo M92z desktop (Lenovo, Beijing, China), Lenovo Z580 laptop (Lenovo), iPad 3 (Apple, Cupertino, CA), and iPad mini (Apple). Observers recorded the number of circles detected for each image, and a perceptibility curve was used to compare the devices. Additionally, 42 extracted teeth were imaged with working length files affixed at various levels (short, flush, and long) relative to the anatomic apex. Observers measured the distance from file tip to tooth apex on each device. The absolute mean measurement error was calculated for each image. Analysis of variance tests compared the devices. Observers repeated their sessions 1 month later to evaluate intraobserver reliability as measured with weighted kappa tests. Interclass correlation coefficients compared interobserver reliability. There was no significant difference in perceptibility detection between the Lenovo M92z desktop, iPad 3, and iPad mini. However, on average, all 3 were significantly better than the Lenovo Z580 laptop (P values ≤.015). No significant difference in the mean absolute error was noted for working length measurements among the 4 viewing devices (P = .3509). Although all 4 viewing devices seemed comparable with regard to working length evaluation, the laptop computer screen had lower overall ability to perceive contrast differences.
Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcificatio... more Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcification of the investing fascia of skeletal muscle. It is often related to repeated trauma and was formerly known as traumatic myositis ossificans. Surgical procedures involving muscles are also believed to be a factor in the origin of the lesion. When FOC develops in the muscles of mastication it can lead to severe trismus. A case is reported of FOC in the left masseter muscle of a 44-year-old man who presented with marked limitation of opening. It was believed that previous fractures of the left maxilla and mandible and/or the subsequent surgical treatments were responsible for the onset of FOC. The radiographic and microscopic features of FOC are discussed in relation to recent theories on the etiology, pathogenesis, and treatment of the lesion.
Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to ... more Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.
A questionnaire was mailed to members of the Michigan Dental Association to determine the extent ... more A questionnaire was mailed to members of the Michigan Dental Association to determine the extent and adequacy of infection control procedures utilized during intraoral radiography. These measures were then compared with the infection control guidelines recommended by the American Dental Association for exposing and processing radiographs. During exposure procedures, it was found that an overwhelming majority of practitioners wore disposable gloves and placed saliva-contaminated film packets in a receptacle after removing them from the mouth. Very few clinicians complied with the ADA recommendations for wrapping surfaces in the X-ray operatory, but many used disinfectants to decontaminate surfaces touched by the operator. Most respondents washed or removed their gloves before leaving the operatory to process films, thereby stopping the spread of saliva. ADA recommendations for infection control during processing were generally not followed although alternate methods were frequently used. It is emphasized that infection control regimens be employed for all patients, and not only for those who are thought to be infectious. Auxiliaries should be educated in these protocols because they expose radiographs in many dental offices.
Introduction: Limited field cone-beam computed tomography (CBCT) imaging has become a modality fr... more Introduction: Limited field cone-beam computed tomography (CBCT) imaging has become a modality frequently used by endodontists to evaluate the teeth and surrounding tissues of their patients. Accurate image interpretation is vital to obtain needed treatment information as well as to discern coincidental findings that could be present. The goal of this study was to determine the accuracy of CBCT volume interpretation when performed by endodontists and endodontic residents. Methods: Eighteen deidentified limited field CBCT scans were obtained and evaluated by an oral and maxillofacial radiologist and an endodontist experienced in reading CBCT images. Their collective findings were combined as the ''gold standard'' of interpretation for this investigation. Using standard CBCT software, 4 practicing endodontists and 5 second-year endodontic residents evaluated each scan and recorded any notable findings and whether or not each scan warranted referral to a radiology specialist. Their interpretations were then compared with the gold standard to determine accuracy and any significant differences among the groups. Results: The overall accuracy was 58.3% for endodontists and 64.3% for residents. Paired t tests showed no statistically significant differences in accuracy between the 2 groups for findings in teeth or in bone, but residents were significantly better for maxillary sinus findings. Endodontists agreed with the gold standard 38.9% of the time and residents 49.8% of the time on necessity of referral. The Cohen kappa coefficient showed moderate agreement between the groups. Conclusions: Endodontists and residents had similar accuracy in CBCT scan evaluation. More training and experience are warranted for both groups in order to maximize image assessment accuracy.
Journal of the International Clinical Dental Research Organization, 2010
Objectives: To determine the effect on caries diagnosis of exposure reduction on intraoral digita... more Objectives: To determine the effect on caries diagnosis of exposure reduction on intraoral digital radiographs compared with optimally exposed film images. Materials and Methods: F-speed film radiographs of 61 extracted molars and premolars were made with optimal exposure parameters. The teeth were radiographed using a complementary metal oxide semiconductor (CMOS) digital system with exposures equal to 50%, 30%, 20%, 10%, and 5% of the film exposure. Five observers, who were permitted to adjust brightness and contrast on the digital images, scored the proximal and occlusal surfaces for the presence of caries using a 5-point confidence scale. Areas under receiver operating characteristic (ROC) curves represented accuracy of caries detection. Sensitivity and specificity were also calculated. The significance level was P = 0.05. Results: All digital images resulted in lower diagnostic accuracy than film images for all lesions (P ≤ 0.036) and for caries in enamel only (P ≤ 0.030). With dentin caries, there were no significant differences between film and any digital radiographs (P ≥ 0.065) except the 5% exposures (P ≤ 0.034). Digital radiographs of 5% of the exposure of film were significantly poorer than all other exposure categories (P ≤ 0.014) except for the 10% exposures for accuracy for all lesion sizes and for dentin lesions only. Exposures at 10% and 20% resulted in lower sensitivity scores for enamel caries, while 50% exposures were associated with the poorest specificity. Conclusions: Exposures of 30% of optimal F-speed film exposure settings appear to balance acceptable levels of accuracy, sensitivity, and specificity for caries detection. Observer-controlled enhancements were ineffective at extremely high and low exposures.
Physicians often do not provide adequate information regarding patients' medical conditions when ... more Physicians often do not provide adequate information regarding patients' medical conditions when presented with consultation requests (CR) generated by dental students and their instructors about the students' patients. We hypothesized that a structured CR form, which requests specific information by providing a checklist and/or closed-ended questions for physicians to answer, would lead to better communication and improved responses. We also hypothesized that providing in-service education to clinical faculty on the conditions that require and don't require CRs would reduce the number of unwarranted CRs sent to physicians. We assessed the responses obtained with the new form and compared them to findings over a similar period using our older, unstructured CR forms. We also evaluated the numbers of CRs written unnecessarily during both time periods. Improvements in the appropriateness of information provided by physicians were noted with the new CR forms for diabetes mellitus, hypertension, heart murmur, and anticoagulant therapy. The number of CRs written for conditions that did not need a consultation was approximately the same after provision of instruction as before. We conclude that structured CR forms improve the flow of information between dentists and physicians and should enhance student knowledge and skills in soliciting relevant information. Greater efforts must be taken to inform clinical faculty about the indications for CRs.
X-ray exposure to dental patients has been significantly reduced by the introduction of speed gro... more X-ray exposure to dental patients has been significantly reduced by the introduction of speed group E intraoral film, rectangular beam limitation, long position indicating devices (PIDs), and rare-earth intensifying screens for extraoral radiography. Research indicates that many dentists do not use these techniques. However, schools of dentistry have implemented them to varying degrees for many years, so this investigation was conducted to determine the extent to which dental school faculty members use these materials and techniques in their own practices. Comparisons were made between full-and part-time instructors, those in practice for fifteen years or less and those in practice for more than fifteen years, and those with postgraduate education versus those with no formal education beyond dental school. The significance of differences was measured with chisquare analysis. The results indicate that dentists with faculty appointments utilize dose-reducing techniques to degrees that are comparable to or greater than reported usage by non-dental faculty practitioners. Faculty dentists in practice fifteen years or less are more likely than their older colleagues to use E-speed film (p = 0.001), whereas those in practice more than fifteen years are more likely to use longer PIDs (p = 0.049). Greater acceptance of these practices by faculty may lead to reinforcement of their use in the clinical education of dental students.
1. J Mich Dent Assoc. 2003 Dec;85(12):40, 42-3. Oral pathology quiz: an unusual pericoronal cyst.... more 1. J Mich Dent Assoc. 2003 Dec;85(12):40, 42-3. Oral pathology quiz: an unusual pericoronal cyst. The diagnosis was glandular odontogenic cyst, although focal areas consistent with dentigerous cyst were seen. Geist J, Gordon S, Wesley R. ...
This study compared images displayed on 1 desktop monitor, 1 laptop monitor, and 2 tablets for th... more This study compared images displayed on 1 desktop monitor, 1 laptop monitor, and 2 tablets for the detection of contrast and working length interpretation, with a null hypothesis of no differences between the devices. Three aluminum blocks, with milled circles of varying depth, were radiographed at various exposure levels to create 45 images of varying radiographic density. Six observers viewed the images on 4 devices: Lenovo M92z desktop (Lenovo, Beijing, China), Lenovo Z580 laptop (Lenovo), iPad 3 (Apple, Cupertino, CA), and iPad mini (Apple). Observers recorded the number of circles detected for each image, and a perceptibility curve was used to compare the devices. Additionally, 42 extracted teeth were imaged with working length files affixed at various levels (short, flush, and long) relative to the anatomic apex. Observers measured the distance from file tip to tooth apex on each device. The absolute mean measurement error was calculated for each image. Analysis of variance tests compared the devices. Observers repeated their sessions 1 month later to evaluate intraobserver reliability as measured with weighted kappa tests. Interclass correlation coefficients compared interobserver reliability. There was no significant difference in perceptibility detection between the Lenovo M92z desktop, iPad 3, and iPad mini. However, on average, all 3 were significantly better than the Lenovo Z580 laptop (P values ≤.015). No significant difference in the mean absolute error was noted for working length measurements among the 4 viewing devices (P = .3509). Although all 4 viewing devices seemed comparable with regard to working length evaluation, the laptop computer screen had lower overall ability to perceive contrast differences.
Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcificatio... more Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcification of the investing fascia of skeletal muscle. It is often related to repeated trauma and was formerly known as traumatic myositis ossificans. Surgical procedures involving muscles are also believed to be a factor in the origin of the lesion. When FOC develops in the muscles of mastication it can lead to severe trismus. A case is reported of FOC in the left masseter muscle of a 44-year-old man who presented with marked limitation of opening. It was believed that previous fractures of the left maxilla and mandible and/or the subsequent surgical treatments were responsible for the onset of FOC. The radiographic and microscopic features of FOC are discussed in relation to recent theories on the etiology, pathogenesis, and treatment of the lesion.
Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to ... more Arteriovenous malformations (AVMs) are rare vascular lesions that can be life-threatening due to potential massive hemorrhage. AVMs can be subdivided according to the type of vessel involved (capillary, venous, and arterial) and can be categorized, according to hemodynamic features, into high-flow and low-flow lesions. AVM of the jaws is an uncommon disease. Clinical signs and symptoms of AVM may include pain, erythematous gingiva, spontaneous gingival bleeding, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic and frequently have indistinct margins. Computed tomography can demonstrate enhancement of the lesions, while angiography can depict distended feeder vessels and arteriovenous shunts. Magnetic resonance imaging can visualize flow voids in high-flow abnormalities. The purpose of this paper was to present 2 high-flow cases of arteriovenous malformations: one with a large AVM lesion in the mandible that presented clinically as a discoloration on the mucosa and gingiva with loss of lip sensation; and the second with a lesion in the maxilla discovered during an extraction of a root fragment. Management of the lesions was achieved by embolization.
A questionnaire was mailed to members of the Michigan Dental Association to determine the extent ... more A questionnaire was mailed to members of the Michigan Dental Association to determine the extent and adequacy of infection control procedures utilized during intraoral radiography. These measures were then compared with the infection control guidelines recommended by the American Dental Association for exposing and processing radiographs. During exposure procedures, it was found that an overwhelming majority of practitioners wore disposable gloves and placed saliva-contaminated film packets in a receptacle after removing them from the mouth. Very few clinicians complied with the ADA recommendations for wrapping surfaces in the X-ray operatory, but many used disinfectants to decontaminate surfaces touched by the operator. Most respondents washed or removed their gloves before leaving the operatory to process films, thereby stopping the spread of saliva. ADA recommendations for infection control during processing were generally not followed although alternate methods were frequently used. It is emphasized that infection control regimens be employed for all patients, and not only for those who are thought to be infectious. Auxiliaries should be educated in these protocols because they expose radiographs in many dental offices.
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Papers by James Geist