Abstract
Objectives: To evaluate the quality of bitewing radiograph taken by Universiti Teknologi MARA (UiTM) dental
students during daily clinical practices and to evaluate the difference in caries lesions found on bitewing
radiographs and clinical examination.
Materials and method: 120 patients who attended the undergraduate dental clinic for dental examination were
included in this study. The inclusion criteria were patients within the age range of 17-45 years old, possessing
at least three sets of posterior teeth, with bitewing radiographs taken by undergraduate dental students. The
number of caries lesions detected by clinical examination, bitewing radiographs, and a combination of both
methods were recorded. The quality of 240 bitewing radiographs was classified into three categories; excellent,
acceptable, and unacceptable. The frequency of radiographic errors; foreshortening/elongation, horizontal
overlapping, inadequate film coverage, non-ideal centering and inadequate contrast and density were also
evaluated.
Results: The quality of bitewing radiographs are mostly accepted to be used as a diagnostic tool and one of the
factors which commonly affected the quality of the bitewing is the overlapping of adjacent teeth. The highest
number of caries lesions were detected radiographically (74%) compared with 25% caries by clinical
examination. The majority of radiographs (71%, n=171) were deemed to be of acceptable quality, 39(16%) were
excellent, and 30(13%) were diagnostically unacceptable. “Horizontal overlap” was the most common error
detected on the radiographs (n=139, 57.9%), followed by “non-ideal centering” (n=93, 38.8%), “inadequate
contrast” (n=46, 19.2%) and “inadequate film coverage” (n=24,10%). The highest number of caries lesions were
detected radiographically (74%) compared with 25% caries by clinical examination.
Conclusion: The quality of the majority of bitewing radiographs taken by undergraduate dental students in this
institution is acceptable. However, given that more than half of the radiographs possessed horizontal
overlapping error, caries diagnosis may have been underestimated. Further training and periodic audits are
required to reduce the percentage of errors in bitewing radiographs amongst undergraduate dental students.