Dr Michael Sernik, July 2006 - OPGs are making a comeback in private practice. Many practitioners were and still are happy to outsource the service to the radiologist down the road. Many more, however, are being enticed by the reduced cost of the latest digital panoramic systems and bringing this valuable diagnostic tool in house. So should you?

Clinical relevance
Have you ever gained valuable information from an OPG that was not visible on routine bitewings or periapicals? If the answer is yes and if you don’t use an OPG routinely, then by deduction, you are probably missing valuable information. You are waiting for the inevitable problems to arise. If you have never had this sort of problem, then you are lucky. All is well until a problem arises, and we don’t want to deal with problems, we want to prevent them. History teaches us that it is human nature to be reactive rather than preventive (Most people buy their first burglar alarms after they have been burgled!).

Regardless of the current legal requirements, a dentist would be foolhardy to undertake extensive treatment such as orthodontics, implants or bridgework without the more complete picture an OPG can provide.

So, if we can agree that there is a clinical benefit in taking an OPG prior to extensive treatment and at appropriate intervals, it begs the question... are you better off owning one? The alternative is to send the patient to a radiographic facility. If you don’t have an OPG, you may well follow the common trend of avoiding referring patients to get one, thereby potentially missing important pathology as we touched on above. Dentists without OPGs will normally point out that since the patient may be eligible for a Medicare rebate, they feel uncomfortable charging for something that could be cheaper elsewhere. But does this best serve the patient? If you do feel that way, then perhaps you should consider sending all your patients to the public dental hospital. Some of them will qualify for cheaper treatment!

Convenience
We should never underestimate the value of convenience. People pay a fortune for it every day. Most people would sooner have the treatment on the spot rather than making an appointment with another healthcare provider elsewhere, taking yet more time off work, travelling, parking and then re-booking with you when the films are developed. Time is often a far more precious commodity than the cost of an OPG.
Worse still, if the patient who is booked in for some restorative work gets an OPG elsewhere, opens the envelope (people do, especially if they think they shouldn’t) and they read the two magic words: “No Abnormalities”, then there is a real possibility the patient will wonder why they need treatment if nothing is wrong!

From the perspective of your practice, referring patients out for an OPG delays treatment as the patient must reappoint after they have had the OPG. Also, if you’ve spent a great deal of time, money and effort developing an up-market practice image with the utmost in patient care, then do you want to risk referring to another healthcare facility that may not share your passion?

Profitability
Some would argue that the major reason most dentists resist purchasing an OPG is cost. Machines range from $35,000 and up depending on whether it is film or digital, the brand name and the available features, which can include Cephalometrics, SCARA (Selected Computerised Articulated Robotic Arm), TSA (Transversal Slice) and more.

Sales reps tend to focus on selling the unit as a profit centre and you’ll hear things like, “just 1 scan a day will pay for the lease”. Maybe. If you adhere to a regime of taking an OPG for every new patient and updating OPGs for patients of record every three years, then a practice with 2000 patients per practitioner may take as many as 1000 panoramics a year. An average charge of $90 per panoramic would generate some $90,000 in gross revenue.

Most dentists, however, are really more motivated by wanting to do better quality dentistry. We’re an altruistic bunch and I don’t know that all the sales reps realise this. Possibly because sales reps hear incessant complaints about the cost of materials! Notwithstanding that, we really do care about providing quality treatment and I think the fact that we are going to provide our patients with superior treatment, makes a strong case for owning one.

[Published in Australian Dental Practice, July/August 2006]