Mustafa ÜSTÜN, Serkan BAHRİLLİ, Ali ALTINDAĞ
Medical Science and Discovery - 2026;13(9):284-292
Objective: This study aimed to determine the prevalence of pulpal calcifications on bitewing radiographs and to assess their associations with dental characteristics and demographic variables in an adult Turkish population. Materials and Methods: This retrospective cross-sectional study evaluated 200 adult patients who underwent routine bitewing radiography in our clinic. Only patients with a complete posterior dentition, in whom all sixteen posterior teeth were present and diagnostically assessable, were enrolled; this design decision yielded a balanced dataset of 3,200 posterior teeth (1,600 molars and 1,600 premolars). Two experienced oral and maxillofacial radiologists examined teeth independently and categorized them by tooth group (molar/premolar), jaw (maxilla/mandible), and arch side (right/left). Patients were grouped into three age categories (18-30, 31-45, >45 years). Pulpal calcifications were identified as discrete radiopaque masses within the pulp chamber or the coronal third of the root canal. Because sixteen teeth were nested within each patient, we analyzed tooth-level associations using generalized estimating equations (GEE) with an exchangeable working correlation structure and robust standard errors. In contrast, we analyzed patient-level variables (age and sex) using binary logistic regression with the patient as the unit of analysis. Odds ratios (OR) with 95% confidence intervals (CI) and exact p values are reported throughout. Results: Pulpal calcifications were identified in 45 of 200 patients (22.5%) and in 455 of 3,200 teeth (14.2%). The within-patient correlation was substantial (exchangeable alpha = 0.68), corresponding to a design effect of 11.2 and an effective sample size of approximately 286 independent teeth. After adjustment for this clustering, molars remained significantly more often affected than premolars (16.1% vs. 12.4%; OR = 1.36, 95% CI: 1.24-1.48; p < 0.001) and mandibular teeth more often than maxillary teeth (15.3% vs. 13.1%; OR = 1.20, 95% CI: 1.08-1.33; p < 0.001). At the patient level, prevalence rose from 10.8% (18-30 years) and 15.4% (31-45 years) to 40.0% (>45 years); the oldest group differed significantly from the youngest (OR = 5.52, 95% CI: 2.20-13.84; p < 0.001), whereas the intermediate group did not (OR = 1.51, 95% CI: 0.54-4.24; p = 0.437). No association was found with sex (OR = 1.06, 95% CI: 0.55-2.06; p = 0.866) or arch side (OR = 0.99, 95% CI: 0.87-1.14; p = 0.942). Conclusion: Pulpal calcifications are common incidental findings on bitewing radiographs and are significantly associated with age, tooth group, and jaw location, but not with sex or arch side. Because teeth within a patient are strongly correlated, interpret tooth-level prevalence data with cluster-adjusted methods. Recognition of these patterns may help clinicians anticipate calcified canal systems and plan magnification, ultrasonic troughing, or guided endodontic access before treatment begins.
