Dental X-Rays

DENTAL RADIOGRAPHS

Dental radiographs are an important piece of the puzzle when a dentist is determining a diagnosis or treatment plan for dental care. However, due to the exposure to radiation, many patients are apprehensive to allow dental radiographs to be taken on them.

Dental radiographs show the dentist what can not been seen clinically; radiographs give a picture of both the hard and soft tissues of your mouth. These images are vital in diagnosis of:

Caries (tooth decay) both in between teeth and under old restorations (crowns, fillings, etc.)
Diseases in the bone
Periodontal (gum) disease
Infections that develop under your gums and at the roots of teeth
Some types of tumors
See the status of developing teeth in children

Dental radiographs allow the dentist to have a visual record of your hard and soft tissues and future radiographs allow them to compare and track any changes over time. Dental radiographs allow for the early detection of infections and diseases, allowing for treatment to take place before these issues become emergent or spread to other tissues or areas.

When in the dental office; radiographs are taken under a principle known as ALARA or “As Low as Reasonably Achievable.” When a dentist and their staff follows the ALARA principle, they take only the radiographs necessary along with following general radiographic techniques which results in exposing you to the lowest possible amount of radiation.

Some of these techniques include:

Using digital image receptors
Use of proper exposure and processing techniques
Use of lead aprons and thyroid collars

Another aspect of ALARA is the frequency of which the dental

staff chooses to take radiographs on their patients. Some offices

may take a standard set of bitewing radiographs every 6 months

while others only do so every 12 or 18 months. The frequency at

which a dentist chooses to prescribe radiographs to a patient, however, should be more of an individualized decision based on a patient’s personal risk for caries, periodontal disease or other dental issues. The American Dental Association released recommendations for dental radiograph frequency based on patient risk category for dental professionals to follow to maintain these ALARA principles.

COMMON TYPES OF DENTAL RADIOGRAPHS

Bitewing Radiographs: Used to visualized the in between areas of posterior teeth. Bitewing images show mostly the crown of the teeth. For adults, 4 bitewing images (2 on each side) are standard. For children, depending on age and size, 2 or 4 bitewing images may be needed.

Periapical Radiographs: Shows only a small section (one to two teeth) in each image. Unlike the bitewing, which mostly shows the crown of the tooth, a periapical radiograph shows the entire length of the selected teeth from crown to root tip.

Full Mouth Radiographs: A full mouth radiograph set includes a combination of bitewing and periapical films of the entire mouth involving anywhere from 18-20 films.

Panoramic Radiograph: Shows the entire mouth as well as jaw and joint on a single image. This type of radiograph is taken in a special machine where the image sensor circles around your head. Panoramic radiographs are not ideal for diagnosing caries.

Cephalometric Radiograph: Shows both the hard and soft tissues of the entire side profile of the head. These are used by orthodontists to determine treatment needs of patients.

Cone-beam Computed Tomography (CT): Provides three-dimensional images of the teeth and jaw. CT images are generally used only for the placement of dental implants.

WHAT TO EXPECT WHEN VISITING THE DENTIST

As a New Patient:

If you are visiting a dental office as a new patient the dentist will need to evaluate the condition of your mouth in its entirety. This will require either a full radiographic series (18-20 films) or bitewing radiographs with a panoramic image. If you have had radiographs taken by another dentist in recent months be sure to have those images transferred to the new office. This will give your new dentist the opportunity to potentially eliminate the need to take some or all of the radiographs or at least give them images to compare to for changes over time.

As a Returning Patient:

Once you are an established patient in a dental practice, dental radiographs will be required as needed for any pain or issues and as prescribed by the dentist based on your individual risk for caries or other dental diseases. The time frame will differ for everyone and can range anywhere from 6 to 18+ months.

REFUSING RADIOGRAPHS

While the radiation dose from dental x-rays is minimal, some may still not be comfortable with having them taken. As a patient; you are allowed to decline or refuse treatment or exam, including radiographs, at your own discretion. Please keep in mind that without these images the dentist is unable to provide a complete and accurate diagnosis. Other considerations to make when weighing risks vs. benefits for yourself:

Some states may mandate that a dental hygienist can not see a patient who has not had a complete exam (radiographs included) by the dentist within a specified period of time.
A dentist can dismiss you from their practice if you continually refuse radiographs; whether or not you know the risks, if a dentist continues to see you without being able to fully assess your oral health puts them at risk for supervised neglect.
Many dental issues don’t present with pain or clinically visible symptoms until the infection has spread and more extensive treatment is needed. Finding an issue while it is isolated and easily mended is preferable.

RADIOGRAPHS DURING PREGNANCY

Generally, the dental team will avoid any routine radiographs during pregnancy. However, if there is a dental emergency during pregnancy, acquiring dental radiographs may become necessary. With the use of a lead apron shield, taking the images is recognized as safe. Some dental offices may require clearance from medical doctor before they will treat a pregnant patient.