Dental x-rays (radiographs,) whether taken digitally or with dental film, are a vital component in the prevention, diagnosis and treatment of dental disease. Without x-rays, proper dental treatment cannot be performed. Most states require dental x-rays be taken on a regular interval and State Dental Boards can dictate no treatment be performed without them. This is considered within the appropriate ‘Standard of Care’.
Routine Dental X-rays include
Full mouth x-rays
A series of 18 pictures showing root tips and areas between your teeth, this type of x-ray is good for showing close detail of each individual tooth. It allows views of the tooth from different angles, an important tool for diagnosing questionable areas. Understanding how to move the tube head or “camera,” and watching the image shift from x-ray to x-ray allows dentist to determine the location of areas of concern with a high degree of accuracy. Full mouth x-rays are taken every 3-7 years: every three years in the case of patients with a history of gum disease (periodontal disease); every five years on average; and every seven years for patients who have reached adulthood with little or no dental disease and immaculate oral hygiene.
These x-rays involve four pictures of the areas between the teeth. Bitewings help to determine the level of decay and bone between the teeth. For the average patient and non-flossers, it is recommended these be taken every year.
Routine x-rays taken once a year to detect tooth decay and monitor bone levels are termed “bitewing x-rays.” In situations where a patient has suffered bone loss, the bone level may not be viewed on traditional bitewing films. In this case, to view the bone, the films (taken in a horizontal position for routine visualization between the teeth) are turned and the x-rays taken with the film in a vertical position.
These x-rays show the whole tooth and area around the root of the tooth. There are 14 periapical views in full mouth set of x-rays. Occasionally, a patient comes in with a specific problem and is not due for a full mouth x-ray, but is in pain or having a specific problem. This is when one or two periapical x-rays are taken to determine the source of the pain. Often the dentist will use the existing full mouth x-rays and the new periapical x-ray for comparison to determine the proper course of treatment.
This type of dental x-ray (see photo above in “overview”) aids in viewing a large area around teeth and surrounding structures. Dental professionals can see the TMJ, or temporomandibular joint (more specifically, the condyle and fossa and its general condition); the maxillary sinus; the canal where the nerve, artery and vein supplying the lower teeth and jaw and much more. Oral surgeons often will only remove your teeth after a panorex x-ray is taken, allowing them to see the entire tooth and surrounding structures to determine how the tooth is positioned in the jaw.
Digital x-rays (digital radiography) require much less exposure to radiation and use a ‘sensor’ vs. dental film that has to be developed. The image is produced immediately and viewed on a computer.
This is a side view of the head used in oral surgery and as a part of planning treatment for “braces” .
When you request that no x-rays be taken, we document that request and inform you that we cannot properly diagnose or treat any condition we cannot see. Decay can often be seen on front teeth by transmitting a dental light through the thinner front teeth and looking in a mirror placed behind the teeth. Decay cannot be seen between the back teeth without dental x-rays.
Requesting no x-rays would be considered an unsafe practice when:
- You have had a long absence between dental visits. Most dentists are conservative by nature and give you the benefit of the doubt when it comes to whether to watch an area or just fill the tooth. They will explain that you have areas that have begun to decay, that the progression of the tooth decay does not warrant filling the tooth at this time (because the decay is less than halfway through the enamel) but it needs to be kept clean (brush/floss) so the decay process can be halted. If you have taken a longer-than-recommended break from routine dental care, have been lax in your home care and regularly consume foods containing sugars, dental -rays are necessary. Saving money or worrying about radiation by foregoing x-rays could be a risky decision. You may need to spend more money in the future to repair a larger problem that could have been fixed when it was smaller and less expensive to repair.
- You have been diagnosed with periodontal disease and you are undergoing maintenance treatment. In this case, regular dental x-rays are of vital importance (full mouth x-rays every three years and bitewing x-rays every year).
- A “baby tooth” has significant decay. If the adult tooth that replaces it is not close to pushing out the “baby” tooth and erupting into the mouth, a filling is warranted. However, if the adult tooth is close to eruption, and the baby tooth is going to be lost soon, no filling is indicated. A decision cannot be made without dental x-rays.
- You were raised in an area without a fluoridated water supply.