Dental Examinations

Without getting into a lot of technical detail, a radiograph is a special kind of picture taken of hard structures, such as bone or teeth, which demonstrates the density of the subject of the picture. The more dense the matter shown, the lighter the image will appear on the x-ray or radiograph. Conversely, the less dense the subject, the darker that part of the radiograph will appear. Caries, fractures of the bone or tooth, and many tumors of the bone are less dense than healthy tissues, and the darker on the radiograph.

There are three types of radiographs used in dentistry:

1. Panoramic - This type of radiograph is taken by a machine that rotates around the head while projecting the radiograph beam onto a long film, which is also rotating in a canister. The result is a picture of the entire lower face from the eye sockets to the chin. This type of radiograph is excellent for detecting tumors and irregularities of the maxillary sinuses and upper and lower jaws, including fractures, as well as offering the best view of the position of the third molars (wisdom teeth). In most cases, the detail of the remaining teeth themselves is not adequate for diagnostic purposes.

2. Periapicals – Literally meaning “around the roots” of the teeth, this film shows the roots and bone around 2-4 teeth per film, and has excellent detail for diagnosing abscessed teeth, bone and tooth fractures, and bone loss due to advanced periodontal disease.

3. Bitewings – Either two or four films, this set of radiographs is taken specifically to detect caries (decay) that occurs between the teeth. Bitewings plus 14 periapical images constitute a “Full Mouth Series” of radiographs.

For a complete dental examination adequate to diagnose a patient’s dental problems and potential future problems, all the above mentioned radiographs are necessary. The panoramic in most cases, does not provide sufficient detail to diagnose decay or bone loss due to periodontal (gum) disease. Conversely, the periapicals and bitewings do not expose areas of the jaws where tumors and fractures of the bone typically occur. Be advised that your dental insurance company may not agree that all types are necessary.

The frequency of prescribed radiographs is based upon the dentist’s assessment of your individual needs, including whether you are a new patient, adult, child, and pregnant females. Many dental offices are now using the new technology of digital radiography. Much like a digital camera, there is no film. Instead, a sensor is used to capture the image. Directly connected to the computer, the sensor transfers the image into the computer data bank to be retrieved whenever needed. The image can be made larger, smaller, darker, lighter-changed in many ways to enhance diagnostic ability. In communicating with specialists or other dental offices, the image can be electronically transferred or emailed in seconds. An advantage for the patient is that less radiation is required to create the image.

A planned course of treatment is only as good as the information obtained in the diagnostic examination. Caries between the teeth, root fractures, bone loss caused by gum disease, fractures of the bone and many cancerous and non-cancerous tumors of the bone would be impossible to diagnose without the use of dental radiographs.