Dr. Bob Merrill
112 S. Stone St.
Augusta, WI 54722
Most people know that x-rays are used to
take pictures of the jaw bone and teeth, but few know that
x-rays also enable dentists to examine for diseases such as
oral cancers, sinus infections, gum diseases, and jaw joint
pain. Many diseases that would go undetected for a long period
of time through visual examination can be caught at an early
treatable stage through x-rays. Radiographs (x-rays) are a
vital and necessary part of the dental diagnostic process.
Due to early detection, many diseases are treated without
the need for drastic treatments, such as roots canals or extractions.
Without xrays, certain conditions can and
will be missed. The exposure from dental radiographs is extremely
small, especially with new advancements in film speed and
Bitewing radiographs are the radiographs
taken most frequently. These are the ones where you close
your mouth and bite on a tab. Bitewing radiographs are important
for detecting decay in between the teeth and for evaluating
the periodontal condition.
Xrays provide a good view of the bone level.
Changes in bone height can also be detected with bitewing
radiographs. Bitewings can also be quite useful for detecting
calculus (or tartar) between the teeth. This information can
help the dentist or hygienist clean the teeth properly.
is what Dr. Bob saw in the mouth. The cavities between
these teeth were undetectable on clinical examination.
This is part of a bitewing x-ray
taken of the two teeth seen in the above photo. This type
of x-ray is commonly taken for diagnosis of cavities. The
cavities that you can see in the xray were not visible clinically,
and they are, as you can see, quite deep. The pulp chamber
is where the nerve of the tooth is.
Periapical radiographs show the entire
tooth from the crown to the end of the root. This type of
film will show any root anomalies, changes in the bone surrounding
the root, cysts, abscesses, etc. The fine detail obtained
in these films can be extremely important and helpful in diagnosis.
Full mouth series radiographs are
a series of 16-18 periapical radiographs taken at the
same time, of all of the teeth, so that bone levels,
periapical problems, and periodontal (problems with the gums
and supporting bone), tartar levels, and caries can be evaluated.
The advantage of full mouth radiographs is the fine detail
that can be seen on each tooth and tooth root. The disadvantage
is that problems deeper than the end of the tooth root cannot
This is a full mouth series of x-rays.
This is sometimes taken instead of a panorex to see greater
detail of the teeth only.
Panoramic radiographs are the ones
where you stand or sit and the x-ray machine moves around
your head. With panoramic x-rays, a broad area is imaged,
exposure level is relatively low (about the same as 4 bitewing
radiographs), and they are convenient. The disadvantage is
that the image does not provide the fine detail that bitewings
and periapical radiographs provide. Panoramic radiographs
are excellent for evaluation of trauma, third molars, tooth
development, and certain anomalies. They also will give a
good impression of the overall bone levels and sinus position.
They are not good for diagnosing decay and certain types of
is a panorex radiograph. The dentist can see all of
the teeth, the sinuses, bone levels, as well as any
abnormal pathology. As you can see, the roots are not
totally covered by bone. The teeth of this patient are
loose. This is an example of the destructive nature
of periodontal(gum) disease.
Cephalometric radiographs are used
for diagnosing and treatment planning in orthodontic cases.
Many measurements are taken, giving the treating dentist information
about growth patterns, relative position of the upper and
lower jaw to the cranium (skull) and to each other. Cephalometric
radiographs also give the treating dentist a good indication
of the presence of airway problems (shows the size and position
of tonsils and adenoids).
is a cephalometric x-ray. It is used along with other
records to diagnose and treat an orthodontic case (straightening
teeth with braces)
The American Dental Association has recommended
that the type and frequency of dental radiographic examination
be based upon clinical judgement after examination and consideration
of the dental and general health of the patient. There are,
however, some basic guidelines dentists follow. On average,
dentists do request bitewing radiographs approximately once
a year. This is mainly to detect and treat conditions early
before they become a major problem. If a patient has a healthy
mouth and does not appear to be cavity prone, I might take
bitewings every 18 to 24 months. If a patient has a serious
cavity problem, I will take bitewings every six months until
I am certain that the problem is under control. Approximately,
every 5-7 years, it is generally a good idea to obtain a full
mouth series of radiographs (or a panoramic radiograph) and
bitewings. Occasionally, conditions can develop "quietly,"
and obtaining these films will help dentists determine if
any developments have taken place. Again, while I do understand
certain concerns from patients, these radiographs are invaluable
for diagnosing conditions and obtaining and maintaining oral
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