The fear of the dangers of exposure to radiation permeates our consciousness. Yet in the medical environment, patients are often exposed to great amounts of radiation in diagnosing as well as treating diseases. The side effects of radiation are well documented and should be avoided unless absolutely necessary.
The amount of exposure from one, or even several, dental radiographs (X-Rays) is minimal when compared to the diagnostic information that they provide your dentist.
Dental X-Rays are not always necessary on children and adults who have very healthy mouths upon a thorough visual clinical examination. For my reassurance, I still may recommend some pictures, because visual clinical examination does not reveal all of the possible dental problems.
Unfortunately, by the time most people come to the dental office, they have developed problems and have backed themselves into a compromising situation. At that point, dental radiographs are necessary if successful reconstruction is going to be accomplished. Dental X-Rays help the dentist in the following ways:
1) to see roots, nerves, (including the pulp (nerve of the tooth), ligaments, and surrounding bone of teeth;
2) to determine bone level and depth of decay and fillings;
3) to see impacted teeth, broken root tips, abscesses, tumors, fractures, growths abnormalities within bone;
4) to assess the extent of bone level or damage;
5) to evaluate the presence and position of adult teeth beneath deciduous (baby) teeth;
6) to assess the periodontal (gum and bone) condition;
7) to assess the orthodontic condition;
8) to better visualize the extent and the depth of decay and fillings;
9) to efficiently render most dental treatment including, but not limited to, endodontics (root canal therapy), emergency treatment, periodontal (gum and bone) treatment, oral surgery, dental implants and orthodontics;
10) to see the TMJ (Temperomandibular Joint);
11) In most procedures, it is necessary to obtain X-Rays for legal protection of the dentist and the patient. Many people have insurance or Medicaid, which require pre-treatment X-Rays in order to okay the treatment.
There are several types of dental radiographs.
1) The most common is the periapical X-Ray. Each one shows the tooth structures and surrounding bone of three to four teeth. It helps diagnose cavities and many dental problems. Bitewing X-Rays show decay and bone level of back teeth. A full mouth series of up to 14 periapicals and two bitewings is recommended as needed in five- to ten-year intervals.
2) A panorex is one single X-Ray of the oral cavity showing all the teeth and surrounding bone structures. A Panorex is mainly used to look at the structures of the maxilla (upper jaw)and mandible lower jaw), neck, and head. It is a screening tool that is used to make sure that there are no abnormalities. It is often used by orthodontists to diagnose and treat abnormal bites, by oral surgeons to determine position of impacted teeth, abscesses, tumors, and fractures, and to see the TMJ (Temperomandibular Joint) in order to diagnose muscular or TMJ pain. Panorex X-Rays use less radiation than a full mouth series. They are, however, not a substitute for the full mouth series, which provides more accurate detail for most general family dentistry.
3) Tomogram and Transcranial X-Rays are used to see the position of the mandible (lower jaw bone) in relationship to the maxilla (upper jaw bone) and the skull bone. These X-Rays are used to show the space where the top of the mandible (condyle) and underside of the maxilla (upper jaw) meet. This is called the glenoid fossa. This space is actually a fibrocartilage disc that acts as protective cushion between the head of the condyle and the maxilla. If the space or the disc becomes too thin or dislocates, TMJ pain can result.
4) Head/Skull X-Rays can also be used to show the position of the maxilla, the mandible, the skull and neck bones. These help to determine where any imbalance may exist. Computerized renditions of these X-Rays may help to determine the causes of pain and may help to plan future treatment.
5) Computer technology has allowed a dramatic decrease in the amount of potential exposure to radiation. Direct digital filmless radiography may reduce radiation by as much as 90% over conventional techniques. This approach is equal in diagnostic quality to conventional X-Rays. Some patients report discomfort from the sensor pressing on soft tissue. However, since this approach decreases both the radiation and environmental impact of conventional X-Rays, and since it offers an increased ability to enhance the image—to enlarge small areas for closer inspection, and though the cost of a machine to the dentist is sometimes prohibitive in many practices, I believe that it offers very a important option for dentists and their patients.
I have recently had experience with an oral surgeon who is doing an implant for my son. He took a cat scan of his maxilla (upper jaw) and mandible (lower jaw) with the Icat Cone Beam 3-D Dental Imaging for dental applications. It produces an accurate photopolymer replica of a patient’s mandible or maxilla based on CT scan data. He was able to save the scans and burn them on a CD and mail it to me. I then downloaded software to open the CD. It was remarkable. X-Rays of various sections and angles showed the existing implants in the bone. It is used by the oral surgeon to help to properly plan for future treatment. This technology is fast becoming a necessity in the rapidly growing field of dental implantology.
There are many precautions that your dentist may take to reduce the amount of radiation that a patient receives:
1) taking the minimum number of X-Rays for the age, physical condition, and dental needs of the patient;
2) usage of lead-lined walls and lead aprons to cover vital organs;
3) using fast-speed films;
4) using proper equipment and machine settings;
5) periodic required testing and inspection of the equipment.
Again, please note that children and adults with healthy dentition generally need fewer X-Rays. Pregnant women, particularly those in the first trimester, should avoid radiographs, except in an emergency. Women who are of child-bearing age or are lactating, and patients who are undergoing radiation therapy should limit their exposure.
Keep in mind that you do not necessarily need to have X-Rays taken by every dental professional you see. If you have had X-Rays taken within the last five years by a previous dentist, periodontist, or orthodontist, obtaining them may eliminate or reduce the need for additional X-Rays.
At present, the use of dental X-Rays is an unfortunate necessity in order to render proper dental care. The dental profession is doing its best to protect the patient and allay the public’s apprehension about radiation exposure. By becoming knowledgeable about this issue, and expressing your concerns, you should be able to create a cooperative partnership with your dentist. In most cases, without the information that an X-Ray affords the dentist, he/she cannot render treatment as effectively.