Dental X-Rays
More Than Just a Picture
Mary Elise Golowic
Wayne County Community College District – DEN 100
Abstract
Many dental instruments used today are similar or identical to the day they were created, although it is not the case with the diagnostic tool used by dentists known as oral radiographs or dental x-rays. This paper will explore what a diagnostic radiograph is, how the x-ray is performed, how it provides dental professionals an aid in the finding of cavities, abscess and infection under tissue prior to having the ability to see it with the naked eye saving the patient time, money and possible pain, also with touching on how today’s technology has improved the dental professionals ability to detect many abnormalities from bone loss to tumors by using the ability to view medical issues prior to physical or visual signs are present (ADA 2014). Today, x-rays have become state of the art; occlusal radiographs, panoramic and intraoral views, or even the newer digital x-rays have become valuable tools in the care and treatment of dental health.

Dental X-Rays
More Than Just a Picture
Diagnostic radiographs or dental x-rays, are a type of image of the teeth and mouth that are used to diagnose or treat patients by recording images of the internal structures in order to assess whether or not there is disease, foreign objects, or structural damage. X-rays are a form of high energy, electromagnetic, radiation that can penetrate the body to form an image on film. Structures that are dense, such as silver fillings or metal restoration, will block most of the light energy from the electromagnetic radiation. Dense structures will appear white on developed film. Areas containing air will appear black on film while teeth, tissue, and fluid will appear as grey areas. X-ray imaging provides a fast, non-invasive way of answering many clinical questions which may help with the diagnosis, treatment planning and evaluation of dental conditions. As stated by the American Dental Association (A.D.A.), “Radiographs and other imaging modalities are used to diagnose and monitor oral diseases, as well as to monitor dentofacial development and the progress or prognosis of therapy. Radiographic examinations can be performed using digital imaging or conventional film…either form is acceptable.”
X-rays are done in the dentist’s office and there are many types of dental x-rays, some are bitewing, peri-apical, palatal which is also called an occlusal, and the panoramic. The bitewing displays the crown portions of the top and bottom teeth together when the patient bites on a piece of dental film material. To see one or two complete teeth, the peri-apical type of x-ray will give the view from crown to root of the teeth or tooth. A palatal or occlusal x-ray captures all of the upper and lower teeth in quick one shot while the x-ray film piece rests on the biting surface of the teeth. Requiring special equipment that rotates, a panoramic x-ray that will pivot around the head. This type of x-ray captures both jaws and the teeth in one picture. It is used to plan ahead treatment for dental implants, check for impacted wisdom teeth, and detect jaw abnormalities, although it is not the best method for detecting dental caries unless they are severely decayed and deep, which would be giving pain signals to the patient prior to this type of x-ray.
Many dentists are taking x-rays using digital technology. The image goes through a computer and an image of the area that had been x-rayed appears on the computer screen. The amount of radiation given off during the digital x-ray is less than traditional x-rays. In the start of the new millennium the United States had begun selling the cone beam computerized tomography type systems (CBCT). These types of systems rotate around the patient, it uses a cone-shaped x-ray beam that recreates a 3-D image of teeth, oral and maxillofacial regions, ears, nose, and throat. With these images the dental professional can visualize and plan for dental implants, abnormal teeth, cleft palates, endodontic diagnosis, jaw and face evaluations, dental trauma, and for the diagnosis of dental cavities.
Dental radiographs help diagnose disease and injury of the teeth and gums. When the results are normal the x-rays show a normal number, structure, and position of the teeth and jaw bones for that patient. There is no evidence of cavities or other dental problems. An abnormal x-rays would inform the dentist of the number, size, and position of teeth un-emerged or impacted teeth, the presence and extent of dental caries, periodontitis, abscessed teeth, fractured jaw bone, malocclusion of teeth or other abnormalities around the teeth and the jaw bones for the dentist to prepare for care. The use of dental radiographs with patients is determined by the guidelines set forth by The United States Department of Health and Human Services (F.D.A.) and the A.D.A. A) Positive Historical Findings: 1. Previous periodontal or endodontic treatment 2. History of pain or trauma 3. Familial history of dental anomalies 4. Post-operative evaluation of healing 5. Remineralization monitoring, and/or presence of implants 6. Previous implant-related pathosis orevaluation for implant placement B) Positive Clinical Signs/Symptoms: 1. Clinical evidence of periodontal disease 2. Large or deep restorations 3. Deep carious lesions 4. Malposed or clinically impacted teeth 5. Swelling 6. Evidence of dental/facial trauma 7. Mobility of teeth 8. Sinus tract (fistula) 9. Clinically suspected sinus pathosis 10. Growth abnormalities 11. Oral involvement in known or suspected systemic disease 12. Positive neurologic findings in the head and neck 13. Evidence of foreign objects 14. Pain and/or dysfunction of the temporomandibular joint 15. Facial asymmetry 16. Unexplained bleeding 17. Unexplained sensitivity of teeth 18. Unusual eruption, spacing or migration of teeth 19. Unusual tooth morphology, calcification or color 20. Unexplained absence of teeth 21. Clinical tooth erosion 22. Peri-implantitis.

There is a very low risk for radiation exposure with dental x-rays. However, no one should receive more radiation than necessary. The United States Department of Health and Human Services (F.D.A.) states that, “Although the radiation doses from dental CBCT exams are generally lower than other CT exams, dental CBCT exams typically deliver more radiation than conventional dental X-ray exams. Concerns about radiation exposure are greater for younger patients because they are more sensitive to radiation…” Dental practices use a lead apron to cover the body and reduce radiation exposure. Only when it is positively necessary, pregnant women should not have x-rays taken. Dental x-rays can reveal tooth decay before visible to the naked eye of the examiner, even to the dentist; which is why many dental practices will take yearly bitewing x-rays for the early development of cavities; these yearly x-rays are very useful in finding caries that are wedged between teeth, or under the gum-line. Patients with hidden or wedged cavities are difficult or impossible to detect visually or with the explorer hand piece. There are some cases where none of these methods are adequate, and a dentist must use a special disclosing solution to diagnose a suspicious area on a tooth.
When it comes to diagnostic radiographs, there is no special preparations that a patient would take; the dental professional would use a lead apron, placed to cover the body. The x-ray itself causes no discomfort. Biting on the piece of film does make some people gag; slow, deep breathing through the nose usually relieves this feeling and the x-ray process is quite quick.

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