If you could have any super power, what would it be?
A Marist Poll of United States residents conducted in 2010 revealed the ability to read people’s minds and the ability to time travel as the most desired super powers, while invisibility, the ability to fly, and the ability to teleport were among the other contenders for preferred powers.(1) While there is no widely circulated poll for top super powers among dentists, one may argue that “x-ray vision” would be both practical and just plain cool for a dentist to boast. Although your dentist may strive to reach “superhero status” on a daily basis, it is unlikely that he or she possesses the x-ray vision of Superman.
As a result, dentists must rely on dental radiographs, or x-rays, to complete a thorough evaluation and oral health assessment. Patients and parents often ask if radiographs are a necessary part of the dental visit. While radiographs typically are not necessary at every visit (or even every other visit), they are an imperative part of monitoring your health and are necessary to complete a thorough evaluation. As the American Academy of Pediatric Dentistry (AAPD) explains in its guidelines for prescribing dental radiographs, “Radiographs should be taken only when there is an expectation that the diagnostic yield will affect patient care.” (2) You still may be wondering exactly what this statement means and how it will affect your child’s next dental visit. To understand why radiographs are prescribed, it is important to consider their diagnostic yield (simply put, the information they provide).
First, have you ever looked in the back of your child’s mouth (or even your own!) and noticed how closely the teeth fit together? While it is possible to detect cavities on the biting surfaces of teeth without x-rays, x-rays are necessary to check accurately for cavities between teeth that can go unnoticed and progress without intervention. The same crevices in the oral cavity that harbor food between tight molar contacts are the same crevices susceptible to developing cavities. Without x-rays, it would be nearly impossible to detect early signs of cavities. Just as radiographs assist in identifying fractured bones after a fall at gymnastics or another sporting event, dental radiographs assist in maintaining healthy smiles through the identification of cavities and other dental pathology, including fractured roots and teeth, cysts, and tumors. If you knew x-rays could help you see where you needed to work on brushing and flossing to prevent the need for dental treatment, why would you not consider the benefits of x-rays? One of the reasons we may order bitewing, or posterior, x-rays in children more frequently than in adults is that cavities progress more quickly in primary, or “baby,” teeth than they do in “adult” teeth.
Second, have you ever wondered if your child needs or will need braces? Without radiographs, we are unable to check for a full complement of teeth or detect poorly positioned or ectopic teeth. Radiographs provide critical information regarding bone health, root development, and appropriate timing for orthodontics. With a panoramic radiograph, we also can detect third molars (wisdom teeth) earlier and help plan for the future.
Finally, did you know that radiographs may provide the first information relevant to both localized and systemic pathology or disease? For example, a radiograph revealing early bone loss may provide another piece of the puzzle in identifying an underlying systemic disease. As you know, early identification of disease and illness aids in improved prognoses and management. Several diseases, syndromes, and pathologic entities, including Gorlin-Goltz syndrome, Langerhans’ cell histiocytosis, Gardner syndrome, neurofibromatosis, and hypophosphatemia, possess unique radiographic findings that may be noted prior to these entities being diagnosed in an individual.
As with any technology or medical device, it is important for healthcare providers to be good stewards of radiology and use it only when its diagnostic yield will impact patient care.2 At Camp Smile Pediatric Dentistry, we are committed to providing the highest quality of care for our patients. This commitment includes implementing the principle of ALARA (As Low As Reasonably Achievable) and utilizing appropriate protective barriers.3 By judiciously obtaining x-rays, we safely can make the most accurate diagnoses and ultimately provide the best treatment and outcomes for our patients and families.
Furthermore, it is helpful to understand that we all encounter several sources of ionizing radiation on a daily basis and may not fully realize it. The effective dose from a diagnostic x-ray examination composed of posterior bitewing x-rays is reported to be 5.0 μSv, while its equivalent background exposure measured in days is 0.6.(3) Background exposure may vary for individuals in different places. Due to Denver’s lower atmospheric protection and increased elevation, an individual living in the Mile High City receives greater effective dose from cosmic radiation than someone living at an elevation closer to the average of the United States.(3) Certainly, it is interesting and relative to our discussion regarding dental radiology when we consider that there are additional sources of radiation which we may not otherwise consider. You can appreciate the benefits of dental x-rays in the early detection and identification of disease when used conscientiously and appropriately.
We invite you to visit our website at www.campsmile.com, contact us at (763) 383-1788, or stop by one of our three locations to learn more about dental radiology, its safety and efficacy, and pediatric dentistry for your little ones.
- Council on Clinical Affairs. Prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. Pediatr Dent 2018;(40)6:213-15.
- White SC, Pharoah MJ. Oral radiology: Principles and interpretation. 6th ed. St. Louis: Mosby Elsevier; 2009.