Dental X-Rays
It's that time of year again. Memories of our amazing Montana winter bittersweet, and yearnings for sum- mer impatient. I appreciate all of your beautiful and bright Montana smiles joining mine out there on the slopes this past winter. I make an effort every winter to take my snowboard somewhere new, and whether its Squaw Valley, Austria, or Park City, nowhere puts together a total package of great people, charm, and conditions better than Montana. I keep my mouth shut however, in my attempts at becoming a true local I've learned the unspoken rule that we keep our treasure secret.
Your mouth is also full of secrets. Most of these secrets are not visible to the human eye. As an Oral Health Care Provider, I have a valuable tool in the form of dental radiography (x-rays). These images allow me to complete an accurate and detailed assessment of my patient's oral condition. In fact, a patient's x-rays tell the majority of their story and it would be impossible to provide high-quality dentistry without the X-Ray sensor. When an X-Ray them.
If you have read my column before you know that I like my audience to be well informed on dental topics and potential investments that they might make concerning their own oral health. The routine dental patient typically receives some type of dental x-ray every year. So let's get to the business of producing well-informed readers on the topic of dental x-rays.
How is an X-Ray image produced?
Don't worry, I'll be brief. Electromag- netic radiation, not unlike visible light, at a specific energy wavelength is called an X-Ray. X-rays differ from visible light in that they can penetrate the soft tissues of our bodies. An X-Ray image called a radiograph is produced using an X-Ray sensor and an X-Ray producing source. In the case of dentistry, the teeth and supporting tissues is placed between the X-Ray source and reaches the sensor it produces a dark spot, as a result harder objects such as teeth and bone appear white on a radiograph because they block more X-Rays than the surrounding softer tissue (lips and gums). Even within the tooth itself one can see the difference between enamel (the hardest tissue in the human body) and the less dense underlying dentin.
TYPES OF DENTAL X-RAYS
The Bitewing X-Ray:
The What: A bitewing x-ray shows the upper and lower back teeth and how they contact each other in a single view.
The Why: Bitewings allow the dentist to identify cavities between teeth (the area where you would floss...you are flossing right?). The contact area between teeth is the most common location to develop tooth decay. These cavities are not visible in the mouth. In other words, without bitewing x-rays these cavities would likely not be identified before it was too late. Bitewings are also used to evaluate the bone health around the teeth and identify hardened plaque deposits below the gumline.
The When: Taken at the patient's initial visit and then once per year following that.
The Periapical X-Ray:
The What: A periapical radiograph shows the entire tooth from the crown to the end of the root including the surrounding bone.
The Why: Periapical radiographs provide detailed images below the gumline and in the While the most common pathologic finding in periapical radiographs are dental root infections (abscesses), other common findings include impacted teeth, cysts, tumors, and bone changes associated with gum disease.
The When: A full series is taken at the patient's initial visit and then again every three to five years. However, patients who present with dental pain typically receive a single isolated periapical radio-graph to aid in diagnosis.
The Panoramic X-Ray:
The What: Panoramic radiographs show a broad view of the jaws, teeth, sinuses, nasal area, and temporomandibular (jaw) joints.
The Why: Panoramic radiographs during early childhood provide information on the developing teeth below the bone. During the teenage years information concerning impacted teeth such as wisdom teeth is provided. And throughout the patient's entire life, bone abnormalities, cysts, solid growths (tumors), infections, and fractures can be visualized in a panoramic radiograph. Any pathology identi- fied on a Panoramic radiograph is followed up with a Periapical or Bitewing radiograph because they produce a much more clear image for proper diagnosis.
The When: Taken at the patient's initial visit and then again every three to five years.
What About Radiation Exposure:
Radiation in any form is concerning, especially for all of us from the "Cold War" era when nukes were all the rage. This concern prevents some patients from receiving dental X-Rays. This section will educate the reader on the actual levels of radiation received from dental X-Rays relative to other common radiation sources.
The average set of bitewing X-Rays, that are taken annually, result in 0.038 mSv of radiation exposure to the patient. Just the simple act of living for a year exposes a person to approximately 3.5 mSv of radiation from sources such as outer space, mother earth, food, other humans, etc. A cross-country flight is the equivalent to almost 2 sets of bitewings, any flight attendants in the audience. I'm not trying to make these items out to be dangerous, I just want the reader to understand that radiation is part of life and receiving dental X-Rays amounts to little more than 1/100 of total radiation exposure.
So what's the deal with the heavy lead apron? Why does the Doctor and Hygienist always leave the room when X-Rays are being exposed? The answers are "Why NOT?" and "Because they do it all day" respectively.
If you are still with me, Congratulations!! You not only made it through another dental article, but a dental article focused on X- Rays. Keep these things in mind the next time you visit your friendly neighborhood Montana Dentist. Take an active role in your dental exam and inquire about your X-Rays and have the Doctor point out his findings. Blow his mind and ask, "Is there evidence of interproximal caries on my bitewings kind Doctor?" Remember that dental X-Rays provide the bulk of your oral information and excellent gold standard dentistry simply cannot be performed without up-to-date X-Rays.
As always, continue smiling Montana. For we have every reason to. Thank You!!
Read Dental X-Rays and other Smile Montana articles by Dr. John F. Miller, DDS, in 406 Woman magazines.