Dental X-Rays - The How, Why, What, & When
Since the last time I checked in with you all, my family and I rolled over our 10-year living in Montana mark. Are we locals yet? Probably not (with the exception of my two youngest children Maxwell and Lennon who were born here), but we've dug in our heels and we're never leaving. This also means that I have been submitting my articles well past the deadline for 406 Woman magazine for approximately eight years. At six articles a year that totals al- most 50 articles to this point. In other words, there isn't a dental topic that I haven't ad- dressed in these pages. Some I have addressed more than once because they are obviously important and warrant repetition.
My wife Juli and I are raising four children. The two girls Nayvee and Lennon are the book ends with the two boys Banks and Maxwell in the middle. While we all have our different personalities and interests, there is one activity that we all do and love. An activity that we all participate in almost every summer evening weather permitting, and that is the sport of Wakeboarding. I should specify that I am not referring to Wake Surfing which has recently exploded in popularity, but Wakeboarding.
Juli and I both grew up participating in water sports and the sport of wakeboarding was invented in the mid-90's and we both fell in love with it. In fact, the day before I proposed to my wife she landed her first invert, a backflip maneuver known as a Tantrum, in Blackies Bay on Echo Lake...the same bay that we ride on today with our children. The year was 2003 and it remains as the only invert I have witnessed (in person) performed by a female...although my daughter Nayvee is getting close.
When we go out as a family to ride our goal is to progress as riders and we encourage our children to practice progressive maneuvers to increase their abilities and comfort level on the board. At times my intensity level gets elevated, and my wife has to remind me to "not take the fun out of it." And while multiple knee injuries, operations, and age have toned down my riding significantly, my stoke levels for the sport are at an all-time high and I'm the ultimate wakeboarding hype-man.
My kids are getting pretty good at riding, but about once or twice a week I tone down the wake, shorten the rope, and slow down the boat so they can work on the fundamentals of wakeboarding. Techniques such as their progressive cut towards the wake, the tension and position of their legs and bodies at the wake, their control while in the air, and everyone's favorite... jumping from their toe-side. I won't get into it, but you can identify a good rider by whether or not they jump from their toe-side...google it.
As with wakeboarding, it's important in all aspects of our lives to slow down every so often and remember the fundamentals. So, for the foreseeable future of my 406 Woman articles, I am going to dig deep into the fundamentals of dentistry and hopefully pull back the curtain on some practices and procedures that you might not understand or wonder why the heck we even do them.
So where do we start? Anytime a patient sched- ules an appointment at a new dental office one of the first questions they are asked is whether they have current radiographs at their former dental office. Radiograph is another way of saying X-Ray. Why do we (dental professionals) care so much about dental radiographs? I'm here to tell you.
Dental Fundamental #1: Radiographs
HOW the heck is a radiograph produced anyway? Without getting too technical a radiograph is pro- duced when a sensitive plate (called a sensor is my world) is exposed to radiation. The radiation turns the plate black so if there is something dense and solid blocking the radiation it's shadow will remain white. Dense objects such as bone, teeth, dental restorations, foreign objects, etc.
WHY the heck do we need dental radiographs any- way? Great question. The majority of oral and dental pathologies progress very slowly and are painless most of the time. They are also not visible clinically dur- ing the early stages. Fortunately, these pathologies are easily identifiable on routine dental radiographs and intervention can be initiated before irreparable dam- age is done.
WHAT the heck are Dentists looking for when they evaluate a dental radiograph? The quick and clean answer to this question is the confirmation of health and the absence of anomalies and pathologies. To best describe these specific pathologies, I'll introduce the reader to the 4 major types of dental radiographs and the specific pathologies that they highlight for the dentist.
The Bitewing Radiograph:
Bitewings are the most frequently captured dental radiograph and are recommended annually. They are produced by having the patient bite down on a thin "wing" which positions the sensor on the inside of the patient's teeth. The resulting image shows the upper and lower molar and premolar teeth essentially biting together.
Bitewing radiographs are an excellent diagnostic tool that gives the evaluating dentist a lot of information. As you can see from the example, bitewing radiographs when taken correctly, show the dentist the contact areas between the posterior teeth. This contact area, called the interproximal surface, is the most common area for cavities to form, especially in the non-geriatric population.
A cavity is the loss of healthy tooth structure, which allows for more radiation to pass through, resulting in a darker "shadow" area in the interproximal surface. In the provided radiograph I can easily identify a compromised interproximal area between the two teeth on the top in the middle. For information's sake this is between the upper left 2nd premolar and the upper left 1st molar. This might look minor to the reader, but a dental professional such as myself knows these are moderately sized cavities.
What does this interproximal contact area look like in real life? Great Question! I have a photo.
We refer to this view in dentistry as the Clinical view. Basically, what is visible to the naked eye. I imagine the reader at this point sees healthy tooth structure and I can't disagree. I personally can recognize some very minor shading but realize that I evaluate teeth radiographically before I evaluate them clinically. In other words, I already know there is a good-sized cavity between these teeth.
Let's cut away the superficial healthy enamel to get a good look at this decay clinically:
This photo teaches us a lot about the de- mineralization process of tooth structure. When enamel starts losing vital minerals it turns a chalky white color. When that lesion breaches the enamel-dentin boundary it turns the dentin a dark brown. At this point in the procedure the lesion has been located and now more precise excavation will take place until we are on solid/healthy tooth structure. This is demonstrated in the next photograph.
This is a nicely prepared tooth ready for tooth- colored composite resin restoration. I captured a final picture of the teeth after the completion of the filling, and at this patient's regular cleaning appointment we captured an updated bitewing.
Bitewing radiographs are also excellent diagnos- tic tools for evaluating gingival (gum) health. But gum tissue does not show up on radiographs, how can you tell if they are healthy? Because bone health equals gingival health. This is not to say that a patient can't have inflamed gum tissue and healthy radiographic bone levels, but if the inflammation persists bone loss will occur transitioning into a condition called periodontitis. The ex- ample bitewing provided shows radiographically healthy bone levels.
So, I hope that this series of images has impressed upon you the importance of regular radiographs. The above cavity left untreated would continue to grow and eventually reach the pulpal nerve tissue of the tooth resulting in a painful toothache requiring much more extensive treatment than was needed as a result of early detection by routine radiographs.
That is enough dental talk for this article. Check back in with me in 2 months to continue our discussion of dental radiographs when I educate you on the Peri-Apical and Panoramic radiographs. Hopefully I didn't take the fun out of something that wasn't fun to begin with, and you all have a great end of summer and beginning of autumn. It's the best time of year in MT.
Read Dental X-Rays - The How, Why, What, & When by Dr. John F. Miller, DDS, in 406 Woman magazine.