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Panoramic X-Rays – When the Whole Picture is Not Enough

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When the Whole Picture is Not Enough

Panoramic X-Rays – When the Whole Picture is Not Enough

September 20, 2006
By: Shelagh McNally for Dental1

There is no doubt that dental X-rays have improved our dental care. They show our dentists conditions that can’t be seen with the naked eye such a cavities, abscesses, cysts, tumors, bone loss and even erupting wisdom teeth. Using X-rays dentists can also check on crowns, bridges and root canals.

Most of us have spent time in the dentist’s chair, biting down on those bites of soft plastic so the dentist can get shots of the upper and lower teeth. But periapical or bitewing x-rays take time to develop so when panoramic X-rays were developed they were thought to be a good substitute. Panoramic X-rays capture a broad view of the jaw, teeth, sinuses and nasal area, allowing the dentist to see the entire structure of the mouth in a single film. They soon became routine for most patients during their visits.
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Know your X-ray types:

  • Bitewing X-rays: Used to detect decay between the teeth and indicate gum infection or disease. Called bitewing because the patient bites down on the plastic over where the film is held.
  • Periapical X-rays: Used to detect dental problems below the gum line or in the jaw. Most used for impacted teeth. It shows the entire tooth down into the end of the root and supporting bone
  • Occlusal X-rays: Used to detect more complicated problems such as fractures, cysts, abscesses, or tumors. Either the roof or floor of the mouth is taken in one shot.
  • Panoramic X-rays: Used to detect impacted teeth, bone abnormalities, cysts, tumors, infections, and fractures. It takes a broad, sweeping shot of the jaws, teeth, sinuses, nasal area, and mandibular joints.

  • But are we getting too many panoramic X-rays? The University at Buffalo believes so. They presented a study about panoramic X-rays at the International Association on Dental Research meeting in Baltimore. The study asked expert dentists to analyze 1,000 randomly selected panoramic X-rays to detect problems like bone lesions or other abnormalities that might require special care. While they were able to identify 352 lesions they concluded that all but a few of those lesions would have been detected by a full-mouth series of periapical X-rays. “You can't assess cavities or gum disease on a panoramic X-ray. If a small X-ray isn't good enough for a condition you see in a patient, then a panoramic X-ray can be done,” stated senior researcher and assistant professor of oral diagnostic Lida Radfar.

    The problem may be that panoramic X-rays simple don’t get all the details while periapical or bitewing X- rays show a highly-detailed image of a smaller area, making it easier to see decay or cavities between your teeth. Periapical X-rays also show the entire tooth to the end of the root and the supporting bone, which is invaluable for detecting problems below the gum line or in the jaw.

    The report states that routine panoramic x-rays may be completely unnecessary and should be done on an individual basis. "Based on our study, the panoramic X-ray has limited value. Eliminating it as a routine part of dental care would expose patients to fewer X-rays, although the amount is minimal, and save costs. And if it isn't necessary, why do it?" Radfar said.

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