Dental X-Rays or Radiographs

“Intra-oral radiographs permit detection of lesions between teeth and are the only widely available clinical test that can assess periodontal bone support in situ.” – U.S. Surgeon General’s Report

1. What are dental x-rays?
2. How safe are x-rays?
3. Can I have x-rays taken while I am pregnant?
4. How often do x-rays need to be taken?
5. What role do x-rays play in dentistry?
6. What are the different types of x-rays?

 
1. What are dental x-rays?

• Dental x-rays are pictures of the inside of teeth and bone.
  Radiation is used to create an image on a photographic film or on a digital disc.

• How to read or interpret an X-ray:
  Soft objects appear black, solid objects are white on x-ray.

• What you see as grey/black on x-ray:
  • Decay.
  • Abscess.
  • Nerves and blood vessels (the pulp).
  • Gum in the spaces between teeth.

• What you see as white/cream on x-ray:
  • The enamel.
  • Metal fillings and crowns will be white.
  • The dentine appears as a creamy white colour.

• Bone has a mottled grey and white appearance.
  It has a fine white line at its margin around the teeth.

Illustration of x-ray showing tooth parts

Abscess above root (the dark area)

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2. How safe are dental x-rays?

• Although x-rays are potentially harmful in large doses, dental x-rays are safe:
  • Infrequent exposure to the low level of radiation used in dentistry, does not result in any harmful side effects.
  • Nevertheless, all necessary precautions are taken, since over-exposure to radiation should be avoided.
  • Modern film is much faster. This means that less exposure time is needed.
  • A lead blanket is used to shield the chest and body from radiation.
• We are all exposed to natural radiation in our environment.
  • Cosmic radiation is greater in cities at high altitudes, yet no harm from radiation has been discovered.
  • A full set of dental x-rays taken weekly, would not equal the exposure to natural radiation at high altitudes.

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3. Can I have x-rays taken while I am pregnant?

• Routine x-rays are not taken during pregnancy.
• If urgent treatment is needed, an x-ray may be taken. There is a lingering fear that the radiation from dental x-rays can affect the unborn child. There is at present no evidence to confirm this view.
• Dentists take precautions to limit the exposure of patients to radiation in two ways:
  • Lead shields are used to protect the body, including the area of the womb.
  • Modern fast film cuts down the exposure time of each x-ray.

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4. How often do x-rays need to be taken?

• Full mouth x-rays provide a benchmark record of your mouth. These are kept for future reference.
  • Changes can then be noticed and acted upon.
  • The age and dental condition of the patient will influence the frequency of taking x-rays.
  • It is not unusual to have yearly x-rays taken for young patients.

Full mouth x-rays

Upper jaw

Lower jaw

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5. What role do x-rays play in dentistry?

• Dental x-rays are invaluable in providing the dentist with detailed records of your mouth.
  • Dentists would not be able to practise modern dentistry without the use of x-rays.
  • Treatment planning is made possible by the use of x-rays.
  • X-rays allow the dentist to detect and correct any existing problems, and to prevent future ones.
  • X-rays provide important information for the following conditions and procedures:

• Detection of decay
  • X-rays show decay starting at the contact point between the teeth where the dentist cannot see.
  • The early discovery of this interdental decay, will prevent the decay from spreading deeper into the tooth.

Illustration of x-ray

• Root canal treatments
  • Successful root canal treatments are made possible with the aid of an x-ray film.
  • Only x-rays can reveal when all the dead nerves and blood vessels have been removed from the tooth.
  • Dead tissue left in the root canal causes an abscess to form at the end of the root. This is what would happen if treatment was not available. The tooth would be lost.

Abscess (dark area) at end of root

Healing after treatment

• Gum disease
  • Periodontal disease results in alveolar bone recession.
  • X-rays reveal the extent of the shrinkage, and show how bone regeneration treatment is progressing.
  • They reveal the presence of calculus on the roots, so that these deposits can be removed.
  • Further gum disease is prevented in this way.

Illustration of x-ray showing gum disease

• Orthodontics
  • X-rays of the jaws will show all the teeth in the mouth, including those that are still growing in the jaws.
  • Treatment planning requires x-rays to be taken.

Orthodontic x-ray

Lower jaw protrusion

• Dentures
  • X-rays can detect remnants of roots that may have been left in the bone after extractions. This can sometimes happen.
  • These roots may be dormant for many years, and only become a problem at a later stage.
  • The condition of the dental ridges are inspected on x-ray film before dentures are to be made.
  • Pre-denture treatment may require oral surgery as a result of x-ray findings.

Root remnant on left

• Trauma or injury
  • Injuries to teeth and to the bone can be seen on x-ray, and treatment can then be planned.

Fracture of root

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6. What are the different types of x-rays?

• Bite wing x-rays are able to show the crowns of teeth and the alveolar bone of both upper and lower jaws.
  They are called “bite wings” from the way the x-ray is taken.
  • The film is placed into a holder that has a handle or wing.
  • This holder is placed into position, and the patient is asked to to hold it in position by biting on it, hence the name “bite wing x-ray”.
  • Bite wing x-rays are usually taken at the annual check up.
    They show early decay starting at the contact point between the teeth, which is only visible on x-ray.

A bite wing x-ray

Permanent tooth growing under baby tooth

• Full length x-ray
  • This shows the roots, crowns and the condition of the alveolar bone.
  • It is indispensable for root canal treatments.
  • It also reveals abscesses, cysts, tumours, and other conditions in the mouth, as well as bone levels around the teeth.

Bone loss on left of root

• Panoramic x-rays
  • A panoramic x-ray shows all the teeth in both jaws on one long film.
  • This is a broad picture of the mouth, and is useful in establishing a record for future reference.
  • Panoramic x-rays are taken early on in treatment and are not often repeated.

Panoramic x-ray showing 2 impacted wisdom teeth

• Digital imaging
  • This is a method of processing the x-ray onto a disc instead of keeping it on a film.
  • Exposure time is shorter than with conventional X-rays.
  • The disc is more efficient for storage and viewing.
  • The use of this type of x-ray is likely to increase in the future.

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