What is a “radiograph” or an “x-ray”?
Radiographs are images that are produced using x-rays instead of light rays. X-rays are able to penetrate the soft tissues and depending on the power of the x-ray through various densities of tissues. X-rays cannot however pass through metal objects of a certain thickness. Radiographs are black and white images produced when the x-rays that pass through are picked up by the radiographic sensor. The term “x-rays” is often used as a lay term to describe radiographs!
A “bitewing” x-ray shows mainly the crowns of your teeth and are used to diagnose cavities that are growing in between your teeth (also known as flossing surfaces) and the loss of supporting bone around your teeth. Without bitewing x-rays, cavities in between your teeth will only become evident when they are very large and cause pain and at this point the tooth may need a root canal therapy or even need to be extracted, thus compromising the health, integrity and long term prognosis of the tooth and your oral health.
A “periapical” x-ray will show the whole tooth: the crown ,the root and the bone around it. These are necessary to check for tooth infections, the health of the tooth after Root Canal Treatments or after trauma to check for fractures, however, they cannot accurately show the smaller cavities that form between teeth on the flossing surfaces.
In a “panoramic” x-ray, the dentist can see your jaws, all of your teeth, your sinuses and your joint. This is necessary in both children and adults to check for missing teeth, development of teeth, position and placement of wisdom teeth, as well as tumors and cysts or other abnormal findings that may be found incidentally.
Are “radiographs” necessary?
In dentistry, we deal with both hard and soft tissues of the mouth. Some soft tissue conditions are often associated with the underlying hard tissue. Visual inspection or symptoms such as pain or sensitivity are not always enough to observe what is happening with the hard tissue which is why radiographs are taken to visualize the hard tissue.
Some findings on radiographs are incidental and not associated with any symptoms or pain. Due to the low radiation from dental digital “x-rays”, the American Dental Association recommends taking a set of radiographs to visualize all the hard dental tissues every 2-3 years as a preventive measure. It has been shown that prevention of certain conditions such as dental caries, tumours, cysts and periodontal disease and bone loss are a much more effective method of maintaining optimum oral health.
We follow the American Dental Association’s recommendations as to how often radiographs should be taken which varies from patient to patient depending on their caries risk, periodontal or condition of the gums and other risk factors.
Why do I need to have radiographs for just a “cleaning”?
Dental cleaning is a lay term used to describe periodontal therapy. The aim of this therapy is to remove the bacterial deposits from the surface of the teeth both above and under the gums. Our hygienists or doctors cannot visualize the anatomy of the teeth without radiographs and asking them to clean without radiographs is like asking your mechanic to repair your car with the hood closed!
There are certain factors that will determine what x-rays you will need and the frequency at which we recommend to take them: your age, stage and development of your teeth and jaws, the overall health of your mouth and body, the present and potential risk for cavities and the status of your gum health. Each factor is assessed on an individual level and discussed with you prior.
What if I have radiographs from my previous dental office?
While radiographs from your previous dentist can be very beneficial to providing optimum care, the treating doctor will make the ultimate decision as to whether they require a new radiograph either from a different angulation or a more recent one. This is always to facilitate a proper diagnoses and an optimum treatment plan.
How much radiation is in dental “x-rays”?
Fortunately, at Stouffville Smiles Dentistry we use state of the art dental radiography equipment. All of our sensors are digital and we always use lead aprons (which absorb 100% of the radiation) to protect the most radiation prone organs such as the thyroid gland and the torso. The following chart shows the radiation from dental “x-rays” compared to other sources: (according to Mayo Clinic and American Dental Association)
| Type | µSv (micro) |
|---|---|
| Single intra-oral PA or BW | 5 |
| Panoramic | 20 |
| Full set of recommended dental radiographs for an average new patient | 70 |
| Daily background atmospheric radiation | 8 |
| Annual background atmospheric | 2,000 |
| Flight to Vancouver, BC from Toronto, ON | 40 |
| Chest CT | 70,000 |
| Dental Small Field of View CBCT | 300 |
| Annual radiation from ingested food | 400 |
At Stouffville Smiles Dentistry, we use ALARA principles (As-Low-As-Reasonably-Achievable) which basically means that we always assess to see if the benefits of taking a radiograph outweigh the radiation risks. For example, if by not taking a radiograph, we could potentially miss a cavity due to which you could need a root canal, well, then we better take that radiograph to reduce the chances of missing that cavity.
What if I refuse the recommended dental “x-rays”?
If your choose to refuse dental radiographs which have been recommended at Stouffville Smiles Dentistry at the interval determined by our doctors, we may refuse to further treat you as we believe in providing an excellent care that is in your best interest. We do not recommend radiographs or other treatment based on what your insurance company covers and always recommend what is best for you as a patient. Certain treatment such as extractions, deep restorations, root canal therapy, implants, deep cleaning or scaling and root planing, surgeries, etc will not be performed without the presence of radiographs that are recent and acceptable to the treating doctor.
