Joseph Ramellini, DMD

Gabrielle Ramellini, DMD, Diplomate, ABDSM

Joseph Ramellini, DMD

Gabrielle Ramellini, DMD, Diplomate, ABDSM

The Importance of Routine X-Rays

Cancer free girl after dentist finds tumorI recently came across an article linked in a dental forum I belong to and wanted to share it with everyone for a couple of reasons. First, it is a heartwarming story and we are so happy that little girl is doing well now, but also because it highlights the importance of periodic screenings with dental X-rays, and not just with bitewings—the 2 or 4 X-rays used by dentists to look for cavities on back teeth in children and adults respectively.

As dentists, of course, cavities (tooth decay) are one of the most common problems we diagnose in our patients. Besides bitewings, we also take panoramic (also commonly called Panorex, which is a brand name like calling a tissue a Kleenex) or a full-mouth series of X-rays (typically 18 X-rays including the bitewings), and now we can even take 3D images called a CBCT (cone beam computed tomography). We are looking for many other things on these images, such as bone loss related to gum disease, infections around the roots of teeth, X-ray evidence of other systemic health issues that are not dental in origin, and yes, even life-threatening tumors. 3D images are often used to very accurately plan the placement of dental implants and also to see things that are difficult or impossible to see on traditional 2D x-rays.

We know that a lot of people have concerns about exposure to X-rays and we definitely understand and share those concerns. That’s why we are completely digital in our practice. This significantly reduces the amount of X-ray exposure compared to the standard film X-rays much more common years ago. Also, these types of X-rays are typically taken much less often and based on ongoing treatment or a risk assessment based on current and past history of dental problems. Every 5 years or so is a fairly common recommended interval for many patients who are basically healthy and low risk. However, patients with a lot of older dentistry, a history of frequent cavities or a history of gum disease might require more frequent X-rays to monitor their condition to catch new problems earlier. Another group of patients who often require more frequent monitoring is patients with dry mouth issues. It is not unusual for tooth decay in patients with dry mouth to progress from barely noticeable on an X-ray to rendering a tooth unfixable in a 6 month period. That same tooth decay could take years to turn into a deep cavity on a patient with normal amounts of saliva.

The most important thing to remember, though, is that even though there is some small risk associated with dental X-rays, which, on a side note, are a drop in the bucket compared to most medical X-rays, that risk has to be balanced against the risk of missing things we can only see on X-rays. Ultimately the final decision on any treatment, including the taking of X-rays, is up to the patient.

At Peak Dentistry we are here to answer your questions on this and any other oral health issues you would like to discuss. One of our main goals is to be a resource for advice so our patients get the information they need to make their own decisions and achieve the level of oral and overall health they desire.


Joseph Ramellini, D.M.D.

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