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X-Rays

  • Why Do I Need X-Rays?

  • Types of X-Rays

  • The Academy of General Dentistry (AGD) Sets the Record Straight on Dental X-Rays

  • X-Rays Help Predict Permanent Bone Damage from Bisphosphonates

Why would I need an x-ray?

 

Early tooth decay does not tend to show many physical signs.  Sometimes the tooth looks healthy, but your dentist will be able to see from an x-ray (radiograph) whether you have any decay present under the enamel, any possible infections in the roots, or any bone loss around the tooth.  X-rays can help the dentist to see in between your teeth or under the edge of your fillings. Finding and treating dental problems at an early stage can save both time and money.

In children, x-rays can be used to show where the second teeth are and when they will come through. This also applies to adults when the wisdom teeth start to come through.

 

How often should I have x-rays taken?

 

If you are a new patient, unless you have had dental x-rays very recently, the dentist will probably suggest having x-rays. This helps them assess the condition of your mouth and to check for any hidden problems. After that, x-rays are usually recommended every 6 to 24 months depending on the person, their history of decay, age and the current condition of their mouth.

 

 

Whose property are the x-rays?

 

X-rays are an essential part of your health records and must be kept with your personal dental file. As dental records work differently to normal health records, your dentist must keep your dental records for at least two years from the date of your last course of treatment.  You are entitled to copies of your records and X-rays under the Access to Health Records Act 1990.  But you will have to pay for these copies.  In most cases your X-rays and records will not be needed by your new dentist. However, if they are important, your new dentist will let you know and either ask for your permission to send for them, or ask you to fetch them personally.

 

 

What will an x-ray show?

 

X-rays can show decay that may not normally be seen directly in the mouth,

for example: under a filling, or between teeth. They can show whether you

have an infection in the root of your tooth and how severe the infection is. 

In children an x-ray can show any teeth which haven't come through yet, and let

the dentist see whether there is enough space for the teeth to come through. 

It can show any impacted wisdom teeth in adults that may need to be removed,

before they cause any problems.

 

 

Are x-rays dangerous?

 

The amount of radiation received from a dental x-ray is extremely small. We get more radiation from natural sources, including minerals in the soil, and from our general environment. 

With modern techniques and equipment, risks are kept to a minimum.  However, your dentist will always take care to use X-rays only when they need to.

 

 

What if I'm pregnant?

 

You should always tell your dentist if you are pregnant. They will take extra care and will probably not use X-rays unless they really have to, particularly during the first three months.

 

 

What types of x-rays are there?

 

There are various types of x-ray.  Some show one or two teeth and their roots while others can take pictures of several teeth at once. 

The most common x-rays are small ones, which are taken regularly to keep a check on the condition of the teeth andgums. These show a few teeth at a time, but include the roots and surrounding areas.   

There are large x-rays that show the whole mouth, including all the teeth and the bone structure that supports the teeth. These are called panoramic X-rays.

There are also medium-sized X-rays, which show either one jaw at a time, or one side of the face.  

There are also electronic imaging systems in use today. These use electronic probes instead of X-ray films and the picture is transmitted directly onto a screen.

 

 

Why does the dentist leave the room during an x-ray?

 

The dental team might take hundreds of X-rays every week. Staff limit the amount of radiation they receive by moving away from the X-ray beam. However, the risk to patients from one or two routine X-rays is tiny.

Staff check how much radiation they are exposed to by wearing a small badge during working hours. This is sent off to be analysed at regular intervals.

Why Do I Need X-Rays?

Radiographic, or X-ray, examinations provide your dentist with an important tool that shows the condition of your teeth, its roots, jaw placement and the overall composition of your facial bones. X-rays can help your dentist determine the presence or degree of periodontal (gum) disease, abscesses and many abnormal growths, such as cysts and tumors. X-rays also can show the exact location of impacted and unerupted teeth. They can pinpoint the location of cavities and other signs of disease that may not be possible to detect through a visual examination.

 

Your radiographic schedule is based on your dentist's assessment of your individual needs, including whether you're a new patient or a follow-up patient, adult or child. In most cases, new patients require a full set of mouth X-rays to evaluate oral health status, including any underlying signs of gum disease, and for future comparison. Follow-up patients may require X-rays to monitor their gum condition or their chance of tooth decay.

Types of X-Rays

 

Typically, most X-rays require patients to hold or bite down on a piece of plastic with X-ray film in the center.

Some dentists are now using digital X-rays. To take a digital X-ray, your dentist will place a sensor on the tooth that looks like a piece of film. Once the picture is taken, your dentist can adjust the contrast and brightness of the image to find even the smallest area of decay. Other benefits of digital X-rays are decreased exposure to radiation and reduced time to develop photos, which helps eliminate treatment disruptions.

 

A panoramic radiograph allows your dentist to see the entire structure of your mouth in a single image. Within one large film, panoramic X-rays reveal all of your upper and lower teeth and parts of your jaw.

  

What is apparent through one type of X-ray often is not visible on another. The panoramic X-ray will give your dentist a general and comprehensive view of your entire mouth on a single film, which other X-rays cannot show. On the other hand, you might need close-up X- rays to show a highly detailed image of a smaller area, making it easier for your dentist to see decay between your teeth. X-rays are not prescribed indiscriminately. Your dentist has a need for the different information that each X-ray can provide to formulate a diagnosis.

 

The Academy of General Dentistry (AGD) Sets the Record Straight on Dental X-Rays

 

On Tuesday, April 10, 2012, in the journal Cancer, the American Cancer Society published an article entitled "Dental X-Rays and Risk of Meningioma," which summarized a study that sought to develop a correlation between dental radiographs and brain cancer.

 

According to the Academy of General Dentistry (AGD), a professional association of more than 37,000 general dentists dedicated to providing quality dental care and oral health information to the public, the study's findings are not applicable to modern dentistry because the study was based upon an examination of outdated radiographic techniques, which produced considerably more radiation than patients would be exposed to today.

 

"Modern radiographic techniques and equipment provide the narrowest beam and shortest exposure, thereby limiting the area and time of exposure and reducing any possible risks while providing the highest level of diagnostic benefits," said AGD President Howard Gamble, DMD, FAGD. "Today, patient safety is always maintained with the recommended use of thyroid collars and aprons."

 

The article from the American Cancer Society, which received attention from many reputable news outlets, could cause the public to decide to limit or even refuse X-rays in an effort to keep their families safe.

 

"It is regrettable to think that an article based on outdated technology could scare the public and cause them to avoid needed treatment," said Dr. Gamble. "With the radiography techniques in use today, the amount of radiation exposure is reduced and more controlled than it was in years past."

 

The AGD supports radiographic guidelines provided by the American Dental Association (ADA) and the U.S. Food & Drug Administration, and concurs with the ADA that dentists should order dental radiographs for patients only when necessary for diagnosis and treatment.

 

The AGD encourages patients to discuss their concerns with their dentists in order to determine what's best for them. The AGD also encourages dentists to communicate with their patients and address any unexpressed concerns of radiographic risks in order to reduce fear and promote a better understanding of the benefits and the risks associated with the specific needs of each patient.

 

"Neglecting one's oral health has serious oral and systemic risks," said Dr. Gamble. "Radiographs play an important role in improving the oral health of the public, and patients should not be deterred from seeking oral health care due to misperceptions from this study."

 

The Cancer study contained many inconsistencies and possibilities for error, including the fact that its findings were based upon a population-based case-control study. This means that it relied upon the patients themselves to recall and self-report past events, many of which were from decades earlier.

 

The AGD supports ongoing scientific research on any correlations between dental radiographs and incidents of disease in an effort to provide the most accurate information to the public and to correct any misperceptions created by the Cancer study.

X-Rays Help Predict Permanent Bone Damage from Bisphosphonates

 

Breast cancer patients, individuals at risk for osteoporosis and those undergoing certain types of bone cancer therapies often take drugs containing bisphosphonates. These drugs have been found to place people at risk for developing osteonecrosis of the jaws (a rotting of the jaw bones). Dentists, as well as oncologists, are now using X-rays to detect "ghost sockets" in patients that take these drugs and when these sockets are found, it signals that the jawbone is not healing the right way. Early detection of these ghost sockets can help the patient avoid permanent damage to their jawbone, according to a case report and literature review that appeared in the March/April 2009 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

 

A ghost socket occurs when the jawbone is not healing and repairing itself the right way. For example, if a tooth was removed, a divot forms in the jawbone instead of the bone growing to replace the spot where the tooth was removed. "The good news is that even though these ghost sockets may occur, by using radiographic techniques we can see that the soft tissue above these sockets can still heal," according to Kishore Shetty, DDS, MS, MRCS, lead author of the report. Dr. Shetty states these findings are important news to learn about because early prevention and detection can halt permanent damage from happening to a patient's jawbone.

 

In 2006, about 191 million prescriptions of oral bisphosphonates worldwide were written and today, associated with the increase in sales of this drug is a growing patient population in need of the drugs as baby boomers age and become more susceptible to osteoporosis. The National Osteoporosis Foundation estimates that nearly 44 million people in the United States are at risk for developing osteoporosis. Currently, approximately 10 million Americans suffer from the disease.

 

Bisphosphonates are a family of drugs used to prevent and treat osteoporosis, multiple myeloma, Paget's disease (bone cancers), and bone metastasis from other cancers. These drugs can bond to bone surfaces and prevent osteoclasts (cells that break down bone) from doing their job. Other cells are still working trying to form bone, but it may turn out to be less healthy bone leading to the ghost-like appearance on X-rays.

 

"Healthy bones can easily regenerate," says Dr. Shetty. "But, because jawbones have rapid cell turnover, they can fail to heal properly in patients taking any of the bisphosphonate drugs. It's very important for patients to know about complications from dental surgery or extractions. Since these drugs linger in the bone indefinitely, they may upset the cell balance in how the jaws regenerate and remove unhealthy bone."

 

According to AGD spokesperson Carolyn Taggart-Burns, DDS, FAGD, patients who are taking bisphosphonates should inform their dentist to prevent complications from dental surgical procedures."Widespread use of bisphosphonates to prevent or treat early osteoporosis in elatively young women and the likelihood of long-term use is a cause for concern," says Dr. Taggart-Burns.

 

Drs. Shetty and Taggart-Burns agree that, "how bisphosphonates interfere with healing after dental surgery is still unclear and further research will be needed. It is imperative that the public understands there is no present treatment or cure for this problem."

 

Tips to reduce the risk for osteonecrosis of the jaw and maintain a healthy mouth:

 

  • Inform general dentist or specialist about bisphosphonates.

  • Check and adjust removable dentures.

  • Maintain regular dental cleanings.

  • Opt for root canal therapy over extractions when possible

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