Dental patients ask: ‘Why the X-rays?’

This article was originally published on registerguard.com by Dr. Tara Paluska on June 19, 2017

My new patient was expressing doubt about the need for dental ­radiographs — X-rays — as part of her appointment to have her teeth cleaned.

“It’s just a cleaning,” she said. “Why do I have to get all those X-rays? I had some taken last year, and I don’t want that radiation exposure.”

Her reaction isn’t uncommon, ­especially for patients who remember the early days of dental radiology. Back then, lead aprons were required to ­protect patients from radiation.

Today, however, dental X-rays don’t expose patients to that same level of radiation. Dentists use digital processes now, and our equipment has continually improved over the years. Patients receive less radiation at a dental visit than they get spending a day at the beach or flying on an airplane. X-rays are safe for pregnant women. Yes, we still use the aprons; they are comforting, but they aren’t considered necessary anymore.

My dental assistants are good about giving this information to patients. Sometimes, however, the patients are still hesitant and want to talk to the dentist. One of the points I make to patients is that I am required by the Oregon Board of Dentistry to diagnose a dental ­condition before treating it. To aid in diagnosis, I use X-rays, among other methods. I could face discipline if I practice below the standard of care, and this standard includes obtaining appropriate dental radiographs as needed.

For my patients, avoiding X-rays could mean needless suffering from dental conditions. Radiology is important because surface inspections alone don’t reveal what lies inside the tooth or bone. Abscesses, cavities, bone loss, resorption of teeth — all of it should be treated and is detectable with X-rays.

I use three types of X-rays:

Panoramic, providing views of the upper and lower jaws and sinuses;

Periapical films, showing the roots of teeth; and

Bitewings for views between the teeth and evaluating the bone level.

The bitewing and periapical X-rays are ­tailored to an individual’s risk of dental disease, and the interval falls within a one- to three-year time frame in an effort to stay current on my patient’s dental conditions. The panoramic X-ray generally is taken about once every five years, or as oral findings dictate, but it is important. I have referred a patient to an oral surgeon in the past because the panoramic X-ray revealed a possibly cancerous defect.

Sometimes, patients are concerned about the cost of X-rays and may want to use ­previous bitewings or transfer X-rays from a former dental office. If the X-rays are diagnostic and within an acceptable time frame, they can be used; ­however, X-rays can age out, making it ­impossible for me to use them with any confidence. It’s worth checking with your dental insurance, should you have that ­coverage, because ­preventive or diagnostic X-rays often are covered at 100 ­percent.

A child’s first ­panoramic X-ray should be taken around age 7. I want to be certain that all teeth are present, in the right location and developing correctly. Sometimes, teeth are hiding in the palate. If this is not detected in a timely manner, it can lead to tooth loss.

Patients also wonder why my staff and I ask for detailed medical histories. It’s because I am a health care ­professional, ready to respond in an emergency. If my patient begins to have chest pains and his chart ­indicates use of ­erectile dysfunction medicine, for example, it changes the medications I can administer safely. In addition, I may spot oral conditions that are related to systemic ­disease, and these should be addressed by the patient’s physician.

Kaiser Permanente opened its Lane County dental office in early 2016, and I have seen a steady stream of new patients since then. Even if they question dental radiology, I am ­heartened that everyone wants the same thing: good oral health.