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Dental X-Rays Part 3
by Dr. John F. Miller DDS SMILE MONTANA
The HOW, WHY, WHAT, & WHEN Happy New Year!! Welcome to 2022 everyone…fingers crossed. At the beginning of every new year, I think about the events that will take place in mine and my family’s little world before that year ends. Right now, at the beginning of 2022 I have two children in elementary school, one child in middle school, and one child in high school. By the end of this year my 3rd child will have joined his older brother in middle school, an older brother that will become a teenager, and my oldest child will have her driver’s license. Scary. As always, I hope this year sees my family happy and healthy as I hope it does to all of yours. As the title states this is the 3rd installment of a deep dive into the world of dental radiographs (X-Rays) for the lay person…aka you, the reader. To prepare for typing out this final article I have gone back and re-read the first two to prevent any redundancies. I have to admit, they were pretty good if I don’t say so myself. So, if this is your first time reading my section of 406 Woman it might benefit your understanding by reading the September and November submissions. These can be found @ www.406woman.com. In part one we discussed the most common dental radiograph The Bitewing. In part two we discussed the Peri-Apical radiograph commonly known as the P.A. In this, the 3rd and final discussion on the topic, we will tackle full facial radiographs in two and three dimensions.
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The Panoramic Radiograph (Pano)
Panoramic radiography, also called panoramic x-ray, is a two-dimensional (2-D) dental x-ray examination that captures the entire mouth in a single image, including the teeth, upper and lower jaws, surrounding structures and tissues. It provides diagnostic information of both the bones and the teeth. It is also entirely extra-oral (outside the mouth) save a tiny bite-stick used to position the patient’s head correctly. As with the PA discussed last time, the Panoramic radiograph is prescribed every 3 to 5 years to confirm health. When would a panoramic radiograph be prescribed outside of the recommended interval?
1. To evaluate 3rd molar (aka wisdom teeth) eruption with or without the presence of symptoms. Wisdom teeth are so far back in the jaw
that the sensor used for a routine radiograph cannot capture it comfortably, and since wisdom teeth typically come in fours it is standard procedure to evaluate with the Pano. The provide Pano has the 3rd molars circled in red.
2. To evaluate the eruption and to confirm the presence of the permanent teeth in a child.
Most of our permanent teeth are forming in our jaw
from a very young age (essentially birth). If a parent or dentist has a concern about the development of these teeth a Pano is a good choice as most little children can’t tolerate an x-ray sensor simply due to their smaller mouths. The provided Pano is a good example of a child in their “mixed-dentition” phase. I would place this individual at approximately 10 years of age. As you can see, they have three baby teeth remaining in each quadrant with their permanent successors developing underneath.
3. To prepare and plan for more complex full mouth procedures. This can be full mouth extrac-
tions in preparing for dentures, or when planning on placing implants. A Pano will show important anatomical features in relation to available bone, namely the sinus in the maxillary (upper) jaw, and the Inferior Alveolar Nerve* in the mandibular (lower) jaw. * The inferior alveolar nerves supply sensation to the lower teeth.
4. When there is a pathological concern. 5. When a traditional sensor is not an option due to comfort, prohibitive anatomy, or pathology/swelling.