Guidelines for Prescribing Dental Radiographs

Patient
Categorization

Radiographic Examinations

Growth and development

Periapical Radiographs
Periapical views show all of a tooth and the surrounding bone
Useful for revealing the following:
Caries
Periodontal
Periapical disease
Dental anomalies
Occult disease
Paeriapical radiographs have high resolution
Have limited coverage area

Type of Visit
New

Posterior bite-wing
if proximal
surfaces can not
be visualized

Child with
Transitional
Dentition
After eruption of
first permanent
tooth

Individual
radiographs
Posterior
bitewings
Panoramic exam
Or
Posterior
bitewings and
selected periapical
images

Adolescent with Permanent

Dentition
Prior to eruption of third molars

College of Dentistry

Adult

Dentate

Edentulous

Individual radiographs
Posterior bitewings
Panoramic exam
Or
Posterior bitewings and selected periapical
images
A full mouth intraoral radiographic exam is
preferred when the patient has clinical
evidence of generalized dental disease or a
history of extensive dental treatment

Bitewing Radiographs show the coronal

aspects of both the maxillary and mandibular
dentition
They are most useful for revealing proximal
caries and evaluating the height of the alveolar
bony crest
Bitewing radiographs have high resolution
Have limited coverage area

No clinical caries
No high- risk factors for caries
Transitional Dentition
After eruption of first permanent tooth

Periodontal disease
History of periodontal treatment

Recall patient
Clinical caries
High- risk factors for caries

Primary Dentition
Prior to eruption of
first permanent tooth

Child with
Transitional
Dentition
After eruption of
first permanent
tooth

Posterior bitewing
examination at 6- to 12
month intervals
Or until no carious lesions
are evident

Adult

Dentate

Edentulous

Posterior bitewing
12- to 18 month
intervals

Not applicable

Periodontal disease
History of periodontal treatment

No clinical caries
No high- risk factors for caries

Posterior bitewing
at 12- to 24
month intervals if
proximal surfaces
of primary teeth
cannot be
visualized or
probed

Adolescent with
Permanent
Dentition
Prior to eruption of third
molars

Posterior bitewing examination at 6-month

intervals or until no carious lesions are evident

Full mouth intraoral or panoramic radiographic examination

Primary Dentition
Prior to eruption of
first permanent tooth

Edentulous

Clinical caries
High- risk factors for caries

Primary Dentition
Prior to eruption of first
permanent tooth

Bitewing Radiographs

Adolescent with
Permanent
Dentition
Prior to eruption of third
molars

Adult

Adolescent

Dentate

Radiographic Examinations

New patient
All new patients to assess dental diseases and development

Risk Category

Child

Recall

Prepared by:
Dr Saad Al Bayatti
B.D.S., M.Sc., Oral Radiologist
University of Sharjah
College of Dentistry

Primary Dentition
Prior to eruption of
first permanent tooth

Dental Status

Child with
Transitional
Dentition
After eruption of
first permanent
tooth

Adolescent with
Permanent
Dentition
Prior to eruption of third
molars

Posterior bitewing
at 12- to 24-month
intervals

Posterior bitewing at
18- to 36-month intervals

Primary Dentition
Prior to eruption of
first permanent tooth

Adult

Dentate

Edentulous

Adult

Child with
Transitional
Dentition
After eruption of
first permanent
tooth

Adolescent with
Permanent
Dentition
Prior to eruption of third
molars

Dentate

Edentulous

NEVER DISCARD A RADIOGRAPH

IT IS A RECORD,, KEEP IT FOR THE RECORD
Individualized radiographic examination consisting of Selected periapical and/or bitewing
areas periodontal disease (other than nonspecific gingivitis) can be demonstrated
clinically

Posterior bitewing at
24 - to 36 month intervals

Not applicable

Not applicable

Radiographic Examinations

Radiographic Examinations

Occlusal Radiographs

Cone Beam Computed Tomography

Often used in children in place of Periapical views due to

small size of the patient's mouth
In adults, occlusal radiographs may supplement Periapical
views to provide visualization of a larger area of teeth and
bone
Useful for demonstrating impacted teeth
Abnormally placed maxillary anterior teeth
Visualizing the region of a palatal cleft
Demonstrate buccal or lingual expansion
of bone
Demonstrate salivary stones
Paeriapical radiographs have high resolution
Have moderate coverage area

Designed for imaging hard tissues of the maxillofacial region

CBCT is capable of providing sub-millimetre resolution
in images of high diagnostic quality
Short scanning times (1070 seconds)
Radiation dosages reportedly up to 15 times
lower than those of conventional CT scans
Provides the dental clinician with
a 3-dimensional
representation of the maxillofacial
skeleton with minimal distortion
Images provide anatomically
accurate measurements
Provides 3-D
reconstructed in multi-planar directions

Growth and development

Primary Dentition
Prior to eruption of
first permanent tooth

Child with
Transitional
Dentition
After eruption of
first permanent
tooth

Adolescent with
Permanent
Dentition
Prior to eruption of third
molars

Adult

Dentate

Edentulous

Usually not indicated

Usually not indicated

Individualized radiographic examination consisting of
periapical/occlusal or panoramic examination

Periapical or panoramic radiographic examination to

assess developing third molars

Radiographic Examinations
General Rules in Prescribing a Radiograph
Make radiographs only after reviewing the patients
health history and completing a clinical examination
Radiographs are only indicated when they will provide
information about a disease that is not evident clinically
Order only those radiographs that directly benefit the
patient's diagnosis or treatment plan
Use the least amount of radiation exposure necessary to
generate an acceptable view of the imaged area
Consider previous radiographs

Panoramic radiographs

1.
2.
3.
4.

These Guidelines were developed by an expert dental panel

comprised of representatives from:
1. The Food and Drug Administration (FDA) (sponsorship)
2. The Academy of General Dentistry
3. American Academy of Oral and Maxillofacial Radiology
4. American Academy of Oral Medicine
5. American Academy of Pediatric Dentistry
6. American Academy of Periodontology
7. The American Dental Association

5.
6.
7.
8.
9.

Indicated to view:
Jaws
Present teeth
Relative state of teeth development
Presence or absence of dental
abnormalities
Maxillary sinuses
Nasal fossa
TMJs
Traumatic and pathologic lesions in
bone.
The examination of choice for initial
examinations of edentulous patients

1.
2.
3.
4.

May be preferred over a periapical

examination of unerupted third
molars
Panoramic views are most useful
when the required field of view is
large
Less resolution of images due to
the use of intensifying screens
Inadequate for diagnosis of:
Insipient caries
Root abnormalities
Periapical changes
Panoramic radiographs have
moderate resolution