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For April 18, 2006 Health column:
The Independent

The Facts on Dental X-Rays
By Tareq Khalifeh, DDS

While eating sweet treats this Passover and Easter, did you get a twinge of pain from somewhere in your mouth? It’s probably time to visit the dentist for a quick look. Your dentist may have to take an x-ray to determine the cause.

The dental x-ray, or “radiograph,” is one of the dentist’s most important diagnostic tools. Radiography shows the presence and severity of tooth decay between and inside teeth and around restorations, such as crowns or existing fillings. It can also show broken or cracked teeth or bones, which happen all too frequently during sports activities. Radiography can also reveal abscesses, gum disease, bone infections, or space and alignment problems (“malocclusions”) in a child’s emerging teeth.


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When Are X-Rays Needed?
Dental radiography uses extremely low doses of radiation and is considered very safe. For example, a full-mouth x-ray series, which the dentist typically needs to assess he health of a new patient, provide only 0.038 MsV for 19 films, compared to an abdominal x-ray series, which exposes the patient to 4.060 MsV.

The cumulative impact of exposure to multiple radiation sources over a person’s lifetime does present some health risks, however. So responsible dentists are very conservative with the use of radiography, and recommend it only when needed to identify problems before they get out of hand.

Rather than follow a pre-set schedule of x-rays, for example, dentists follow guidelines published by the American Dental Association and the U.S. Food and Drug Administration, which recommend using radiation levels “As Low As Reasonably Achievable” and ordering X-rays only when diagnosis cannot be fully established without them. Capturing a full oral history, conducting a comprehensive visual examination, and obtaining copies of a patient’s prior dental x-rays are important non-radiological ways to get a complete picture of a patient’s oral health.

One of the most important ways dentists try to minimize x-ray use is encouraging frequent dental visits and good home dental care to maintain good oral health.

And, when x-rays are needed, dentists are careful to protect their patients from radiation exposure by using protective leaded aprons. A leaded thyroid collar may also be used for women of childbearing age, pregnant women, and children. (Occasionally, a pregnant woman may require an X-ray for a dental emergency that can pose a risk to the fetus or the mother. In such situations, the use of both leaded apron and a leaded thyroid collar is important.)

All of these precautions are equally important in pediatric dentistry. In general, children need X-rays more often than adults because their mouths are changing rapidly and they are more susceptible to tooth decay. For this reason, the American Academy of Pediatric Dentistry recommends X-ray examinations every six months for children with a high risk of tooth decay. Children with a low risk of tooth decay require X-rays less frequently.

Digital Radoiography Reduces Exposure
Some dental practices are now replacing conventional x-ray with digital x-ray technology. Digital radiography offers speed, storage, and accuracy benefits that improve the quality of patient care. It also can reduce radiation exposure by 70 to 80 percent, particularly in procedures requiring multiple images.

There are several factors contributing to these benefits. One is the speed of the process. Conventional x-rays use film coated with phosphorous, which must be processed in a darkroom by immersing the film in chemical emulsifiers and fixatives before they can be viewed. Digital x-rays are visible on the computer screen instantly, eliminating the need for darkroom process completely. This provides the dentist with instant visualization of the work the dentist is doing. As a result, the dentist can reduce the number of exposures needed during a complex procedure, such as an oral implant or crown fitting.

Heightened visual accuracy is another key benefit. Digital x-rays can be enlarged, darkened, lightened, or otherwise manipulated right on-screen for better visualization.

Finally, digital radiography eliminates manual handling, storing, and retrieving of bulky x-ray films. And, in the event that a patient needs a second opinion or specialist procedure, or moves to a new location, the digital images can be electronically transmitted to any other dentist equipped with digital x-ray technology.

Digital radiography has not yet achieved critical mass, partly because it still requires even a small dental practical to make a sizeable investment. Philmont Family Dentistry is making the digital transition this month, and will also be investing this summer in another visualization technology that will use the same computer to give patients a dentist’s-eye view into their own mouths. We believe that such advances will eventually become standard practice in American dentistry.

Dr. Khalifeh owns the Philmont Family Dentistry located on Rte 217 in Philmont, NY. A graduate of the New York City School of Dentistry, he completed his residency at Albany Medical Center and practiced in Albany until 2004. For more information, call 672-4077 or visit

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