# routine panoramic dental x-rays?



## indigosky (Sep 4, 2007)

My 8-year-old's dentist recommends a routine panoramic x-ray on all children once their two permanent top front teeth are in. I delayed when I was at the dentist with her yesterday, saying I wanted to learn more about it first. I'm not finding any practice guidelines that recommend routine panoramic dental x-rays for kids -- can anyone give me more information about what is considered best practice? 

I asked lots of questions but they just say general things about how it could "detect pathology" etc. In this case there is no specific cause for concern: healthy kid, good dental care, never had a cavity.


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## Xerxella (Feb 6, 2008)

I would run far, far away from this dentist. This is absolutely NOT recommended by all major health agencies, including the ADA who recommends bitewing only if needed every one-two years for children with no history of cavities. Frequent x-rays in children have been linked to brain tumors in adults. Here's a web MD article:

http://www.webmd.com/brain/news/20120410/dental-x-rays-linked-brain-tumors

Dental x-rays should be limited and are not needed yearly. The worst kind are panoramic x-rays. From the article, "This risk was higher in people who received panoramic X-rays when they were younger than 10."

Look. I get that they're necessary sometimes. Just know that there is risk. My eldest is definitely going to need braces AND they're going to have to do a panoramic x-ray. I get that. But, I'm certainly limiting them as much as possible and we're doing nothing until he's at least ten.

Your dentist should know the risk and NOT be recommending this. Either he doesn't know the risk (which to me is inexcusable) or he simply doesn't care (even worse).


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## lauren (Nov 20, 2001)

Many dentists are fine with you limiting exposure to Xrays. I've raised 3 children and I've been cautious with fluoride and x-rays and they have tolerated me just fine. If it is an otherwise good dentist that your child likes, I"m sure you could work together on this. 

I know a panoramic set can aid them a lot when all the teeth come in, and it is a necessity if any orthodontic work is being considered (i.e. braces). Just limit them and use a more cautious schedule even then the article in the post before recommends.


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## japonica (May 26, 2005)

My daughter's had two panoramic X-rays so far (she's aged 11.5) and about two sets of the smaller bite wing ones. She's been seeing the orthodontist since age 8 and has braces now at 11. It was only through the initial routine x-rays that we diagnosed the missing adult incisor and the impacted adult teeth. So, in my experience, it was good that this stuff was detected early and fixed early (the orthodontist told me that waiting would likely mean corrective surgery later). That said, I obviously don't advocate that the x-rays be used without a justification for them. The digital technology nowadays thankfully means that they are getting a much lower dose of radiation than we all received as children and young adults, but still, it's a risk that has to be calculated against any perceived benefit of proceeding.


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## blessedwithboys (Dec 8, 2004)

indigosky said:


> My 8-year-old's dentist recommends a routine panoramic x-ray on all children once their two permanent top front teeth are in. I delayed when I was at the dentist with her yesterday, saying I wanted to learn more about it first. I'm not finding any practice guidelines that recommend routine panoramic dental x-rays for kids -- can anyone give me more information about what is considered best practice?
> 
> I asked lots of questions but they just say general things about how it could "detect pathology" etc. In this case there is no specific cause for concern: healthy kid, good dental care, never had a cavity.


Do you happen to have really excellent dental insurance? Does your dentist just happen to provide orthodontic treatment?

The only films a kid "needs" is a set of posterior bite wings every other year or every third year.

I'm currently studying dental radiography. Let me know if you have any other questions. This is a fabulous, balanced article.


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## indigosky (Sep 4, 2007)

blessedwithboys said:


> Do you happen to have really excellent dental insurance?


We do have dental insurance (I think Obamacare requires it?), but it doesn't seem that excellent. We still have to pay as much for every visit as we pay out of pocket for my own dentist.



blessedwithboys said:


> Does your dentist just happen to provide orthodontic treatment?


Nope.



blessedwithboys said:


> The only films a kid "needs" is a set of posterior bite wings every other year or every third year.
> 
> I'm currently studying dental radiography. Let me know if you have any other questions. This is a fabulous, balanced article.


This is incredibly helpful -- thank you for speaking up!

I have two followup questions you may be just the person to ask:

1) I've seen that FDA/ADA chart before, and one thing that always puzzles me is the way they call for a panoramic x-ray for a new patient visit. So if a child goes to the same dentist their entire childhood, they would never need a panoramic x-ray, but if they switch practices, then a one-time panoramic x-ray is appropriate? It doesn't make sense to me that the thing that triggers the recommendation of certain kinds of x-rays is "new patient" status.

2) Does living in a city that does not fluoridate the water automatically put a child into the Increased Risk category? Or if their own dental history has no cavities and there's no other reason for increased risk, would they remain in the Low Risk category?

Thank you so much!!!


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## blessedwithboys (Dec 8, 2004)

"It doesn't make sense to me that the thing that triggers the recommendation of certain kinds of x-rays is "new patient" status."

CYA for dentist.

"Does living in a city that does not fluoridate the water automatically put a child into the Increased Risk category? Or if their own dental history has no cavities and there's no other reason for increased risk, would they remain in the Low Risk category?"

According to Those Who Make The Rules, unfluoridated water is almost a form of child abuse. So yes, it will be considered high risk. I had to do an analysis on two people for a class last semester and I chose my own kids, one grown and one still a teen. I marked that they were high risk and then added notes that they did not use fluoride and had no caries (cavities). My professor was not happy LOL

I am so fortunate to have found a dentist 15 years ago who accepts that we don't use fluoride and who does not require frequent radiographs. Our orthodontist is good, too, about me saying no everytime she wants to do a pano just because. Keep looking, you'll find one like that!


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## indigosky (Sep 4, 2007)

The funny thing is, I find most dentists amazingly mellow about not doing the radiographics they recommend. They talk about them as if OF COURSE you'll do them, and then as soon as you say "not today" they move on as if it never mattered at all.

My kids are a long way from orthodontia, but are at least some panormamics essential for orthodontia? Or is that all fiction, as well?


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## blessedwithboys (Dec 8, 2004)

Yes, I would say a pano is pretty important for orthodontia is there unerupted teeth when you start. I had to start very young with one of my kids and he still didn't have very many adult teeth. The pano really helped to see where things were and what we could expect.


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## japonica (May 26, 2005)

indigosky said:


> The funny thing is, I find most dentists amazingly mellow about not doing the radiographics they recommend. They talk about them as if OF COURSE you'll do them, and then as soon as you say "not today" they move on as if it never mattered at all.
> 
> My kids are a long way from orthodontia, but are at least some panormamics essential for orthodontia? Or is that all fiction, as well?


I don't think you'd find an orthodontist who would skip panoramic x-rays given what the treatment is trying to achieve. My daughter had to have one along with the upper and lower modelling done so that he could establish the treatment plan to correct not only the spacing but her jaw alignment.


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## pamrull09 (Nov 4, 2021)

The relatively low cost of the x-ray is nothing compared to what a patient would have to endure suffering from oral cancer or a tumor that was not caught because a panoramic x-ray was not completed at the recommended intervals. One thing that sets good dental offices apart from _great_ dental offices is the willingness to invest in the latest dental technology. 
Because some of the high-tech stuff available to dentists today has transformed patient care.


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