Radiograph indications

Clinical situations for which radiographs may be indicated include but are not limited to: I. Positive historical findings - I. Previous periodontal or endodontic treatment - - ii.History of pain or trauma - iii. Familial history of dental anomalies - iv. Post-operative evaluation of healing - v. Remineralization monitoring - vi. Presence of implants or evaluation for implant placement II. Positive clinical symptoms/signs - i. Clinical evidence of periodontal disease - ii. Large or deep restorations - iii. Deep carious lesions - iv. Malposed or clinically impacted teeth - v. Swelling vi. Evidence of dental/facial trauma - vii. Mobility of teeth - viii. Sinus tract (‘fistula’) - ix. Clinically suspected sinus pathology - x. Growth abnormalities - xi. Oral involvement in known or suspected systemic disease - xii. Positive neurologic findings in the head and neck - xiii. Evidence of foreign objects - xiv. Pain and/or dysfunction of the temporomandibular joint and/or muscles of mastication - xv. Facial asymmetry - xvi. Abutment teeth for fixed or removable partial prosthesis - xvii. Unexplained bleeding - xviii. Unexplained sensitivity of teeth - xix. Unusual eruption, spacing, or migration of teeth - xx. Unusual tooth morphology, calcification, or colour - xxi. Unexplained absence of teeth - xxii. Clinical erosion

Factors increasing risk for caries may include but are not limited to: I.High level of caries experience or demineralization II. History of recurrent caries III. High titers of cariogenic bacteria IV. Existing restoration(s) of poor quality V. Poor oral hygiene VI. Inadequate fluoride exposure VII. Prolonged nursing (bottle or breast) VIII. Frequent high sucrose content in diet IX. Poor family dental health X. Developmental or acquired enamel defects XI. Developmental or acquired disability XII. Xerostomia XIII. Genetic abnormality of teeth XIV. Many multi-surface restorations XV. Chemotherapy/radiation therapy XVI. Eating disorders XVII. Drug/alcohol abuse XVIII. Irregular dental care (From American Dental Association, US Food and Drug Administration: the selection of patients for dental radiograph examinations. Available on www.ada.org. Document created November 2004)

Limitations of radiographs Dental radiographs should always be interpreted cautiously. The dental radiograph is a two-dimensional image of a three-dimensional mass. • A facial or lingual lesion (or radiolucent tooth-coloured restoration) may be radiographically superimposed over the proximal area, mimicking a proximal caries lesion (false positive). • The general finding that approximately 25% mineral loss has to occur before a radiolucency begins to appear on a radiograph means that a caries lesion may be present and not detected (false negative). • Misdiagnosis may occur when cervical burnout (the radiographic picture of the normal structure and contour of the cervical third of the crown) mimics a caries lesion. • Finally, although a caries lesion may be more extensive clinically than it appears radiographically, it is estimated that over half of radiographically detected proximal lesions (in the outer half of dentine) are likely to be non-cavitated and treatable with remineralization measures