06b - Radiograph Selection Criteria

general principles

• patient with higher caries risk need radiographs more often

• patients with lower caries risk need radiographs less often

• radiographs aid in evaluating surfaces and structures which cannot be directly visualized

• each patient’s individual oral health and health history should be comprehensively evaluated to form an individually-tailored radiographic prescription

guidelines for new patients

• children → BW recommended if interproximal surface of teeth cannot be visualized and selected PA and/or occlusal views

  • Pano recommended for transitional dentition to replace selected PA or occlusal radiographs

• adolescents and adults → BW and selected PA radiographs or FMX when there is evidence of generalized oral disease or extensive existing dental treatment

guidelines for recall high caries risk patients

• children and adolescents → BW at 6-12 month intervals

• adults → BW at 6-18 month intervals

guidelines for recall patients not at increased risk for caries

• children → BW at 12-24 month intervals

• adolescents → BW at 18-36 month intervals

• adults → BW at 24-36 month intervals

guidelines for recall patients with periodontal disease

clinical judgement as need for and thype of radiographic image for evaluation of periodontal disease

• selected BW and/or PA of areas where periodontal disease can be identified clinically

• can also take Pano

guidelines for monitoring of growth and development

• children → clinical judgement as to need for and type of radiographic images for monitoring and/or evaluation of dentofacial growth and development

• adolescents → clinical judgement as to need for and type of radiographic images for monitoring and/or evaluation of dentofacial growth and development; Pano or PA to assess developing third molars

guidelines for patients who are pregnant

• radiographs recommended if there is a known need, assuming risks of stress caused by pain and discomfort is more damaging to fetus than risk of radiographs

• limit radiographs to area of interest

• fetal dose from FMX while using lead apron is about 1mcSv

guidelines for patients undergoing radiation therapy

• for malignancy in oral cavity, some oral tissues may receive up to 50Gy or more, which is over a million times more than the dose of intraoral radiograph

• many of these patients have radiation-induced xerostomia and are at higher risk of caries, indicating greater need for radiographs

• oral mucosa can be very tender within 2 months of heavy radiation therapy, so avoid taking radiographs during this period for patient comfort

• normally, patients have teeth with questionable prognosis extracted prior to radiation therapy