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Chart: Guidelines for Prescribing Dental Radiographs

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Chart: Guidelines for Prescribing Dental Radiographs

From: American Dental Association, U.S. Food & Drug Administration. The Selection of Patients for Dental Radiograph Examinations. Also available at: www.ada.org

 

The recommendations in this chart are subject to clinical judgment and may not apply to every patient. They are to be used by dentists only after reviewing the patient’s health history and completing a clinical examination. Because every precaution should be taken to minimize radiation exposure, protective thyroid collars and aprons should be used whenever possible. This practice is strongly recommended for children, women of childbearing age and pregnant women.

Type of Encounter

Patient Age and Dental Developmental Stage

Child with 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 or Partially Edentulous Adult, Edentulous

New patient*

being evaluated for dental diseases and dental development

Individualized radiographic exam consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be visualized or probed. Patients without evidence of disease and with open proximal contacts may not require a radiographic exam at this time. Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images.

Individualized radiographic exam consisting of posterior bitewings with 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.

 

Individualized radiographic exam, based on clinical signs and symptoms.
Recall patient* with clinical caries or at increased risk for caries**

Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot be examined visually or with a probe

 

Posterior bitewing exam at 6-18 month intervals Not applicable
Recall patient* with no clinical caries and not at increased risk for caries**

Posterior bitewing exam at 12-24 month intervals if proximal surfaces cannot be examined visually or with a probe

 

Posterior bitewing exam at 18-36 month intervals Posterior bitewing exam at 24-36 month intervals Not applicable

 

Guidelines for Prescribing Dental Radiographs, cont’d.

 

Type of Encounter

Patient Age and Dental Developmental Stage

Child with 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 and Partially Edentulous Adult Edentulous
Recall patient* with periodontal disease Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images of areas where periodontal disease (other than nonspecific gingivitis) can be identified clinically. Not applicable
Patient for monitoring of growth and development

Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development

 

Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development. Panoramic or periapical exam to assess developing third molars

Usually not indicated

 

Patient with other circumstances including, but not limited to, proposed or existing implants, pathology, restorative/endodontic needs, treated periodontal disease and caries remineralization

Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances.

 

*Clinical situations for which radiographs may be indicated include but are not limited to:

A. Positive Historical Findings

  1. Previous periodontal or endodontic treatment
  2. History of pain or trauma
  3. Familial history of dental anomalies
  4. Postoperative evaluation of healing
  5. Remineralization monitoring
  6. Presence of implants or evaluation for implant placement

B. Positive Clinical Signs/Symptoms

  1. Clinical evidence of periodontal disease
  2. Large or deep restorations
  3. Deep carious lesions
  4. Malposed or clinically impacted teeth
  5. Swelling
  6. Evidence of dental/facial trauma
  7. Mobility of teeth
  8. Sinus tract (“fistula”)
  9. Clinically suspected sinus pathology
  10. Growth abnormalities
  11. Oral involvement in known or suspected systemic disease
  12. Positive neurologic findings in the head and neck
  13. Evidence of foreign objects
  14. Pain and/or dysfunction of the temporomandibular joint
  15. Facial asymmetry
  16. Abutment teeth for fixed or removable partial prosthesis
  17. Unexplained bleeding
  18. Unexplained sensitivity of teeth
  19. Unusual eruption, spacing or migration of teeth
  20. Unusual tooth morphology, calcification or color
  21. Unexplained absence of teeth
  22. Clinical erosion

* * Factors increasing risk for caries may include but are not limited to:

  1. High level of caries experience or demineralization
  2. History of recurrent caries
  3. High titers of cariogenic bacteria
  4. Existing restoration(s) of poor quality
  5. Poor oral hygiene
  6. Inadequate fluoride exposure
  7. Prolonged nursing (bottle or breast)
  8. Frequent high sucrose content in diet
  9. Poor family dental health
  10. Developmental or acquired enamel defects
  11. Developmental or acquired disability
  12. Xerostomia
  13. Genetic abnormality of teeth
  14. Many multisurface restorations
  15. Chemo/radiation therapy
  16. Eating disorders
  17. Drug/alcohol abuse
  18. Irregular dental care

Document created: November 2004