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Chart: Guidelines for Prescribing Dental Radiographs
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
- Previous periodontal or endodontic treatment
- History of pain or trauma
- Familial history of dental anomalies
- Postoperative evaluation of healing
- Remineralization monitoring
- Presence of implants or evaluation for implant placement
B. Positive Clinical Signs/Symptoms
- Clinical evidence of periodontal disease
- Large or deep restorations
- Deep carious lesions
- Malposed or clinically impacted teeth
- Swelling
- Evidence of dental/facial trauma
- Mobility of teeth
- Sinus tract (“fistula”)
- Clinically suspected sinus pathology
- Growth abnormalities
- Oral involvement in known or suspected systemic disease
- Positive neurologic findings in the head and neck
- Evidence of foreign objects
- Pain and/or dysfunction of the temporomandibular joint
- Facial asymmetry
- Abutment teeth for fixed or removable partial prosthesis
- Unexplained bleeding
- Unexplained sensitivity of teeth
- Unusual eruption, spacing or migration of teeth
- Unusual tooth morphology, calcification or color
- Unexplained absence of teeth
- Clinical erosion
* * Factors increasing risk for caries may include but are not limited to:
- High level of caries experience or demineralization
- History of recurrent caries
- High titers of cariogenic bacteria
- Existing restoration(s) of poor quality
- Poor oral hygiene
- Inadequate fluoride exposure
- Prolonged nursing (bottle or breast)
- Frequent high sucrose content in diet
- Poor family dental health
- Developmental or acquired enamel defects
- Developmental or acquired disability
- Xerostomia
- Genetic abnormality of teeth
- Many multisurface restorations
- Chemo/radiation therapy
- Eating disorders
- Drug/alcohol abuse
- Irregular dental care
Document created: November 2004
Updated January 4, 2005 |