Radiology in Pediatric Dentistry 2

RADIOLOGY IN PEDIATRIC
DENTISTRY
Roentgen’s discovery of the x-ray in 1895
provided one of the most important diagnostic
aids in dentistry.
Early diagnosis of caries prevents the pediatric

patient from experiencing dental pain,
extraction and emotional stress.
Some restorative procedures require an

accurate registration of the pulpal outline that
only a radiograph can reveal.
The selection of appropriate radiographs
for the pediatric patient depends on the age
of the child, the size of the oral cavity and the
level of patient cooperation.
The child’s cooperation is essential to

theradiographic examination as is the
selection of thecorrect radiographic
technique.
“Show and Tell” will go a
long way in gaining
cooperation.
Careful wording of the description of the
procedure is essential to gain patient
cooperation.
The easiest region first may ensure success

in other areas.
This is particularly important if the child

has an exaggerated gag reflex or objects to the
placement of the film.
RADIATION SAFETY AND PROTECTION
The effects of low levels of x-radiation (as
used in diagnostic radiology) on biological
systems are virtually unknown.
Our assumptions of damage are based on

extrapolation of data from high levels to lower
levels of radiation.
Concern is focused on three primary biologic
effects of low-level radiation:
1) Carcinogenesis
2) Teratogenesis
3) Mutagenesis
Carcinogenesis and
malformations are a response
of somatic tissues.
Mutation may occur as a

response of genetic tissue
(gonads).
In general, younger tissues and

organs are more sensitive to
radiation.
These critical organs and the associated adverse
biologic effects are the following:
1) The skin (cancer)
2) Red bone marrow (leukemia)
3) The gonads (mutation, infertility, and fetal
malformations).
4) The eyes (cataracts).
5) The thyroid (cancer).
6) The breasts (cancer).
7) The salivary glands (cancer).
With regard to patient
protection, evidence has
shown that there are
critical organs vulnerable
to possible development
of late effects. These
organs should be shielded
when possible.
The most obvious method of
protecting the patient is to shield
those areas not being evaluated.
This is easily accomplished using
a lead apron and thyroid collar.
The apron and collar may be

incorporated as a single unit or
used separately.
1. Faster film speeds have contributed most
significantly to the reduction in radiation to the
patient.
2. The use of higher kilovolt peak techniques reduces

patient exposure to radiation and lowers contrast,
thus increasing the number of shades of gray on
the film. The exposure time is shortened.
3. Quality control in the darkroom. Not necessitating

additional patient exposure.
DEVELOPMENT OF THE DENTITION AS
CRITERIA
Dental radiographs are indicated in the following
situations.
a) Primary Dentition: If the proximal surfaces of the
primary teeth cannot be visually and tactilely
inspected.
b) Early Transitional Dentition: Radiographs are taken

to evaluate the presence of interproximal caries,
developmental anomalies of teeth, and pathologic
conditions of the hard and soft tissues of the
mouth, jaws, and associated structures.
c) Early Permanent Dentition: Radiographs are
taken to evaluate the same tissues as in the
early mixed dentition and to check the
position and developmental status of the third
molars.
The procedures commonly used by the dentist
include the following:
1.- Bite-wing
2.- Periapical
3.- Occlusal
4.- Panoramic
Commonly Used Radiographic Techniques
The technique used depends primarily on the size of

the oral cavity, the number of teeth present, and
patient cooperation.
Adult Film: Size 2

Child Film: Size 0
Oclusal Size
Panoramic Size
For lateral Size
Types of findings anticipated as criteria
Bite-wing radiographs are usually taken
every 12 to 18 months in the absence of
dental caries with primary tooth contact or
every 24 months with permanent tooth
contact.
Occlusal
• Adult Film
• Mother needs
to help
• Mandibular Occlusal
• Easy to cooperate
• Diagnosis of anterior
area.
• Oclusal Film or Adult

Film size 2
Radiographic Examination
In cases in which more complex facial injuries have occurred,
or bone fracture are suspected, extraoral films may also be
necessary.
McDonald- Avery-Dean. Dentistry for the Chlild and Adolscent. 8 edition. 2004. Mosby.
Soft tissue radiograph is useful in detecting where the

fractured tooth fragment is located.
25 % of the usual time
McDonald- Avery-Dean. Dentistry for the Chlild and Adolscent. 8 edition. 2004. Mosby.
Occlusal X Ray in lateral position

Impacted tooth
By the time the first permanent tooth has erupted
(posterior or anterior), an anterior occlusal radiograph
should be taken.
This allows detection of conditions such a

supernumerary teeth, missing teeth and dens in
dente.
The radiographic examination may consist of the
following:
1) Posterior periapical radiographs.
2) Panoramic radiographs.
3) Lateral jaw 45-degree-projections.
Another similar radiographic examination may
be made within 2 years after of the eruption
of the permanent second molars.
Paralleling Technique
In principle the paralleling technique requires

the object (long axis of the tooth) and the film
to be parallel in all dimensions.
Bisecting Angle Technique
The bisecting angle
technique is based on a
principle called The rule
of isometry which
basically states that two
triangles are equal if
they have two equal
angles and a common
side.
Positioning landmarks for film placement
Panoramic Radiography
A panoramic radiographic unit can be used for

examination of children.
Since the examination is obtained without
placement of the film in the mouth, it does
not alarm the anxious child who may refuse an
intraoral film.
A diagnostic film includes:
1) The teeth
2) The supporting structure
3) The maxillary region extending to the
superior third of the orbit.
4) The entire mandible including the
temporomandibular joint region.
Pediatric dentists who have used
panoramic radiography technique have
discovered condylar fractures, traumatic cysts,
and anomalies that might have gone
undetected with the routine periapical series
of radiographs.
Digital Receptors for pediatric patients
Photostimulable Phosphor Systems:

• Soredex (Digora)
• AirTechniques (Scan X)
• Gendex (DenOptix)
Dental Clinics of North America, April 2002

INTERPRETATION
When interpreting radiographs, the dentist must

develop a systematic approach so that no
areas of the radiographs are missed.

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RADIOLOGY IN PEDIATRIC

Early diagnosis of caries prevents the pediatric

Some restorative procedures require an

The child’s cooperation is essential to

The easiest region first may ensure success

This is particularly important if the child

Our assumptions of damage are based on

Mutation may occur as a

In general, younger tissues and

The apron and collar may be

2. The use of higher kilovolt peak techniques reduces

3. Quality control in the darkroom. Not necessitating

b) Early Transitional Dentition: Radiographs are taken

The technique used depends primarily on the size of

Adult Film: Size 2

• Oclusal Film or Adult

Soft tissue radiograph is useful in detecting where the

25 % of the usual time

Occlusal X Ray in lateral position

This allows detection of conditions such a

In principle the paralleling technique requires

A panoramic radiographic unit can be used for

Photostimulable Phosphor Systems:

Dental Clinics of North America, April 2002

When interpreting radiographs, the dentist must

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