Panoramic dental image

If a person has a toothache, he rushes to the dentist for help and insists on treatment, not to remove such a treasure. But the dentist is not God, he cannot see the condition of the diseased tooth from the inside. It is impossible to act at random in this matter. After all, if the whole problem is in the exposed roots, then the treatment will be one thing, but in the case of purulent inflammation of the gums, the approach to therapy will be completely different. And here the well-known X-ray comes to the aid of the doctor, which in dentistry is called an orthopantomogram or simply a panoramic dental x-ray. It is this procedure, or rather the information obtained with its help, that allows the doctor to act purposefully and effectively, seeing the entire front of work in the future.

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Indications for the procedure

We are used to the fact that doctors give a referral for an X-ray of teeth if caries has penetrated deep into the tooth and affected the nerves, causing severe pain when biting the tooth or when food and acids get into the hole. But similar symptoms can also be observed during an inflammatory process in the root area, which can be accompanied by an accumulation of pus. This situation is dangerous because at one far from wonderful moment, pus can come out of the affected cavity into the bloodstream and penetrate with it to the brain, causing blood poisoning and inflammatory processes in the brain itself.

The question arises whether it makes sense to remove the nerve from the tooth, under which inflammation is progressing, posing a danger to human life, or whether it would be more correct to remove the diseased tooth, facilitating access to the cavity with pus for further treatment of the gum. It is this important question that the dental X-ray helps the doctor to resolve.

But so far we have only considered a special case of dental X-ray, in which we can see a couple of our teeth on a small piece of tape. Such a picture is needed right here and now in order to solve an existing problem that caused pain, while a panoramic dental picture, which is becoming increasingly popular, allows you to see even those moments that the patient does not yet feel in terms of discomfort and pain. The whole point is that an orthopantomogram shows not 2-3 teeth, as in a regular picture, but two entire rows of your teeth, including baby teeth.

Let's be honest, not everyone rushes to the dentist even when dental problems arise, unless pain forces them to seek help. Needless to say, preventive examinations have long been out of fashion among patients of dental offices. And it's a shame, because it's worth taking one panoramic picture to reliably find out information about the condition of all your teeth and gums in one fell swoop.

But orthopantogram of teeth is not only a preventive procedure that allows you to fix a problem at its very beginning. It is an opportunity to seriously prepare for various types of dental operations and manipulations that affect several teeth or gums on which the teeth are attached.

Indications for performing dental X-rays on both jaws are:

• any surgical operations on the jaw, including the removal of problem teeth,
• carrying out implantation,
• procedure for aligning the teeth of the upper and lower jaw, installing braces
• dental prosthetics (assessment of the condition of teeth, gums, bone tissue),
• determination of the degree of gum damage in periodontosis, assessment of the effectiveness of treatment,
• complex cases of diffuse toothache, which are associated with inflammation of bone tissue,
• assessment of jaw formation and growth of permanent teeth in children,
• assessment of the consequences of traumatic damage to the jaw,
• determination of the degree of development of wisdom teeth.

Let's dwell on some points in more detail. Some readers may not understand the meaning of a panoramic dental x-ray when installing braces. In fact, it is of great importance, because such a picture allows you to assess the degree of development of the teeth and jaw, the possibility of installing braces and the recommended load.

This examination is usually carried out in childhood. If this is the age of about 12 years (recommended for orthodontic treatment, the purpose of which is to align the dentition), then there are no problems here, since the dental and jaw structures have already fully formed. In young children, a panoramic dental X-ray allows you to make predictions about the possibility of jaw changes in the future, the degree of root formation, and also to determine whether the teeth are firmly held in the sockets. This information influences the doctor's decision on the timeliness of treatment for teeth alignment.

A panoramic X-ray is often taken to assess the condition of the third molars, also called wisdom teeth. Their location is such that it is very difficult to take a regular targeted X-ray, so severe distortions are possible. But these teeth can be quite a hassle: they are the last to erupt (usually in adulthood), they erupt and grow very slowly, painfully, and not always correctly (for example, at an angle or sideways). Sometimes doctors even have to intervene in the process of their eruption if the "wisdom" teeth cannot do this on their own, or remove them when the 3rd molars are prematurely destroyed or cause noticeable discomfort.

A panoramic dental X-ray allows you to assess the condition of each wisdom tooth and evaluate its growth prospects. This type of X-ray is especially useful if one of the teeth has not been showing for a long time, causing periodic excruciating pain or not showing itself at all.

An X-ray will be of great help to dentists and patients with jaw injuries. It is clear that a fracture or bruise of the jaw is within the competence of a traumatologist. However, such an injury can cause damage to teeth or their roots. But if everything is clear with a fracture, then a bruise may not manifest itself for the time being, although it is fraught with great danger associated with a certain risk of cyst formation at the site of the bruise. It is this pathology that a panoramic dental X-ray will help to identify.

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Preparation

A panoramic dental x-ray is one of the types of x-ray examination in dentistry. Like the fluorogram we are used to, which a person must undergo annually, the procedure does not require any special preparation. A panoramic x-ray can be taken for both therapeutic and preventive purposes.

Many readers immediately ask: how safe is it? Their concern is understandable, because any radiation (including X-rays) can cause harm to health. But in our case, tiny doses of radiation are used, which will not harm even a child. If we compare the radiation doses during a fluorogram of the lungs and an orthopantomogram, then in the latter case the radiation dose will be more than 10 times less. The same dose of radiation can be received during a 2-hour flight on an airliner.

The maximum permissible annual dose of radiation during patient treatment is about 15 millisieverts, and even less during prevention - 10 millisieverts. As for a panoramic X-ray, the dose used is almost 40 times less. Probably, even with the most active dental treatment throughout the year, it is very difficult to get the maximum dose of radiation, unless you take pictures every week. And if you also consider that only the jaw is exposed to radiation, and the rest of the body is protected by special devices (a protective apron), then the harm to the body is minimal.

It is also worth noting that during targeted film dental imaging, higher doses of radiation are used than during digital panoramic imaging. This is another important advantage of this method of examination in dentistry.

Low doses of radiation, however, are not a reason to independently prescribe such studies. This procedure should be carried out after consultation with a doctor, who decides on its appropriateness. During this consultation, it is necessary to warn the doctor about such nuances as pregnancy or breastfeeding.

Like a fluorogram, a panoramic dental X-ray does not require any special preparation. The only thing the doctor may ask is to remove metal jewelry from the head and neck, as they can introduce certain distortions into the information received by the receiver of the device for analyzing the condition of the jaws and teeth.

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The device for carrying out the procedure

Dental X-ray machines are called orthopantographs. They can be either film or digital. At the same time, a digital panoramic dental X-ray is considered more preferable, because its implementation requires a radiation dose more than 2 times higher than for film X-rays. This is due to the fact that the exposure of the film material for panoramic dental X-rays requires higher X-ray doses.

The moments that speak in favor of digital images are the possibility of longer storage of high-quality photos on various media (disks, flash drives). Plus, on the computer, you can enlarge individual segments of the image and change their contrast in order to examine suspicious areas in the smallest detail. A digital image can be quickly sent by email to both the patient and other doctors for urgent consultation.

When X-raying the jaws with a dental tomograph, it is possible to obtain not just one image, but several taken from different projections. And with computer processing on the monitor, you can see not a flat image, but a three-dimensional model of the jaws and teeth, i.e. a panoramic 3D image of the teeth.

The devices that provide panoramic images of teeth and jaws differ in size and structure from the usual equipment used for targeted dental imaging, but the patient does not have to sit, pressing the film to the tooth until his hands tremble, which is always trying to move. But a protective lead apron has to be put on in both cases.

Technique dental panoramic

The panoramic jaw radiography device is only slightly smaller than a fluorograph booth, and the procedure is also performed in a standing position. The patient is brought to the device and asked to place their chin on a specially designed device. This makes it easier to fix the head in a static position, which eliminates unwanted blurriness of the frame. The neck should remain straight during the procedure, the jaws should be closed, and the teeth should bite a special block that prevents the teeth from closing tightly and overlapping each other.

Then the doctor turns on the device, and the X-ray tube starts rotating around the patient's head. This movement is carried out for 10-15 minutes. The signal receiver has a reverse direction of movement. This is necessary to obtain an image in different projections.

The entire procedure time with preparation does not exceed 30 seconds. The patient does not feel any discomfort or pain.

The received signals are transmitted to the computer, where they are processed and displayed on the monitor as a complete picture. The dentist examines the image on the screen, deciphers it and issues the image for printing or leaves it in digital form, downloading it to storage media.

Adults can have a panoramic dental X-ray at any age. However, in some cases, ionizing radiation can pose a certain danger. This applies to pregnant women and nursing mothers.

Despite the fact that the radiation dose during orthopantomogram is very small, it can still have a negative impact on the developing fetus, causing various cell mutations. Radiation is especially dangerous in the first two trimesters of pregnancy, when the body is actively forming and growing. Dental X-rays for acute indications can only be performed starting from the 7th month of pregnancy, and then only if the term is determined precisely.

A panoramic dental X-ray during lactation can also be dangerous for the baby if all precautions are not taken, because breast milk with a certain dose of radiation from the mother during feeding enters the child's body. However, X-ray rooms where such studies are carried out are equipped with special protection from radiation: lead aprons and collars that prevent radioactive particles from entering the body.

But be that as it may, X-rays are done for nursing mothers, as well as pregnant women, only in cases of extreme necessity. In this case, all measures are taken to reduce the level of radiation: the distance from the source is increased, the exposure time is reduced, all protective equipment is used, and preference is given to digital images, in which the radiation does not exceed 0.02 millisieverts.

Dental X-rays for Children

In childhood, dental X-rays are allowed to be taken from the age of 6. However, for acute indications, it is possible to take them at an earlier age. In this case, the X-ray is taken with an exposure mode, which allows to reduce the area of irradiation. The trajectory of the tube movement is also adjusted according to the size of the child's jaws and their shape. And, of course, all possible measures are taken to protect the baby from irradiation.

The question of why it is necessary to take a panoramic dental x-ray of a child with baby teeth, if they can be painlessly removed if necessary, can be answered directly - very often the health of permanent teeth, which are still in their infancy, depends on such diagnostics.

It is a mistake to think that baby teeth do not have roots. They do have roots, but at a certain stage of development they begin to dissolve, which is why baby teeth are very easy to remove, even on their own. The roots of baby teeth are widely spaced and penetrate the gum between the rudiments of permanent teeth located under the baby teeth.

Caries can develop on baby teeth, and even more often than on permanent teeth. And it often hides in the most secret places, invisible to the eye. At the same time, untimely treatment of carious teeth often leads to their premature removal. Removal of such teeth with the root leads to the fact that a cavity forms between the permanent teeth, allowing them to shift in one direction or another. Thus, if this is not foreseen, a permanent tooth may erupt in the wrong place, disrupting the bite.

Depending on the indications, a child may be prescribed a targeted dental X-ray, a panoramic X-ray or a 3D tomography. The first is prescribed if there is a need to treat a specific tooth. 3D tomography is of great value in the treatment of dental canals, installation of implants and orthodontic treatment.

But a panoramic dental X-ray gives a complete picture of the condition of the teeth and gums of both jaws of the child, which is useful not only for treatment, but also for preventive purposes. Such diagnostics are useful in order to avoid early removal of both baby and permanent teeth, and therefore makes it possible to prevent bite disorders.

A panoramic dental image shows both erupted permanent teeth and those that, for some reason, cannot erupt. It is quite possible that the cause is its incorrect position in the jaw, which can be quite easily corrected with modern methods at this stage, so that in the future you will not have to resort to removing a tooth that interferes with others and complex orthodontic treatment. In this image, you can also see bone tissue anomalies, inflammatory processes, and neoplasms that were hidden for the time being.

Normal performance

A panoramic dental image is a kind of passport of the human dental system, because it contains complete information that is invisible to the naked eye. At the same time, from the point of view of dentistry, not only teeth but also bone structures may be of interest.

An X-ray panoramic image of an adult's teeth ideally contains 32 teeth, which are clearly visible on the X-ray as light-grey rectangles of irregular shape with branches (roots). On the image, they can be designated by Arabic (permanent teeth) or Roman (temporary) numerals, because in addition to the name (incisor, canine, premolar, molar), the teeth also have their own number.

There is another type of numbering, according to which the last tooth (the lower wisdom tooth on the right side) has the number 48. The world classification of teeth divides the dental arch into 4 equal parts, which should contain 8 teeth (in an adult). The numbering goes from incisors to molars. The teeth of the upper right segment have numbers from 11 to 18, and the upper left - from 21 to 28. Lower segments: the right is numbered from 41 to 48, the left - from 31 to 38.

A child's orthopantomogram contains more teeth than an adult's, although the picture is completely different upon external examination. The reason for this curious situation is that the X-ray image shows not only baby teeth, but also unerupted permanent teeth (20 baby teeth numbered 51-55, 61-65, 71-75, 81-85 and 28 permanent teeth excluding wisdom teeth). The rudiments of permanent teeth may have different sizes and shapes depending on the patient's age, but in any case their number is always visible, i.e. the doctor knows in advance if the number of teeth differs from the norm.

Orthopantomogram is a mirror image of the jaw, which should also be taken into account when interpreting. It is very important to pay attention to the quality of the image. In this case, not only the sharpness and contrast of the image are important, but also the angle from which the radiograph was taken.

Normal radiographic findings include the following:

• some semblance of a smile in the photo (if the corners of the jaw are lowered, the photo was taken incorrectly with distortions),
• the presence of a normal number of erupted teeth with the generally accepted number of root branches,
• the teeth are of normal shape and size, their contours are clear and do not contain irregularities or darkening,
• there are no areas of localized darkening with a light border or limited light areas (in the tooth area, such elements may indicate caries and tartar)
• there are no limited areas in the gum area that differ in color and indicate inflammatory processes and neoplasms,
• there are no signs of destruction of the jaw bone tissue, which are also visible to a specialist on a panoramic dental x-ray (they are characterized by clear contours and an even shape without interruptions or thickenings).

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Caries on a panoramic dental x-ray

Let's take a closer look at the situation with caries, the most common dental pathology, which affects both tooth enamel and dentin, reaching the roots of the tooth and the nerves hidden in it, which provokes acute pain. With the help of a panoramic dental x-ray, you can determine both its obvious and hidden forms.

For example, when caries begins, you may not notice any changes in the tooth externally, but an X-ray will show a lightened demineralized area, which will subsequently be destroyed. Recurrent caries can also occur in a hidden manner, when the destruction of the tooth occurs under a filling, which may remain intact on top. The image will show a light area of the filling and a dark element of the carious cavity.

An extensive x-ray also helps with obvious caries, especially when the patient cannot indicate the exact location of the pain. The degree of caries damage can be seen on a targeted x-ray of the tooth, but it is only possible to determine which tooth caused the pain before it was opened using a targeted x-ray of the teeth. Sometimes the difference between the tooth the patient indicates and the cause of the pain is quite noticeable (plus or minus 2 teeth).

In some cases, a person may even feel that half of the jaw or even the other jaw hurts, which significantly complicates diagnostics. And again, a panoramic dental X-ray comes to the rescue. And some types of caries at an early stage can only be detected using a 3D projection. Plus, at the same time, see other possible deviations.

A fairly common and dangerous complication of caries is the formation of a cyst inside the gum. A cyst is a neoplasm with dense walls and liquid purulent contents. Its formation can be provoked by an open carious cavity or poor-quality filling of the tooth, when part of the canal remains open.

It should be said right away that caries on the surface or inside the tooth is much easier to treat than to fight purulent inflammation deep in the gum. But if it is still not possible to prevent the pathology, it is necessary to take urgent measures to treat it, because the entry of pus into the blood during the growth of the cyst is fraught with sad consequences (sepsis, phlegmon, etc.).

If a cyst has formed at the site of a destroyed or extracted tooth and reminds of itself with pain, then a targeted X-ray will suffice. But sometimes the cause of the pain remains hidden, as in the case of caries, then a panoramic dental X-ray is simply indispensable. By the way, quite often a cyst in the form of a limited darkened area in the area of the tooth root or on its lateral surface on a panoramic dental X-ray is discovered by accident. The patient may either not feel pain or simply ignore it. Thus, an orthopantomogram helps prevent the development of a dangerous condition that can have the most negative impact on the patient's health and life.

Based on the above, a panoramic dental X-ray can be considered the most informative form of X-ray examination. After all, it allows not only to accurately diagnose and treat existing diseases or carry out effective preparation for orthodontic treatment, but also to make assumptions about possible pathologies, which is especially important in childhood. At the same time, in just one examination, you can get information about the condition of the entire dentition, as well as the musculoskeletal system of the jaws, which allows you to identify even hidden pathologies that can turn into big troubles in the future.

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