Exam and X-Rays

Your first appointment will usually be scheduled to gather information. This information will be used for a proper diagnosis and an eventual Treatment Plan This first appointment is also often referred to as a Consultation Appointment or Initial Appointment. This is the appointment where the initial Exam is being conducted and a set of X-Rays is being taken. During this appointment the doctor may:

1. Take a Full-Mouth-Set of x-rays. This set consists of typically 18 small films and covers each and every tooth in your mouth. This allows the doctor to examine all your teeth, their roots, the bone support, and rule out diseases of the teeth and their supporting structures. These X-Rays may be taken with traditional film or a digital sensor.

2. Perform a visual oral examination, where your teeth, soft tissues, lymph nodes and TMJ are examined.

3. Perform a periodontal examination if indicated, where the condition of your gums is checked with a periodontal probe.

4. In some instances take impressions for diagnostic casts and take photographs.

5. Present you with a preliminary treatment plan outlining what treatment is required to restore your dentition back to proper health and function.

The Consultation or Initial Appointment usually lasts between one and two hours. After the Consultation Appointment, the doctor will analyze all the data collected and form a comprehensive treatment plan, or several options thereof, addressing your particular oral health issues. This treatment plan and/or its options will then be presented to you.

The Oral Exam:

As already mentioned the oral exam is an important part of your overall treatment. The results of this examination will set the baseline from which all other treatment goals will be set. A proper oral exam is therefore a very important source of data for the doctor.

The oral exam is typically not only limited to the mouth. The doctor will also check for facial abnormalities, such as abnormal lymph nodes, certain skin lesions, TMJ function and a facial symmetry check.

Part of the intra-oral exam will include a visual check of your soft tissues, tongue, throat and tonsils. The oral cavity is an amazing "mirror" for a host of not only oral pathologies, but also systemic pathologies. Many systemic diseases manifest themselves via certain signs and symptoms in the oral cavity first; so a thorough oral exam if very important. The next step is usually the dental exam, where the doctor will chart the status quo of your teeth and note any defects that need to be corrected. Teeth are numbered according to a certain convention, which is outlined in the Your Teeth page.

The final part is usually the Periodontal Exam, part of which is also known as "Probing". During this phase the doctor or the hygienist gently inserts a probe into the pocket formed between the gums and the tooth at the tooth-gum interface. Depending on how deep the probe will glide in until it reaches the bottom of the pocket, a "reading" in millimeters will be obtained, which the doctor will note in a special section of a chart. Normally there are six readings for each tooth. A pocket reading of 2-3mm is considered normal. We will discuss this in more detail in the Your Gums section.

To the left is an image of a typical "Probing" during a periodontal exam. Notice how the periodontal probe has millimeter gradations.

X – Rays:

Dental X-Rays are an important part of diagnosis and treatment. They help us detect problems that may not become immediately evident in a clinical exam. We typically take a Full-Mouth Set, consisting of 18 small films. This set covers all teeth in their entirety. We understand concerns regarding radiation and, despite the small amount of x-radiation emitted by dental x-ray units, we utilize lead aprons, fast film, and we continually monitor our x-ray equipment for your safety.

With respect to x-rays and any type of dental treatment, please let us know if pregnancy or cancer treatment may be a factor!

X-ray Generation:

X-rays are generated when free electrons give up some of their energy when they interact with the orbital electrons or nucleus of an atom. The energy given up by the electron during this interaction appears as electromagnetic energy known as X-radiation. There are two different atomic processes that can produce x-ray photons. One is called Bremsstrahlung and the other is called K-shell emission. X-rays produced by Bremsstrahlung are the most useful for medical and industrial applications.

Schematic Diagram of an X-ray Generator. The heated filament boils off electrons, which then accelerate toward the positively charged Cu anode. The photons are absorbed by shielding and collimators (not shown), except those headed along the main beam axis. (After Piccard and Carter, 1989.)

X-ray Exposure:

Concerns are often raised adressing the increased exposure to X-radiation from dental x-rays. X-radiation is measured in a unit called millirems (mrems). For the sake of comparison we would like to list a few radiation sources and their yield below:

One small dental x-ray: 2-3 mrems
A full mouth set (18 films): 36 - 54 mrems
One Panographic (see below) x-ray: 4-5 mrems
Yearly background radiation: 300 - 400 mrems
Yearly maximum safe radiation dose (Dept. of Health): 5000 mrems

As you can clearly see, the radiation exposure from dental x-rays is very minimal, compared to the constantly present background radiation as well as the yearly safe maximum dose. On the other hand, radiation exposure is cumulative, so if you had a lot of exposure in the past year, or you are pregnant, you will need to communicate that to the doctor.

Below you will find a description of the different types of x-rays being utilized in Dentistry today.

Periapical X-rays

Periapical x-rays are taken, in order to capture the bottom of the roots of the exposed teeth. This will reveal any type of pathology in that area. The size of the imaged teeth is somewhat distorted, due to the exaggerated angulation of the x-ray cone.

Bitewing X-rays are not designed to capture the roots of the teeth. They are optimized to give the most undistorted and accurate view of a tooth, with respect to its size. This is achieved by angulating the x-ray beam perpendicular to the long axis of the tooth.

A full mouth set of x-rays is a combination of bitewings and periapicals (typically 18 films), covering all of the teeth in your mouth.

Panorgraphic X-ray (Panorex)

A panorex is a very large, single x-ray that shows a frontal picture of all the facial bone structures, as well as the teeth. Their advantage is that everything is visible on one x-ray, the disadvantage is that the structures are somewhat enlarged, so that it can not be used when very exact measurements are needed.

Cephalometric X-ray (Lateral Ceph)

Lateral Cephs are single-film x-rays, representing a side-view image of the entire facial area, including part of the cranial cavity, and part of the cervical spine. This type of x-ray is often used by Orthodontists and Oral Surgeons.

CT-scans are a special kind of x-ray, that show a certain area in "slices" which are 1-5mm apart. These are extremely accurate and have the advantage that they also show the soft tissues, in addition to the bone structures. These type of x-rays are frequently used in conjunction with implant dentistry.