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How Many Dental X-Rays Do Your Kids Need?

Delta Dental encourages parents to talk to their dentist about their children's risk for tooth decay and the need for X-rays.


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OAK BROOK, Ill. (Feb. 12, 2014) - February is National Children's Dental Health Month, the perfect time to take your kids to the dentist for one of their regular visits.

But before you do, Delta Dental encourages you to be well-informed about how often your child should have dental X-rays. Those X-rays are a valuable tool for finding problems in teeth and the bones surrounding teeth. However, all X-rays use ionizing radiation that can potentially cause damage. Though it is spread out in tiny doses, the effect of radiation from years of X-rays is cumulative. The risks associated with this radiation are greater for children than for adults.

"X-rays are an important tool for dentists to diagnose dental diseases. However, they do not need to be part of every exam," said Dr. Bill Kohn, DDS, Delta Dental Plans Association's vice president of dental science and policy. "They should be ordered only after the dentist has examined the mouth and has determined that X-rays are needed to make a proper diagnosis. In general, children and adults at low risk for tooth decay and gum disease need X-rays less frequently."

The purpose of X-rays is to allow dentists to see signs of disease or potential problems that are not visible to the naked eye. They are usually ordered after the dentist has done a clinical exam and considered any signs and symptoms, oral and medical history, diet, hygiene, fluoride use and other factors that might suggest a higher risk of hidden dental disease. So be sure that your dentist checks your child's teeth, health history and risk factors before deciding an X-ray is necessary.

Ideally, your dentist should adhere to the guidelines established by the U.S. Food and Drug Administration and the American Dental Association. The following chart, adapted from those guidelines, gives a basic timeline for recommended frequency of X-rays by age group. Keep in mind that multiple factors such as the child's current oral health, future risk for disease, and developmental stage determine need, and some children will require more X-rays, and some fewer.

Even though the individual risk from a necessary X-ray exam is quite small when compared to the benefit of aiding accurate diagnosis or guiding a treatment, dentists are encouraged to follow the ALARA principle, that is "As Low As Reasonably Achievable." In other words, only order what is absolutely needed to make a diagnosis.

First visit
Routine recall visitRoutine recall visit
Active tooth decay or history of cavities (Increased Risk)No active tooth decay or history of cavities (Low Risk)
Young children (ages 1-5), with no permanent teeth Personalized exam which may consist of bitewing* X-rays of back teeth (if no gaps exist between teeth that allow the dentist to examine the sides of teeth) and select individual (periapical)** X-rays, usually of front teeth. Bitewing X-rays every six to 12 months Bitewing X-rays every 12 to 24 months
Older children (ages 6-12), with some or all permanent teeth Personalized exam consisting of bitewing X-rays of back teeth and select periapical X-rays, usually of front teeth; or a panoramic X-ray.*** Bitewing X-rays every six to 18 months Bitewing X-rays every 12 to 36 months
Adolescent, with permanent teeth but no wisdom teeth# Personalized exam consisting of bitewing X-rays of back teeth and select periapical X-rays; or a panoramic X-ray; or a full mouth survey of X-rays (FMX) if evidence of widespread oral disease. Bitewing X-rays every six to 18 months Bitewing X-rays every 12 to 36 months

Source: (Accessed February 11, 2014).

*Bitewing X-rays show upper and lower teeth in one film; each molar tooth is seen from its crown to about the level of the bone that supports the teeth. Bitewing X-rays are used to detect decay between teeth and changes in bone caused by gum disease.
**Periapical X-rays show the whole tooth, from the crown to beyond the end of the root to where the tooth is anchored in the jaw. Each periapical includes all the teeth in one portion of either the upper or lower jaw. These films can find problems below the gums, including impacted teeth, abscesses, cysts or other problems.
***Panoramic X-rays capture all teeth on a single-X-ray. Usually used to detect positions of unerupted teeth, abscesses, evaluate growth and development. Approximately once every five years, but depends on situation and individual needs.

#Monitoring of third molar (wisdom tooth) development in late adolescence (ages 16-19) is recommended using selected periapical X-rays or a single panoramic X-ray.

Many people believe that if their dental plan pays for a certain number of X-rays, they should take advantage of that benefit. For most patients, however, this yearly X-ray exposure is excessive and unnecessary. Don't let your insurance coverage dictate your decision. Dental X-rays should only be ordered after your dentist has personally checked your child's teeth and determined that they need additional information to make a correct diagnosis. What is apparent through one type of X-ray often is not visible on another and your dentist's clinical judgment will determine what is necessary. If you have questions or concerns related to dental X-rays, discuss them with your dentist.