X-rays are an essential part of any dental care treatment plan. They are diagnostic pictures of the teeth, bones, and soft tissues around them, but they can also be preventive, because it is possible for both tooth decay and periodontal disease to be missed during a clinical exam, so radiographic evaluation of the dental and periodontal tissues is a critical part of the comprehensive oral examination.  These are many of the reasons X-rays are needed:

  • Identify problems in the mouth early, before there are symptoms, such as tooth decay (especially between teeth), damage to the bones supporting the teeth, and dental injuries like broken tooth roots.
  • See teeth that are not in the right position or are not breaking through the gum properly, or are impacted, i.e., too crowded to break through the gums.
  • Find growths like cysts or tumors, and abscesses.
  • Evaluate the position of developing permanent teeth in children who still have their baby teeth.
  • Plan treatment for extra-large cavities, root canal surgery, placement of dental implants, and difficult tooth extractions.
  • Plan orthodontic treatment for teeth that need alignment.

There are two basic categories of X-rays:  1) Intraoral (the film is inside the mouth), and 2) Extraoral (the film is outside the mouth).

INTRAORAL X-rays:  The most common type; give a high level of detail, allowing dentists to develop accurate and effective treatment plans.  There are several types of intraoral X-rays, and technology has been developed to make them safer and more convenient:

Bite-wing:  Used for back teeth; shows decay between teeth; you bite down on a wing-shaped device that holds the film in place while the X-ray is taken.

Periapical:  Used for one or two teeth at a time; similar to bite-wing; shows all of the tooth, crown to root end; can be full mouth (FMX).

Occlusal:  Used for tooth development and position in children; shows most of a full arch; larger than most X-rays.

Digital:   A high-tech replacement (since 1994) for traditional dental X-rays, but an electronic sensor takes the place of film in the bite-wing, that sends the image directly to a computer.  There are many advantages:

  • Images are much clearer, so diagnosis and treatment are much more accurate.
  • Images can be enlarged for a better visual of the tooth’s structure.
  • Brightness, contrast and color can be adjusted; your dentist can better see small cavities.
  • Processed rapidly, often instantly viewable on a computer.
  • Subtraction radiography – dentists compare current images to previous images of the same tooth, helping them find even the smallest changes in your tooth’s structure.
  • Less radiation (up to 90%) is needed to make an image than with standard dental X-rays.
  • Can be printed out If a hard copy of your X-ray is needed.
  • Can be e-mailed to a dental specialist for immediate review.
  • Green – better for the environment! No chemicals or silver are used to develop film; no wasted space of a darkroom; no need to store film that accumulates in a dentist’s files.

EXTRAORAL X-rays:  The film or sensor is outside the mouth, on the opposite side of the head from the X-ray source, some with a scanner that rotates around your head.  They are usually not used to detect cavities or flaws in individual teeth, but they are used to:

  • Keep track of growth and development
  • Look at the status of impacted teeth
  • Examine the relationships between teeth and jaws
  • Examine the bones of the face

There are several types of extraoral X-rays:

Panoramic:  A quick way to show the entire mouth on a single X-ray, as opposed to doing 18 bite-wing photos, so less radiation; less accurate than bite-wings. *

Standard Computed Tomography (CT) scan:  Used to plan dental implant placement; done in a radiologist clinic or hospital; radiation exposure higher than traditional X-rays.

Cone-beam Computed Tomography (CBCT) scan:  Also used for dental implant selection and placement, provides three-dimensional images, uses less radiation than a standard CT.

Lateral Cephalogram:  Used for orthodontic treatment; X-rays of the entire side of the head, to see teeth in relation to the jaw and patient’s profile.

Hand-held units:  Facilitate imaging when patients are sedated or anesthetized.

* The panoramic was developed by the U.S. Army, as a quick way to get an overall view of a soldier’s oral health, since soldiers with a toothache were incapacitated from duty.  Exposing eighteen films per soldier was very time consuming, and it was felt that a single panoramic film could speed up the process. It was later discovered that while panoramic films can prove very useful in detecting and localizing mandibular fractures and other diseased or damaged areas of the lower jaw, they were not very good at assessing conditions like bone loss or tooth decay.

RADIATION:  The amount of radiation used in dental X-rays is low, equivalent to a few days’ worth of background environmental radiation exposure, or similar to the dose received during a cross-country airplane flight (concentrated into one short burst aimed at a small area).

If you are interested in x-rays (radiographs) in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.