November 1st is X-ray Day! In honor of that, I thought I'd answer some questions about dental radiographs.
Q: Why did you call them radiographs instead of x-rays?
A: Good question! Most of the time, in casual conversation, we call them x-rays. The technical answer is that the x-rays are what comes out of the x-ray machine that create the image. The image that we see is called a radiograph. (But, as I said, in casual conversation, most of us just call them x-rays.)
Q: Why are dental x-rays important?
A. They help us to see areas of your mouth that we can't see just by looking in your mouth. If you've flossed your teeth, you've probably noticed that there's a spot where it's hard to get the floss between the teeth. We call that a contact point. When teeth are close together like that, we can't see in between them to see if decay has started. We also can't get our cavity detecting instruments into the contact point to see if decay has started. An x-ray helps us see that area.
Gums cover your jaw bone. The dental x-rays also let us "see" that bone so we can check for bone loss, abscesses or other pathologies in the bone. Some x-rays also let us see bones of the skull and bones that make up the tempromandibular joint (jaw joint).
Q: You said only some x-rays let you see certain bones. What are the types of dental x-rays and what are they used for?
A: There are several types of x-rays that your dentist may take:
Bitewing x-rays: usually 1-4 films though vertical bitewings may involve up to 7-8 films. The traditional method for these is to put the film or sensor into the mouth and you bite down on a tab or plastic bite block. These show both top and bottom teeth from about the gumline to the biting surface. They're most helpful for seeing cavities in between your teeth though for those with healthy bone levels around the teeth, we can sometimes see that as well. Newer panoramic type machines can also take bitewing x-rays with only a bitestick in between your front teeth. These give us a bit more information than the traditional bitewings since there is more bone repressented and we can see the ends of the roots of your teeth. (It's kind of a combination of bitewing x-rays and periapical x-rays which I'll discuss next. The panoramic machine's bitewings do not always show your front teeth, so if you're having a problem with front teeth, a different type of x-ray might be needed.)
Periapical x-rays: traditionally a film or sensor was placed in the mouth near the tooth in question and you'd bite down on a plastic holder. This type of film shows teeth from the biting surface of the tooth to the end of the root. (The end of the root is called its apex.) It is most often used to see if there is a dark circle around the apex of the root (which indicates an abscess) or to see if there is other pathology around the tooth. It can also be used to check the height of bone around a tooth. With the traditional method usually 1-3 teeth (possibly more for lower front teeth) are shown on the x-ray. Newer panoramic machines can take this type of x-ray too, again with only a bitestick between your front teeth. Depending on the settings, we may see more teeth per film than we would with the traditional method of taking them. If you have a root canal, this type of x-ray is used to check that the instruments have reached the end of the tooth root.
Full Mouth Series: This is a set of approximately 18 films or images. The full mouth series includes both bitewing and periapical views of each tooth you have. In the traditional method, films or a sensor would be inserted into your mouth and a series of images taken. They're used for the same reasons as described under each individual type of film. Periodontists like this type of x-ray because it shows them bone levels around teeth. Some offices skip areas of the mouth that don't have teeth, while others will still try to take a film there just to check for pathology.
Panoramic x-ray: the panoramic x-ray is taken in a machine where part of the machine rotates around your head to produce the image. In most cases, there is only a bite stick between your front teeth. (Many people find this more comfortable than having the film or sensors inside their mouth.) It's similar to a full mouth series in that we see all your teeth, but it also shows areas where you don't have teeth, as well as the jaw bones and the bony aspects of the tempromandibular joint area (jaw joint). It is useful for detecting pathology and seeing changes in the bone. It's not as accurate for detecting decay that is just starting (incipient decay) but larger areas of decay can often be seen on this type of x-ray. It's also helpful for checking on unerupted permanent teeth in children and unerupted wisdom teeth.
Cephalometric x-ray: this type of x-ray always reminds me of a profile (only it's showing the bones, not the facial features). Orthodontists use this view most often but there are other times it is useful as well.
Occlusal x-ray: Traditionally, this type of x-ray involved a larger film size and it was set in the mouth almost like you were biting into a sandwich. It was often used to check for unerupted front teeth. I'm not sure if digital platforms make a sensor in that size. CBCT units might be needed to render this view.
CBCT (Cone Beam): This is a specialized machine that's often used for surgical planning (dental implants, orthognatic surgeries etc.) and to detect fractures in teeth. It kind of reminds me of a medical tomography scan. The software and machine take a series of images which the software then compiles into an image, but the operator can look through the various "slices" or images that the machine took to see various levels and to see the position of anatomic structures.
I hope this helps you to understand why your dentist takes dental x-rays. If you're curious to see what a specific type of x-ray looks like, ask your dentist to show you at your next dental visit.
*Note: The information in this post article is not meant to replace the clinical judgement of your healthcare professionals.
Jennifer G. Robb, DMD is a general dentist. Her office is located at 1320 Cooper Foster Park Rd. W, Lorain, OH 44053.
Most people ration out the Halloween candy haul for weeks, but is that wise? After you eat sweets, bacteria feed on the sugars and starches left on your teeth and form plaque. Eventually, the acids in the plaque begin to wear away the enamel coating on your teeth, forming tiny holes (cavities) that grow larger and larger over time.
Eating all of your candy at once and then brushing your teeth after is actually less cavity-causing than parceling out your candy a little at a time each day (unless you plan to thoroughly brush your teeth after each daily treat—something that’s unrealistic for most of us.) From a cavity-causing perspective, the bacteria have a limit to how fast they can make acids—at some point there’s a threshold where they can’t make any more—whether you have one piece of candy or five.
In school, they used to have me state that each sugar exposure causes 20 minutes of acid production in your mouth. So eating one Lifesaver until it is gone is 20 minutes. If you then put a second one in, it’s another 20 minutes, and so on, totaling quite a few hours of acid production. But if you put the whole roll of Lifesavers in your mouth all at once, it would only be 20 minutes of acid production.
What may surprise you is that the treats that are most tooth friendly are those made of chocolate. Chocolate-based candy melts quickly in the mouth. Hard candies, gummies, candy corn and other sticky candies tend to last longer and/or stick to teeth where they are more likely to cause cavities.
Dr. Jennifer Robb is a general dentist who treats both children and adults at her dental office located at 1320 Cooper Foster Park Rd., Lorain, OH 44053. Call 440-960-1940.
This year's Carol Burnett Award, presented at the Golden Globes, goes to Ellen DeGeneres for her “outstanding contributions to the television medium on or off the screen.” This is the latest in a long list of honors for the comedienne, talk show host and activist that includes Emmys, Grammys and Teen Choice Awards. And one not quite as well-known: a 2004 “Flossy” award.
DeGeneres received this honor from the National Flossing Council in recognition of her passionate promotion of oral hygiene, particularly flossing. She wrote about its virtues in her 2003 book, The Funny Thing Is…., saying, among other things, “Don't even think for a second that you can get away with not flossing.”
DeGeneres's motivational cheerleading for flossing is helpful and necessary because, well, many of us just don't like doing it. It requires more manual dexterity than its more popular sibling, brushing. And the tendency for the floss to gunk up with plaque residue for some is simply unpleasant.
Mainly, though, many folks think brushing is enough. Not so fast, according to dental professionals. While brushing removes disease-causing bacterial plaque from broad tooth surfaces, it can't effectively get into the spaces between teeth. It takes flossing to clear plaque from these more difficult areas.
But don't fret: There are ways to make flossing an easier—and more pleasant—task.
Ask us for help. As we said before, flossing does take some hand dexterity and coordination to perform. You may also wonder if you're doing it effectively. We can provide training and tips on how to be a more effective flosser at your next visit.
Practice, practice, practice. You probably think nothing of riding a bicycle, and yet it probably took you weeks or months as a kid to become proficient. Similarly, your first attempts at flossing might feel awkward, but you'll improve with practice, so don't give up.
Brush before you floss. Most people floss before brushing, but if you tend to encounter a lot of soft plaque debris that makes flossing “icky” for you, then try brushing first to clear a good portion of it out of the way before you floss. Just be aware, most professionals believe that flossing first is better because it loosens up debris between teeth so the bubbles from the toothpaste can carry it away. But any flossing is better than no flossing!
Try flossing tools. For some people, floss picks, small pre-threaded tools you can use with one hand, seem easier to maneuver than regular floss thread. If you have issues with manual dexterity, an oral irrigator can make the task easier: This handheld device uses a stream of pressurized water to loosen and flush away plaque between teeth.
So, follow Ellen DeGeneres's advice she gave Tulane University graduates during a commencement speech: “Remember to exfoliate, moisturize, exercise…and floss.” The latter, along with brushing, will certainly help keep your teeth and gums healthy.
If you’ve been to the dentist, you may have heard the words “your gums are inflamed”, but do you really understand what that means or why it’s important?
Inflammation is a localized, protective reaction to injury or infection. Signals of inflammation include: redness; swelling; pain; heat and, for your gums, bleeding. In response to inflammation, your body produces chemicals to try to ward off or destroy the irritating agent. If your inflammation continues for a long time, these chemicals can cause damage to both the surrounding area and your entire body.
The most common spot for oral inflammation is your gums. In this case, the irritants are plaque and calculus. Plaque is a mix of saliva, food and oral bacteria. Calculus, which is also called tartar, is plaque that has hardened. If the inflammation only affects your gums it is called gingivitis. Gingivitis can be reversed if the irritants are removed. Plaque can be removed with a toothbrush or dental floss. Tartar or calculus need to be removed by a dentist, dental hygienist, or dental specialist.
When gingivitis is present for a long time, the chemicals begin to break down the bone around your teeth. Once your bone is gone, it’s gone. There’s no way to replace it. When enough bone is lost, your tooth will loosen and need to be taken out. Once your jaw bone is involved, the process is called periodontitis or periodontal disease.
Inflammation chemicals and other disease-causing agents can enter your bloodstream when your inflamed gums bleed. Many scientific studies link inflammation to disease:
- Heart disease and gum disease seem to share some of the same agents. The common factor seems to be inflammation.
- Diabetes and gum disease have a complex interaction where both diseases affect each other.
- Pregnant women who have oral inflammation are more likely to have premature labor and babies with low birth weights.
- Some respiratory diseases show oral bacteria in the airways.
- Rheumatoid arthritis symptoms seem to worsen when oral inflammation is also present.
In addition, scientists are currently studying whether inflammation in the brain might be a cause of Alzheimer’s disease.
Because oral inflammation is often not painful in its early stages and is not life-threatening, you may think “it’s no big deal” and feel that it doesn’t need to be treated. It is important to remember that your oral health and your overall health are closely related, and making dental care part of your regular schedule is the best way to maintain your health.
If you have any of the symptoms of gum inflammation and do not have a dentist, please call my office at 440-960-1940. We’d love to help you. We are also online at www.drjrobb.com
*Note: The information in this article is not meant to replace the clinical judgement of your healthcare professionals.
Even the simplest, everyday things can be challenging for a child with special needs. Dental care is no exception.
If you have a child with a chronic condition that affects their physical, intellectual or behavioral abilities, you know how difficult keeping up with dental care practices can be. Here are 4 tips to help make dental care easier and ensure your child has healthy teeth and gums.
Take an active role in hygiene. Depending on their abilities, you may need to take a more active role in daily teeth cleaning. If you have to brush their teeth for them, it's usually easier to have them face you “knee-to-knee.” You can also use a second brush to keep their mouth propped open if they tend to bite or clench down while brushing.
Model behavior. If your child could eventually brush for themselves, it may still be a long training road. It can be an easier task if you make a habit of brushing your teeth together, or have them brush with a sibling. Not only does this allow you to monitor their progress, their learning process may be easier watching another person brush and then mimicking their actions.
Find the right dentist. Many children with special needs are subject to anxiety surrounding healthcare visits, including going to the dentist. Choosing the right dentist, skilled in the technical aspects of treatment for a special needs child and providing a “kid-friendly” environment, can make all the difference in the world. A pediatric dentist is often a good fit for children with chronic conditions.
Coordinate medical and dental care. A special needs child could have underlying health problems that complicate dental care, so keep your dentist well-informed about their overall health. Do likewise with their medical providers, particularly if their condition or treatments impact dental health, as in the case of medications they're taking that could inhibit saliva flow.
Ongoing dental care for a child with a chronic health condition can be difficult. But keeping their teeth and gums healthy is an important part of fostering greater overall health.
If you would like more information on dental care for special needs children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Managing Tooth Decay in Children With Chronic Diseases.”
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