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Pediatric Dentistry

January 19, 2016


X-ray was discovered by Roentgen in 1895.

One of the most important diagnostic aids
in Dentistry.
Radiographs are essential in Pediatric
Dentistry for:
Early diagnosis of caries
Eruptive or developmental problems
Restorative procedures requiring an
accurate assessment of the proximity
of caries to the pulp
Checking of pulpal outline.

Selection of appropriate radiographs

Selection of appropriate radiographs for
pediatric patients depends on
1. Age of the child
2. Size of the oral cavity
3. Level of the patient cooperation

Ideal technique used in taking the

radiograph should:
1. Expose the patient to minimum
amount of radiation
2. Require a few radiographs as
3. Take a little time as possible
4. Provide a diagnostically accurate
examination of the dentition and
supporting structures


X-radiation has the ability to impart some
of its energy to the matter it traverses.
High levels of radiation much information
and subsequent damage are known.
Low levels of radiation (as used in
diagnostic radiology) effects on biologic
systems are virtually known.
Assumption of damage from low level
radiation is based on data from high levels.
Risk that the patient may encounter is
focused on three primary biologic effects:
1. Carcinogenesis

2. Teratogenesis (Malformations)
3. Mutagenesis occur as response of
genetic tissue (gonads)
Critical organs vulnerable to possible
development of late adverse biologic
1. The skin (cancer)
2. Red bone marrow (leukemia)
3. Gonads (mutation, infertility and
fetal malformations)
4. Eyes (cataracts)
5. Thyroid (cancer)
6. Breasts (cancer)
7. Salivary glands (cancer)
Younger tissues and organs are more
sensitive to radiation.
Sensitivity is decreasing from the period
before birth until maturity.
Higher doses of radiation can be withstood
by localized areas than the whole body.
Method of protecting the patient:
Lead apron Protects the gonads
and chest
Thyroid collar Protects the thyroid
Radiographic examination may include the
Maxillary anterior occlusal
Mandibular anterior occlusal
Right bitewing
Left bitewing
Maxillary and mandibular anterior
occlusal or periapical
Right and left maxillary posterior
occlusal or periapical
Right and left primary mandibular
molar periapicals
Two posterior bitewings
4 primary molar-premolar
4 canine periapicals
2 incisor periapicals
2 posterior bitewings
The 12-film survey

4 permanent molar x-ray

Commonly used radiographic techniques

1. Bitewing
2. Periapical
3. Occlusal
4. Panoramic

Patient Category

New Patient all new

patients. To assess
dental disease and

Primary Dentition
Transitional Dentition
Permanent Dentition
(prior to the eruption of (after the eruption of the (prior to the eruption of
1st permanent molars)
1st permanent molars)
the 3rd molars)

Posterior Bitewing
examination if proximal
surfaces of primary
teeth cannot be
visualized or probed

Recall Patient clinical Posterior Bitewing

caries or high-risk
examination 6 months
factors for caries
intervals or until no
carious lesions are

Individualized x-ray
examination consisting
of periapical/occlusal
views and posterior
bitewings or panoramic
examination and
posterior bitewings

examination consisting
of posterior bitewing
and selected periapicals.
A full mouth intraoral
examination is
approriate when the
patient presents with
clinical evidence of
generalized dental
disease or history of
extensive dental

Posterior Bitewing
examination 6-months
intervals or until no
carious lesions are

Posterior Bitewing
examination at 6-12
months intervals or until
no caries are evident

No clinical caries and

no high risk factors for

Posterior Bitewing
Posterior Bitewing
examination at 12-24
examination at 12-24
months intervals if
monthd intervals
proximal surfaces of
primary teeth cannot be
visualized or probed

Periodontal disease or
history of periodontal

Individualized x-ray
exam consisting of
selected periapical and
bitewing x-rays where
periodontal diseases
(other than non-specific
gingivitis) can be
demonstrated clinically

Growth and

Usually not indicated

Individualized x-ray

Posterior Bitewing
examination at 18-36
months intervals

Periapical or panoramic

development assessment

exam consisting of
examination to assess
periapical/occlusal or
developing third molars
panoramic examination