DENTAL RADIOLOGY RELATED TO

PEDODONTICS

Dr Sunny Purohit
Dept. of PEDIATRIC & PREVENTIVE
DENTISTRY
SDCH
 Introduction
• Wilhelm Conrad Roentgen's - x-ray in 1895
• Early diagnosis of caries- prevents dental pain,
extraction, and emotional stress,
• eruptive or developmental problems may
reduce the need for prolonged orthodontic
procedures
• Some restorative procedures require an
accurate registration of the pulpal outline that
only a radiograph can reveal
Interesting Fact!
Bertha’s Hand

X rays- “x”
algebraic
designation of
unknown

Dr Otto Walkhoff-1896-
First X ray Radiograph
a : enamel

B : dentin
a
C : pulp c
b
Lamina dura:
It is a thin radio-opaque Layer Of dense bone surrounding the
Tooth socket.

It is thicker than the surrounding Trabecular bone and thickness

Increases with increase in amount In the occlusal stress
Alveolar crest

The gingival margin of the

Alveolar process that extends
Between the teeth is
Apparant on radiographs
As radiopaque line called
Alveolar crest.

It is considered as normal
If it is not > than 1.5 mm
From cej of adjacent teeth.
 Ideal technique
• should expose the patient to a minimum
amount of radiation,
• few radiographs as possible,
• Take as little time as possible, and
• provide a diagnostically accurate examination
of the dentition and sup-porting structures
 Intraoral film size

• Size 0 - Used for bite wing and IOPA of small

children
• Size 1 - Used for anterior teeth in adults
• Size 2 - Standard film, used for anterior
occlusal, IOPA and bite wing in mixed and
permanent dentition
• Occlusal films - 57 x 76mm used for maxillary
or mandibular occlusal radiographs
Intraoral Periapical (IOPA) Radiographs
Indications:
• To evaluate the development of the root end and to
study the periapical tissue
• To detect alterations in the integrity of the periodontal
membrane
• To evaluate the prognosis of the pulp treatment by
observing the health of the periapical tissues
• To identify the stage of development of unerupted
teeth
• To detect developmental abnormalities like
supernumerary, missing or malformed teeth
 Contd.
Indications:
• For early detection of pathologic changes
associated with teeth
• For space analysis in the mixed dentition
• To assess the path of eruption of permanent
teeth
• To evaluate the extent of traumatic injuries to the
root and alveolus
 Radiographic techniques commonly
used in children
Intraoral
• lOPA
• Bite wing –Proximal Caries
• Occlusal –Sialolith etc…
Extraoral
• TMJ and lateral oblique view
• Lateral cephalograms, PNS view
• Orthopantomography
Bitewing Xray
Occlusal Radiograph
 Panoramic Radiographs

• It is an extra oral radiograph in which the X-ray

film and the X-ray source move in opposite
directions.
• It can be used to visualize the entire dentition.
• This reduces the total number of films and thus
reduces the radiation exposures.
• This can also be used to introduce the child to
radiography as it is an extraoral radiograph.
 Contd.

• It requires a total of 15 to 22 seconds to record.

• Although it is considered as a supplement it
cannot substitute intraoral radiographs in the
diagnosis of caries or for viewing the periapical
region.
• This view can be useful in handicapped children
and for viewing a wide area of the TMJ and
associated region.
Panoramic Radiographs
 Localization Technique(SLOB)

localizing embedded or unerupted teeth

uses the buccal object rule, which states
that the image
of any buccally oriented object appears to
move in the
opposite direction from a moving x-ray
source. On the
other hand, the image of any lingually
oriented object
appears to move in the same direction as
a moving x-ray
source
Horizontal angle of the x-ray tube is
shifted posteriorly, the canine appears to move anteriorly.
The
canine lies buccal to the erupted teeth.
 Radiographic examinations

Four film series: This series consists of a

maxillary and mandibular occlusal radiographs
and two posterior bitewing radiographs.
 Radiographic examinations

Eight film survey:

• This survey includes a maxillary and
mandibular anterior occlusal radiographs.
• Four molar periapical radiographs.
• Two posterior bitewings
 Radiographic examinations

Twelve film survey:

• This survey include maxillary and mandibular
permanent incisor periapical radiographs.
• Four primary canine periapical radiographs.
• Four molar periapical radiographs.
• Two posterior bitewing radiographs
Twelve film survey
 Radiographic examinations

Sixteen film survey: This examination consists of

the twelve-film survey and the addition of
four permanent molar radiographs.
 Child's Cooperation
• Child's cooperation is as essential to
radiographic examination as is the selection of
correct radiographic technique. Both increase
the probability of success and reduce
additional radiographic exposure.
• Dental radiographic equipment can be
threatening or can generate curiosity,
depending on the child
What is this ?
 Management of Pediatric Paient
• Euphenisms-Camera
• TSD-Tell Show Do
• In the child less than three years of age it may be
necessary for the child to sit in the parent’s lap while
the radiograph is exposed.
• Obtaining the least difficult radiograph first (such as an
anterior occlusal) desensitizes the child to the
procedure.
• Correct settings are made on the apparatus and the x-
ray head is properly positioned before placing the film
in the child’s mouth.
 Positioning the Radiograph

• Positioning the radiograph

vertically in the mouth for both
periapical and bitewing radiographs
reduces the distal extension of the
radiograph and may result in
greater tolerance by patients,
especially those with a mild gag
reflex.
• The vertical bitewing radiograph
provides greater detail of the
periapical area.
 Contd.

• The Snap-A-Ray is also useful for

those patients that have a fear
of swallowing the radiograph.
• By biting on the large positioning
device and watching in a mirror
they are assured they will not
swallow the radiograph.
 Desensitization Techniques

• Desensitization is defined as gradually exposing the

child to new stimuli or experiences of increasing
intensity.
• An example of this is introducing the patient to x-
rays by initially taking an anterior radiograph which
is easier to tolerate than a posterior radiograph.
 Contd.
• Another example of desensitization is
the “Lollipop Radiograph
Technique.” The child is given a lollipop
to lick (preferably sugarless).
• After a few licks, the lollipop is taken
from the child and a radiograph is
attached to the lollipop using an
orthodontic rubber band. The lollipop
with the attached film is returned to the
child, who is told to lick the lollipop
again.
• After a few licks, the child is told to hold
the lollipop in his mouth while we take a
tooth picture. The exposure is made.
Modeling
 Special technique for the handicapped
child
• The physically handicapped child cannot
usually hold a film in his\her mouth with
fingers.
• In such a child radiograph can be taken by the
parent holding the child or by the use of film
holding devices.
• If the child is unable to open the mouth, extra
oral radiographs such as oblique lateral
radiograph should be preferred.
 Radiation Effects
• x-radiation is its ability to impart some of its
energy to the matter it traverses.
• If that matter is living tissue, then some
biologic injury may occur

effects of low levels of x-radiation (as used in

diagnostic radiology) on biologic systems are
virtually unknown
• 3 primary biologic effects of low-level radiation:
• (1) carcinogenesis,
• (2) teratogenesis (malformations), and (3) mutagenesis.
• Carcinogenesis and malformations are a response of
somatic tissues and in most instances are believed to
have a threshold response; that is, a certain amount of
radiation is necessary before the response is seen.
• Mutation may occur as a response of genetic tissue (gonads)
to x-radiation and is believed to have no
threshold. In general, younger tissues and organs are
more sensitive to radiation
 Critical organs and the
associated adverse biologic effects
(1)The skin (cancer),
(2) Red bone marrow (leukemia),
(3) The gonads (mutation, infertility, and fetal
malformations),
(4) The eyes (cataracts),
(5) The thyroid (cancer),
(6)The breasts (cancer),
And (7) possibly the salivary glands (cancer
 Radiation hygiene measures
• Proper registration and maintenance of radiographic units
• Training of personnel who are associated with radiography
• Dosage monitoring
• Radiation protection of the child patients
by using lead apron with thyroid collar.
• Use of long lead-lined cylinder and cone
positioning devices
• Use of electronically controlled exposure timer
• Use of high speed films
• Use of automatic processing machines that give
good consistent result
• Employing proper technique to avoid the chances
of repeating exposure.
 High Speed Films
• Faster film speeds have contributed most
significantly
to the reduction in radiation to the patient. Film
• speeds of the "D," "E," and "F" groups are
currently available for intraoral radiography.
• Faster film also reduces error from patient
movement
• AAPD

Guideline on Prescribing Dental

Radiographs for Infants, Children,
Adolescents, and Persons with Special
Health Care Needs
THANK YOU