The American Academy of Pediatric Dentistry recommends that a child have their first dental visit at the age of one year. Many dentists and parents believe this is a little too early, but agree that two years of age is appropriate. Dental x-rays are not usually taken at this first visit, but there are times that they will be indicated for a very young child.

Parents should discuss the need for x-rays with their child’s dentist. The decision to take them should be made jointly so parents feel confident that their child is receiving the best possible care.

One situation in which x-rays are necessary is in the case of trauma to the mouth. If a child has an oral injury it is important for the dentist to evaluate the soft tissue, the teeth and the supporting structures, i.e. the bones of the jaw. X-rays will help to rule out fractures of roots or the jaw.

When a dentist examines a child’s mouth it is easy to detect cavities on the chewing surfaces of the teeth. However, if the teeth are close together the dentist cannot detect decay between the teeth. In this situation x-rays would be recommended. X-rays of the molars, called bitewings, are appropriate. No more than one on each side should be taken. Parents should discuss the number of x-rays to be done before they are taken. The dentist or hygienist should explain the need and use of each one.

If a child’s mouth is not crowded and there are spaces between the teeth, bitewing x-rays should not be taken. An exception to this rule is the presence of swelling or an unusual lesion detected by the dentist. If a child is cavity-free and the oral hygiene is good, the dentist can wait 12 to 18 months between x-rays. When there are both permanent and primary teeth in the mouth, the dentist may recommend a panoramic film. This will show development and position of teeth which have not yet erupted into the mouth. The panoramic x-ray is often used to determine whether a child will need orthodontic treatment. It can also show abnormalities such as tumors or cysts.

Whether films are digitally or conventionally taken, parents must be aware that there will be radiation exposure. A high quality dental practice will always limit the number of films and be able to justify each one. Even though dental insurance may cover numerous x-rays, as few as possible should be done. The child must be protected with a lead shield for every exposure.

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