By the Lakehurst Dental Team · Medically reviewed by Brian S. Klohn, DMD, University of Pennsylvania School of Dental Medicine, 1991 · Lakehurst Dental, 19 Union Avenue, Lakehurst, NJ
Quick Answer
Dental X-rays show what an examination physically cannot — decay between teeth, bone levels around the roots, infection at root tips, and unerupted or impacted teeth. There is no universal schedule. The correct interval is set from your individual risk: someone with active decay or gum disease needs them more often than someone with a stable, low-risk mouth. Digital sensors, which most practices now use, require substantially less radiation than the film they replaced, and a lead apron with thyroid collar reduces it further. You can decline, but you should understand what is being checked for and agree an alternative plan for monitoring it.
What This Article Covers
- Why the Examination Alone Is Not Enough
- The Types, and What Each One Is For
- How Often Is Actually Right
- Radiation, in Proportion
- Pregnancy, Children and Specific Situations
- Can You Decline?
- What Actually Happens During It
- Frequently Asked Questions
Why the Examination Alone Is Not Enough
A dentist looking in your mouth can see the outer surfaces of the teeth and the gum tissue. That is genuinely useful, and it is also a minority of what matters.
Several of the most common and most consequential problems are, by their nature, invisible:
- Decay between teeth. Where two teeth touch, the surface is hidden from view and from light. This is one of the most common locations for cavities, and it cannot be diagnosed by looking.
- Bone level around the roots. Gum disease is measured by attachment and bone loss, and bone is not visible.
- Infection at the tip of a root. An abscess forming in the bone produces a dark area on a radiograph long before it produces swelling.
- Decay underneath an existing filling or crown. Hidden by the restoration itself.
- Unerupted, impacted or missing teeth, and their position relative to nerves.
- Cysts and other pathology in the jaw, which are often entirely symptomless.
The blunt summary: an examination without radiographs is checking the parts of the tooth you can already see yourself.
The Types, and What Each One Is For
| Type | What it shows | Typically used for |
|---|---|---|
| Bitewing | The crowns of upper and lower back teeth together, and the bone crest between them | Decay between teeth; early bone loss. The routine workhorse |
| Periapical | One or two teeth in full, from crown to root tip and surrounding bone | Investigating a specific painful tooth, infection, or before root canal treatment |
| Panoramic | A single wide image of both jaws, all teeth, the sinuses and the joints | Overview; wisdom teeth; assessing a new patient broadly; suspected pathology |
| Cone beam CT (CBCT) | Three-dimensional imaging | Implant planning, complex root anatomy, surgical assessment. Higher dose — used selectively |
These are not interchangeable. A panoramic image is excellent for overview and poor for detecting early decay between teeth; bitewings are the reverse. If you are told you need a specific type, it is reasonable to ask what it will show that the others would not.
How Often Is Actually Right
This is where a lot of confusion sits, so it is worth being direct: there is no fixed universal interval, and any practice applying one identical schedule to every patient regardless of circumstances is not individualising care.
The interval should be based on risk, and it should change as your risk changes. Factors that shorten it:
- A history of frequent decay, or active decay now
- Active or previously treated gum disease
- Dry mouth, whether from medication or a medical condition
- Many existing fillings and crowns, since margins need monitoring
- A high-sugar or high-frequency-snacking diet
- Smoking
- Children and teenagers, whose teeth are still developing and whose decay progresses faster through thinner enamel
Factors that lengthen it:
- No new decay over an extended period
- Healthy, stable gums
- Few or no restorations
- Good daily cleaning and consistent attendance
A reasonable thing to ask at your appointment: “What is my decay risk, and what interval does that put me on?” A good answer is specific to you. Our examination page covers what is assessed at each visit.
Radiation, in Proportion
This is the concern people most often have and least often voice, so it deserves a straight answer rather than reassurance.
Dental radiographs use a small amount of ionising radiation. That is a real exposure, not a zero, and it is why the profession applies the principle of keeping doses as low as reasonably achievable and only taking images when there is a clinical reason.
Several things reduce it substantially:
- Digital sensors, which most practices now use, require considerably less radiation than the film they replaced.
- Rectangular collimation, which narrows the beam to roughly the size of the sensor rather than a wider circle.
- Lead apron and thyroid collar where appropriate.
- Taking only what is indicated, which is the largest factor of all.
The honest framing is a comparison of risks rather than an absolute reassurance. The exposure from a routine set of bitewings is small. Undiagnosed decay progressing to an abscess, or undetected bone loss leading to tooth loss, is not a small risk. The reason radiographs are taken is that the balance favours taking them — but only when there is something specific to look for, which is why the interval matters.
Pregnancy, Children and Specific Situations
Pregnancy. Tell your dentist if you are pregnant or may be. Routine screening radiographs are generally deferred, but dental X-rays are not considered a reason to leave a painful or infected tooth untreated during pregnancy. Where imaging is genuinely needed for diagnosis, it can be taken with appropriate shielding — an untreated dental infection carries its own risks. This should be a conversation, not an automatic refusal in either direction.
Children. Children are more radiosensitive, which argues for care in how often images are taken. They also develop decay faster through thinner enamel, and have developing teeth whose position needs checking. The result is that children often need radiographs at shorter intervals than a low-risk adult, with correspondingly careful justification each time.
New patients. A new patient with no available history usually needs a baseline set, because a dentist is otherwise working blind. If you have had recent radiographs elsewhere, request copies and bring them — they are your records and you are entitled to them. This routinely avoids duplicate imaging.
Can You Decline?
Yes. You can decline any procedure, radiographs included. But it is worth understanding what declining means rather than treating it as a neutral choice.
Without images, a dentist can still examine, clean, and treat visible problems. What they cannot do is diagnose decay between teeth, assess bone levels, or detect infection at a root tip. Treatment planning without that information involves genuine uncertainty, and in some cases a dentist may reasonably decline to provide certain treatment — a crown, an extraction, root canal treatment — without adequate imaging, because doing so would fall below a defensible standard.
A more productive approach than a flat refusal:
- Ask what specifically is being looked for on this occasion.
- Ask what the interval is based on, and whether your risk profile justifies a longer one.
- Ask whether fewer images would answer the question — two bitewings rather than four, for instance.
- Provide recent images from a previous dentist rather than repeating them.
- Raise your concern directly. If radiation worries you, say so. It is a reasonable thing to discuss and it should be met with an explanation, not a shrug.
What Actually Happens During It
For anyone anxious about the process rather than the radiation, the practical detail helps.
A sensor or small plate is placed inside your mouth and you bite gently to hold it. The tube head is positioned outside your cheek. The exposure itself lasts a fraction of a second. With digital sensors the image appears on screen almost immediately, and you can ask to see it — most dentists are happy to point out what they are looking at.
The most common complaint is not discomfort but gagging, particularly with sensors placed further back. If you gag easily, say so before you start. Adjusting the placement, breathing steadily through the nose, and in some cases a panoramic image taken entirely outside the mouth are all workable alternatives.
There is no lingering effect afterwards, and nothing remains in your body. The radiation passes through at the moment of exposure and stops.
Frequently Asked Questions
There is no single correct interval — it should be set from your individual risk and adjusted as that risk changes. Someone with active decay, gum disease, dry mouth or many existing restorations needs them more frequently than someone with healthy stable gums, no history of decay and few fillings. Children generally need them more often than low-risk adults because decay progresses faster through thinner enamel. Ask what your risk category is and what interval it puts you on.
They use a small amount of ionising radiation, which is a real exposure rather than none, and that is why the profession takes them only when there is a clinical reason. Digital sensors, which most practices now use, require considerably less radiation than the film they replaced, and rectangular collimation and a lead apron with thyroid collar reduce it further. The relevant comparison is against the risk of undiagnosed decay or bone loss progressing undetected, which is not small.
Decay between teeth where the surfaces touch and cannot be seen or reached by light, bone levels around the roots which determine gum disease severity, infection at the tip of a root, decay hidden underneath an existing filling or crown, unerupted and impacted teeth and their relationship to nerves, and cysts or other pathology in the jaw. Several of these are common and completely symptomless until they are advanced.
Tell your dentist if you are pregnant or may be. Routine screening images are generally deferred until after the pregnancy. However, dental X-rays are not a reason to leave a painful or infected tooth untreated, since an untreated dental infection carries its own risks. Where imaging is genuinely needed for diagnosis, it can be taken with appropriate shielding. This should be a discussion about the specific situation rather than an automatic yes or no.
Yes, you can decline any procedure. Understand what it means though: without images a dentist cannot diagnose decay between teeth, assess bone levels, or detect infection at a root tip, so treatment planning involves real uncertainty. A dentist may reasonably decline to provide certain treatment without adequate imaging. Rather than a flat refusal, ask what is being looked for, whether fewer images would answer the question, and whether your risk profile justifies a longer interval.
A bitewing shows the crowns of the upper and lower back teeth together with the bone crest between them, and it is the standard image for detecting decay between teeth and early bone loss. A panoramic image is a single wide picture of both jaws, all the teeth, the sinuses and the joints, useful for overview, wisdom teeth and suspected pathology. They are not interchangeable — a panoramic is poor at detecting early decay between teeth.
Yes, and you should. Your records belong to you and you are entitled to request copies. Bringing recent radiographs to a new practice routinely avoids duplicate imaging and gives the new dentist a baseline to compare against, which is clinically valuable in itself. Request them from the previous office before your appointment, since transfers can take a few days. If they are not recent enough to be diagnostic, new images may still be needed.
Speak With a Dentist in Lakehurst
If you are unsure why an X-ray is being recommended, ask what is being looked for. It is a fair question and it should have a specific answer. Lakehurst Dental has cared for families in Lakehurst, Toms River and across Ocean and Monmouth counties for more than 34 years. To ask a question or arrange a consultation, call (732) 943-4090 or contact our office.
This article is general information and is not a substitute for an examination and personal advice from your dentist.