DENTAL RADIOGRAPHY FOR

THE PAEDIATRIC PATIENT

Dental
Dental radiography
radiography is
is aa useful
useful diagnostic
diagnostic
aid
aid in
in oral
oral examination
examination of
of children.
children.
Indications
- detection of dental caries in
primary, mixed & permanent
dentitions with approximal
contacts
- injuries to teeth & supporting
tissues
- disturbances in tooth
development & growth
- examination of pathological
conditions
Types of radiographic films

Intra-oral films: are meant for

positioning inside the mouth during
exposure

Extra-oral films: are kept outside

the mouth during exposure
 Intra-oral radiographs
Three types of intra-oral radiographs are

 Intra-oral periapical radiograph (IOPA)

 Bitewing radiograph

 Occlusal radiograph
Film sizes:
Size 0 - Bitewing & periapical radiograph
of small children
Size 1 - Radiograph of anterior teeth in
adults
Size 2 - Standard film used for anterior
occlusal radiograph, periapical,
radiograph, & bitewing survey
in mixed & permanent dentitions
 Extra-oral radiographs

Film sizes:
1.5" X 7" – used for TMJ views & lateral
oblique views
8" x 10" – used for lateral cephalograms,
paranasal views etc.
6" x 12" – used for orthopantomography
 Composition of films
Base:
- made of polyester, polyethylene, terephthalate
- helps in supporting the emulsion & provides rigidity
to the film
Adhesive layer:
– helps in attaching film emulsion to film base
Film emulsion:
– consists of silver bromide crystals with silver iodide
INTRA-ORAL RADIOGRAPH
Intra oral periapical radiograph (IOPA)
- useful in evaluation of teeth & their
supporting structures

IOPA radiography

Short cone or Long cone or

bisecting angle paralleling
technique technique
 Indications
- to determine the status of periapical region in
the deciduous and permanent teeth
- in evaluation of pulp treatment or endodontic
treatment
- detection of developmental anomalies like
supernumerary teeth
- to identify any pathology
- status of periodontal ligament
- pulp calcification & root resorption
- diagnosis of traumatic injuries
 Technique
Employ tell-show-do technique

Introduce child to X-ray machine & explain procedure

Set timer & position cone in approximate angulation

before placing film

Obtain confidence & co-operation of child & take easy

film for patient first

Talk to child calmly to distract attention & establish co-

operation
Angulations……
For projection of maxillary teeth :

For anterior teeth -----> +50

- For premolars -----> +30
- For molars -----> +25
-
 Angulations……
For projection of mandibular teeth :

- For anterior teeth -----> - 20

- For premolars -----> - 10
- For I & II molars -----> - 5
- For III molars -----> 0
 BITEWING RADIOGRAPH
- used to detect incipient proximal
caries
- coronal portions of maxillary &
mandibular teeth can be
visualized
Film size
No. 0 or 1 – Young children
No. 2 - Older children
 Indications
- detection of interproximal caries with respect to
depth & relationship to pulp
- observation of boundaries of pulp chamber &
height of pulp horns
- observation of primary resorption pattern
- observation of location & position of retained
primary roots
- relationship of opposing teeth
- location & position of permanent tooth bud & its
relation to primary root
 OCCLUSAL RADIOGRAPH
used in evaluation of entire maxillary
& mandibular arch
Indications :
- to evaluate cortical plate expansion
- to evaluate fraction displacement
- to evaluate maxillary sinus or
submandibular salivary gland calculi
 EXTRAORAL RADIOGRAPHS

Rationale for panoramic views :

- help in visualization of both maxilla &
mandible & structures associated with film
- X-ray source & film rotate & a zone of
image layer is formed
- in panoramic scanography, selected
areas like maxillary sinus, nasal fossae
are imaged

- used in evaluation of traumatic injuries

as well as dental age evaluation & also
eruption status of teeth
Cephalometric radiography
- mainly used for conventional
cephalometric measurements & also in
case of evaluation of cranio-facial
anomalies
Lateral oblique view
- can be taken using a 5“x7“ screen film
- used to visualize either body of
mandible or ramus region
Wrist radiography :
- used for bone age estimation
Sialography :
- a technique in which a dye or contrast medium is
introduced in a retrograde fashion into the
salivary gland duct & a radiograph taken to
study the path of a major salivary gland
 Computerized tomography :
- very helpful in diagnosis of conditions involving auditory ossicles,
neonatal maxillae & TMJ

Ultrasound :
- helpful in the examination of floor of the
mouth & salivary glands

Postero – anterior view :

- useful to evaluate the skull for any pathology,
trauma or developmental anomalies
Magnetic resonance imaging :
- non-invasive technique in which high strength static
magnetic field pulse radio waves are used
- used to image the head, neck & the musculoskeletal
system

- also used in the neoplasm of maxilla & mandible &

evaluation of lymph nodes
Paranasal sinus view :
- indicated in the visualization of
paranasal sinuses, orbits & zygomatico-
frontonasal sutures

Reverse-town projection :
- used in case of condylar neck fractures
Submento-vertex view :
- helps in visualization of condyles,
sphenoid sinus & curvature of mandible
Direct digital radiogrphy :
- makes use of X-ray machine
- an intensifying screen charged coupled
device is used as the image receptor
system
 “Children are at a higher risk from
radiation exposure than adults”

- Young, rapidly growing tissue is more sensitive

to radiation
- Intracellular effects of radiation are cumulative
- Radiation-induced tumors have a long latency
period
- Child’s head & neck region are close to
central beam because of smaller stature

- Increased carious activity in children

may be associated with increased
frequency of radiographs
 Protection given to the child
• Lead apron should be used to
protect entire trunk
• Thyroid gland may be
protected with the help of
cervical collar
• Long cone paralleling
technique is recommended
• The child’s mind must be
diverted
 ERRORS DURING RADIOGRAPHY
OF A CHILD

• Improper placement of films

• Cone cutting
• Incorrect horizontal angulation
• Over exposure due to defective device
• A high exposure of the patient to
radiation
 REFERENCES
1. McDonald RE, Avery DR, Dean JA.
Dentistry for the child and adolescent, 8th
edn. Mosby, 2004 :117-28

2. Tandon S. Textbook of pedodontics, 1st

edn. Paras Publishing, 2001 :19-28

3. Koch G. Pediatric dentistry, 1st edn.

Munksgaard, 2001 :99-117
 REFERENCES

4. Mathewson RJ, Primosch RE. Fundamentals of

pediatric dentistry 3rd edn. Quintessence
Publishing Co. Inc 1995: 35-55

5. Damle SG. Textbook of pediatric dentistry, 1st

edn. Arya Publishing House, 2000 : 167-71