Dental X-Rays for Children: Why and When to Start?

Dental X-ray is an important tool that provides in depth, two-dimensional pictures of teeth, oral soft tissue, bone, and jaws.  There are four different types of x-rays that are commonly taken for children:

1.  Occlusal Xray — These are taken for the front teeth on both and upper and lower arch.  They are recommended as soon as the child is able to cooperate which for most children happen around the age of 3.  The images allow us to evaluate the location and presence of developing permanent teeth under the baby teeth.  If the child happens to be congenitally missing a front tooth or has extra teeth in the area, such anomalies would show up on these xrays.  They are typically taken just once unless the dentist has something specific that he/she wants to re-examine.


The mouth of this four year old girl appeared completely normal visually

until we discovered her two extra teeth with this upper occlusal xray


2.  Bitewing Xray — These images are taken for both the right side and the left side and show us the presence of cavities in between the back molars.  Bitwing xrays should be taken as soon as the back molars start touching each other, as children become prone to cavities in between the teeth as soon as the contacts are tight together.  Depending on teeth and jaw size of the child, we typically start taking bitewing xrays around the age of 4 or 5.  Because most children have immature brushing skills and high affinity for sweets, we usually recommend bitewing xrays every 6 to 12 months so we can detect cavities as soon as they appear when they’re easy to restore.  For those children are at very low-risk for cavities, the American Academy of Pediatric Dentistry recommends bitwing xrays every 12 to 24 months.


Even though I didn’t see any cavities in this child’s mouth, there are

sigficant decays in between the molars as shown in this bitwing xray


3.  Panoramic Xray — This is taken with a different machine that goes around the child’s head capturing an image of all the teeth in the jaws.  We usually take a panoramic xray when permanent teeth start to appear (approxiomately 6 yr. old) so we can check to make sure that all permanent teeth are developing normally underneath the baby teeth.  Panoramic xrays are also important tools to detect congenitally missing teeth, extra teeth, and oral pathologies such as tumors and cysts.  These are taken every 5 years to rule out developmental anomalies and oral pathologies.


This patient has some missing permanent teeth but the most important finding

is that cystic strcuture with a tooth in towards the lower right side of this image


4.  Periapical Xray — This is a single xray that shows an isolated image of a specific area that needs to be evaluated.  While bitewing xrays are the best xrays for detecting the presence and size of cavities, they don’t do a good job of showing possible infections that could be present.  Periapical xrays provide us with a view of the root area which is where infections usually show up.  They are usually taken in trauma cases or when large cavities are seen and infection needs to be rules out.  These xrays are normally not taken periodically in children unless something special needs to be monitored.


This child complained about unspecific discomfort in the lower left region of his mouth.  Even

though things looked okay in his mouth there is a infection underneath his existing crown

If you have any questions or concerns regarding X-rays for children, please call or email me at my Las Vegas Pediatric Dentist office. 

Stay tuned for X-ray safety issue in future blog post…