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Periodontics/Dental x-rays for me


QUESTION: According to what I've read, dental x-rays including bite-wing should be avoided without a particular reason, as every x-ray increases brain tumor risk. I have, I believe, periodontal disease. (Although that term has not been used, I have gum pockets that reduce the interval between cleanings to 4 months.) I've also read that in cases of periodontal disease x-rays are recommended to monitor bone loss. I know I have bone loss, as for several years or more I have been under treatment for that diagnosed condition by an endocrinologist. I receive an annual bone scan, but not for my head. I am 79 years old

It's been well over a year since my last dental x-rays. What is your recommendation regarding dental x-rays? To what use could I expect the results to be put?

ANSWER: Bone loss around the teeth is the consequence of periodontal disease, but general bone (mineral) loss (osteoporosis) and periodontal bone loss have a totally different background and are not dependent on, or related to each other.

In osteoporosis, bones lose their mineral but the soft, organic part of the bone remains in place. The bones do not totally disappear, they just soften. The reason for osteoporosis is mostly hormonal.

In periodontal disease, the bone around the teeth disappears totally, and the reason for this is a chronic infection around the teeth. Since periodontal disease is an infection, it has several adverse effects on general health. The lost bone around the teeth will never grow back, but fortunately, the infection around the teeth can be treated.

When periodontal disease is treated, x-rays are necessary. They are the only means to find out what the pattern of bone loss is, how much bone is left, and whether there are tooth-related problems that might affect the disease process or the treatment. X-rays are also used for monitoring the healing process.

The study about x-rays and brain tumors that you apparently have read (and that has received widespread attention in the media), was not technically well conducted. It was, moreover, based on interviewing senior people about their dental x-rays in their youth. No actual data on the number of x-rays was presented. Furthermore, the study was about old-fashioned x-rays, taken on film, with radiation doses 10 to 100 times higher than today.

Modern x-rays are digital, which means that the amount of radiation is minimal. And even if old-fashioned film x-rays were taken today, the radiation would be far less than the radiation everybody gets from the outside air. Thus, there is no reason to fear or avoid dental x-rays.

Don't worry. Let your periodontist treat you and trust in the work that is done.

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QUESTION: Thanks very much, Dr. Hormia, for your detailed and helpful reply. If I may trouble your further, I'd like a bit more advice.

I'm not under the care of a periodontist but of my general dentist, who apparently has not felt the need to make a specialist referral. My gum condition has, I'm told, been stable for the last year or so.

The practice at this office is to take bite-wing x-rays yearly and full-mouth x-rays every 3 to 5 years. These x-rays are the same for everyone, regardless of periodontal problems. (The dentist himself does not get involved until *after* the x-rays are taken.) I am overdue for the yearly x-rays now by about half a year. It's about 4 years since my full-mouth x-rays.

The office want to schedule me for a cleaning plus bite-wing x-rays in November.

Should I opt instead for full-mouth? Or should the dentist determine the placement of the x-rays?

Your opinion is invaluable to me, and I'm most grateful for it.

ANSWER: In Finland, where I live and work, we have a different practice in regard to x-rays. We take panoramic x-rays (full mouth radiography of the teeth, upper and lower jaws, surrounding structures and tissues) every third year or so. In addition, we take small intraoral radiographs (periapical or bite-wing) when they are needed.

In Finland we take annual bite-wings predominantly on children and young adults. This is the practice because the contact points of the teeth get cavities mainly in these age groups, and bite-wings are best suited for detecting cavities between the teeth.

I myself do not necessarily take bite-wing radiographs on middle-aged or older adults since I usually want to see the whole tooth and its surrounding structures.

Your x-ray schedule is the American standard and I understand that that's what most dentists do.

But, as a patient, you can, of course, refuse the radiography. Or you could discuss this question with your dentist. You could ask what he expects to see in the bite-wing radioraphs. Have you had many cavities lately? Is he suspecting that you develop cavities between the teeth? If you do have many cavities each year, then I think you should have an intensified fluoride treatment regimen, x-rays won't help that.

So, you see, my advice is that you have a discussion with our dentist about the x-rays. Then you can decide what x-rays you want to have taken and at what kind of intervals.

---------- FOLLOW-UP ----------

QUESTION: I really hate to bother your more, Dr. Hormia, so I hope you will forgive this further encroachment on your time. Your second answer however has left me confused.

Your original answer encouraged me to get any x-rays recommended by the practitioner. Yet your later answer suggests that I might want to refuse recommended x-rays.

I am not particularly concerned about cavities and have not had very many in recent years. My concern is my gum condition, and bone loss that might follow. I understand that x-rays are necessary to monitor bone loss. My question really is, Where should those x-rays be focused? I know that the pockets are greater near some teeth than others. I believe much of my gums are in the normal range. I'm hoping that before I talk to my dentist I can get a feel from you regarding what might be desirable.

I tried to explain that bite-wing x-rays are mainly for diagnosing cavities. In my opinion, you could refuse those if cavities are not your problem.

You could consent to full-mouth x-rays or panoramic radiography as a means to monitor bone loss. Of course, if you have progressing bone loss around some teeth, then you should be referred to a periodontist for treatment.


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Marketta Hormia, DDS, PhD


I am a periodontist living and working in Helsinki, the capital of Finland, where I have my private dental practice. I am an international member of the American Academy of Periodontology. I have a Ph.D degree and a long background in research and teaching at the University of Helsinki and at the University of Turku, Finland. I function as an adjunct Professor at these Universities. I have also worked as a visiting scientist at the Scripps Clinic and research Foundation, la Jolla, CA. I can answer any question in the fields of dentistry and periodontics.


Private practitioner in Helsinki, Finland over 20 years. Former researcher and teacher at two Finnish Universities.

The Finnish Society of Dentists, Division of Periodontology, American academy of Periodontology

Over 30 scientific research articles published in peer-reviewed international scientific journals (can be found on PubMed)

D.D.S., Ph.D, Specialist in Periodontology. Adjunct Professor.

Awards and Honors
Visiting Scientist at the Scripps Research Foundation, San Diego, California, 1992-1994. NIH grant

Past/Present Clients
Dental patients, national and international. All kinds of dental, oral and temporomandibular joint problems

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