Why Dental X-Rays Are Necessary
Your dentist can see the surfaces of your teeth and gums during an exam, but many dental problems develop in places that are not visible to the eye. Cavities between teeth, bone loss below the gum line, infections at the root tip, cysts in the jaw, and impacted teeth are all hidden from view without imaging.
Dental X-rays use a small amount of radiation to create images of your teeth and the surrounding bone. These images help your dentist detect problems early, before they cause pain or become more difficult and expensive to treat. The type of X-ray your dentist orders depends on what they need to see.
Bitewing X-Rays
Bitewing X-rays are the most frequently used type of dental X-ray. They show the upper and lower back teeth (premolars and molars) in a single image, focusing on the area between the teeth where cavities commonly form.
A standard set includes 2 to 4 bitewing images and is typically taken once a year at your routine dental checkup. Your dentist uses bitewings to detect cavities between teeth that are not visible during the exam, check existing fillings for signs of decay underneath, and identify early bone loss that may indicate gum disease.
What a Bitewing Shows
Bitewings capture the crowns of the upper and lower teeth and the bone level between them. Cavities appear as dark spots on the tooth surface. Bone loss shows up as a lowered bone level around the roots. These images do not show the root tips, so they are not used to diagnose root infections or abscesses.
What to Expect
You bite down on a small tab or sensor placed inside your mouth. The process takes about 10 to 15 seconds per image. Most people find bitewings comfortable, though the sensor can feel slightly bulky. Digital sensors have made the process faster and more comfortable than the older film-based method.
Periapical X-Rays
A periapical X-ray shows the entire tooth, from the crown all the way to the tip of the root, plus the surrounding bone. The word "periapical" means "around the tip of the root."
Periapical X-rays are used when your dentist needs to evaluate a specific tooth in detail. They are commonly ordered when you have tooth pain, when a root canal is being planned, or when your dentist suspects an infection or abscess at the root tip.
What a Periapical X-Ray Shows
These images reveal the full root structure, the bone surrounding the root, and any infection or cyst at the root tip. An abscess appears as a dark area at the end of the root. Bone loss, fractures, and unusual root shapes are also visible. Endodontists rely heavily on periapical X-rays during root canal treatment to measure root canal length and confirm that the canals have been properly cleaned and filled.
What to Expect
A small sensor or film is placed inside your mouth against the tooth being examined. You hold it in place with your finger or a positioning device. The exposure takes a few seconds. Only the area around the specific tooth is imaged, so radiation is minimal.
Panoramic X-Rays (Panorex)
A panoramic X-ray, sometimes called a panorex, captures the entire mouth in a single wide image. It shows all the teeth, both the upper and lower jaws, the sinuses, the nasal area, and the temporomandibular joints (TMJ).
Panoramic X-rays are commonly taken at a new patient visit, before orthodontic treatment, before wisdom tooth evaluation, and to screen for jaw pathology such as cysts, tumors, or fractures.
What a Panoramic X-Ray Shows
Because a panoramic image covers such a wide area, it is useful for getting a big-picture view. It shows impacted teeth (including wisdom teeth), the position of developing teeth in children, jaw fractures, cysts or tumors in the jawbone, sinus conditions near the upper teeth, and the overall alignment of the teeth and jaws. However, panoramic images are less detailed than periapical or bitewing X-rays for detecting small cavities.
What to Expect
You stand or sit while the machine rotates around your head, taking the image in about 15 to 20 seconds. Nothing is placed inside your mouth, which makes this the most comfortable type of dental X-ray. You will be asked to stay still and bite on a small notched stick to position your jaw correctly.
CBCT Scans (Cone-Beam Computed Tomography)
A CBCT scan produces a three-dimensional image of your teeth, jawbone, nerves, and soft tissues. It provides far more detail than any traditional dental X-ray and allows your specialist to view structures from any angle.
CBCT scans are used in more complex clinical situations. They are not part of routine dental checkups. Specialists order them when they need precise 3D information that a standard 2D X-ray cannot provide.
What a CBCT Scan Shows
A CBCT scan reveals the exact shape, position, and number of root canals in a tooth. It shows the precise dimensions and density of the jawbone for implant planning. It maps the location of nerves (such as the inferior alveolar nerve) to help surgeons avoid them during procedures. It also identifies fractures, hidden infections, and pathology that standard X-rays may miss.
What to Expect
You stand or sit while the CBCT machine rotates around your head, similar to a panoramic X-ray. The scan takes 20 to 40 seconds. Nothing is placed inside your mouth. The resulting 3D image can be viewed on a computer and rotated to examine specific areas from different angles.
Which Specialists Use CBCT
Endodontists use CBCT to locate hidden canals and diagnose fractures before root canal treatment. Periodontists and oral surgeons use it to plan dental implant placement and evaluate bone graft sites. Oral surgeons use it before wisdom tooth extraction and jaw surgery to map nerve positions. Orthodontists may use it for complex cases involving impacted teeth or jaw discrepancies.
Dental X-Ray Radiation: How Much Exposure?
Radiation exposure from dental X-rays is very low compared to medical imaging and everyday background sources. Understanding the actual numbers can help put any concerns in perspective.
Radiation Dose Comparison
- Single digital periapical X-ray: approximately 5 microsieverts (roughly equivalent to 1 day of natural background radiation)
- Set of 4 bitewing X-rays: approximately 20 microsieverts (equivalent to a 1 to 2 hour airplane flight)
- Panoramic X-ray: approximately 10 to 20 microsieverts
- CBCT scan: approximately 30 to 200 microsieverts depending on the field of view (comparable to 1 to 8 days of natural background radiation)
- For comparison, a medical chest CT scan delivers approximately 7,000 microsieverts
Safety Measures
Digital X-rays use 50% to 80% less radiation than older film-based systems. Lead aprons and thyroid collars further reduce exposure. Your dentist follows the ALARA principle (As Low As Reasonably Achievable), meaning X-rays are only taken when there is a clear clinical reason. Pregnant patients should inform their dentist so that non-urgent X-rays can be postponed.
Dental X-Ray Costs and Insurance Coverage
Dental X-ray costs depend on the type and number of images taken. Costs vary by location, provider, and whether the office uses digital or film-based equipment.
Typical Cost Ranges
Most dental insurance plans cover routine bitewing X-rays once or twice per year and a full-mouth series or panoramic every 3 to 5 years. CBCT scans may or may not be covered depending on your plan and the clinical indication. Costs vary by location, provider, and case complexity.
- Bitewing X-rays (set of 2-4): $25 to $75
- Periapical X-ray (single image): $25 to $50
- Full-mouth series (14-20 images): $100 to $200
- Panoramic X-ray: $75 to $150
- CBCT scan: $150 to $500 depending on the field of view
Which Dental Specialists Use Which X-Ray Types
Different specialists rely on different imaging types based on what they need to see.
- General dentists: Bitewings and periapical X-rays for routine exams. Panoramic for new patients and screening.
- Endodontists: Periapical X-rays and CBCT for root canal planning, diagnosis of fractures, and locating hidden canals.
- Periodontists: Bitewings and periapical X-rays to monitor bone loss. CBCT for implant planning and bone graft evaluation.
- Oral surgeons: Panoramic X-rays for wisdom teeth and jaw evaluation. CBCT for implant planning, jaw surgery, and nerve mapping.
- Orthodontists: Panoramic and cephalometric (lateral head) X-rays for treatment planning. CBCT for complex cases involving impacted teeth.
- Pediatric dentists: Bitewings, periapical, and panoramic X-rays to monitor tooth development and detect problems in children.
- Prosthodontists: Periapical X-rays and CBCT when planning implant-supported restorations and evaluating existing tooth structure.
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