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In Our Efforts To Increasingly Go “Green” In Delivering Oral Health Care And Dental Treatment, We Chose To Use Digital Dental Radiographs (Digital X-Rays) To Better Detect, Diagnose, Treat, And Monitor Oral Conditions And Diseases.

Digital radiography is a type of X-ray imaging that uses digital X-ray sensors to replace traditional photographic X-ray film, producing enhanced computer images of teeth, gums, and other oral structures and conditions. This means the need for traditional film X-ray systems is no longer required. With digital X-rays, we dramatically reduce the harmful chemicals such as lead and silver that are released into the environment.

Additionally, patients are exposed to less radiation with digital imaging compared to traditional X-rays. Also, images are available to us immediately, are of better quality than traditional X-rays and can be enlarged for greater diagnostic detail and accuracy.

Digital dental images are acquired through 3 methods: the direct method, indirect method and semi-indirect method. The direct method uses an electronic sensor placed in the mouth to record images. The indirect technique uses an X-ray film scanner to view traditional dental X-rays as digital images. The semi-indirect digital technique combines a sensor and scanner to convert dental X-rays into digital film.

1. Types & Uses Of Digital Dental Radiographs

Digital dental radiographs can be taken inside (intraoral) or outside (extraoral) of the mouth. Intraoral X-rays, the most commonly taken dental X-ray, provides great detail and are used to detect cavities, check the status of developing teeth, and monitor teeth and bone health.

Extraoral X-rays do not provide the detail of intraoral X-rays, and are not used to identify individual tooth problems. However, they are used to detect impacted teeth, monitor jaw growth and development, and identify potential problems between teeth, jaws and temporomandibular joints, or other facial bones.

Bitewing X-rays, which are taken with the patient biting down on film, showing details of the upper and lower teeth in one area of the mouth. Each bitewing shows a tooth from its crown (top) to the level of the supporting bone. Bitewing X-rays are used to detect decay between teeth and changes in bone density caused by gum disease, as well as to determine the fit of dental crowns or restorations, and the marginal integrity of tooth fillings.

• Periapical (limited) X-rays show the whole tooth from the crown to beyond the root tips, to the supporting bone in one area of either the upper or lower jaw. Periapical X-rays are used to detect root structure and surrounding bone structure abnormalities. Showing bone loss around each tooth, periapical X-rays aid in treating conditions such as periodontitis, advanced gum disease, and detecting endodontic lesions (abscess).

Panoramic (panorex) X-rays, which require a machine that rotates around the head, show the entire mouth including all the teeth in the upper and lower arch in one image. Panoramic X-rays are used to plan treatment for dental implants, detect impacted wisdom teeth and jaw problems, and diagnose bony tumours and cysts.

• Cephalometric projections, which show the entire head, help examine teeth in relation to a patient's jaw and profile. Orthodontists, specialists in aligning and straightening teeth, use cephalometric projections to develop their treatment plans.

• Cone beam computerised tomography (CBCT) shows the body's interior structures as a three-dimensional image. CBCT, often performed in a hospital, is used to identify facial bone problems, such as tumours or fractures.

• CT scans are also used to evaluate bone for dental implant placement and difficult tooth extractions, to avoid possible complications during and after surgical procedures.

• The CBCT, which requires more radiation than panoramic radiographs, does not slice images. Instead, its cone-shaped beam scans on both the upper and lower mouth areas at once. The data is captured by a 2-Dimensional array and creates high-resolution images, then combined to form a 3-D image of the bony structures.

Klinik Pergigian Fauziah has 2 of these machines, the Sirona Orthopos which we use in treatment planning for all surgical procedures like minor oral surgery to remove impacted wisdom teeth, and in detailed planning for placements of dental implants.

2. Benefits Of Digital Dental Radiography

Benefits of digital dental radiographs compared to traditional dental X-rays include the following:

• Digital radiographs reveal small hidden areas of decay between teeth or below existing restorations (fillings), bone infections, gum (periodontal) disease, abscesses or cysts, developmental abnormalities, and tumours that cannot be detected with only a visual dental examination.

• Digital radiographs can be viewed instantly on any computer screen, manipulated to enhance contrast and detail, and transmitted electronically to specialists without quality loss.

• Early detection and treatment of dental problems can save time, money, and discomfort.

• Digital micro-storage technology allows greater data storage capacity on small, space-saving drives.

• Dental digital radiographs eliminate chemical processing and disposal of hazardous wastes and lead foil, thereby presenting a "greener" and eco-friendly alternative.

• Digital radiographs can be transferred easily to other dentists with compatible computer technology, or photo printed for dentists without compatible technology.

• Digital sensors and PSP (photostimulable phosphor) plates are more sensitive to X-radiation and require 50 to 80 percent less radiation than film. This technology adheres to the ALARA (As Low As Reasonably Achievable) principle, which promotes radiation safety.

• Digital radiograph features, including contrasting, colorising, 3-D, sharpness, flip, zoom, assist in detection and interpretation, which in turn assist in diagnosis and patient education. Digital images of problem areas can be transferred and enhanced on a computer screen next to the patient's chair.

• Digital dental images can be stored easily in electronic patient records and sent quickly electronically to insurance companies, referring dentists or consultants, often eliminating or reducing treatment disruption leading to faster dental insurance reimbursements.

3. Infection Control

Most digital sensors and PSP plates can't be sterilised and therefore require protective plastic barriers that must be changed between patients to prevent cross contamination and infection.

4. Safety Considerations

While radiation exposure is low with digital radiographs, no one should receive more radiation than absolutely necessary. Protective lead aprons and thyroid collars are routinely used especially for pregnant women, women of childbearing years, and children.

It is safe for pregnant women to have up to 4 radiographs per office visit, although most patients and doctors will elect to delay radiographs until the pregnancy is over. There should be no concerns for a pregnant woman to have an X-ray taken in an emergency situation. Precautions such as the use of ‘double lead aprons’ cut radiographic exposure down to nearly immeasurable levels. Women who are breast-feeding or trying to become pregnant do not need to delay X-rays.

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