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THIS GUIDELINE TO HELP PRACTITIONERS MAKE CLINICAL DECISIONS BE BASED UPON THE PATIENTS AGE BUT UPON EACH CHILDS INDI
CONCERNING APPROPRIATE SELECTION OF DENTAL RADIOGRAPHS AS PART VIDUAL CIRCUMSTANCES "ECAUSE EACH PATIENT IS UNIQUE THE NEED
OF AN ORAL EVALUATION OF INFANTS CHILDREN ADOLESCENTS AND PER
FOR DENTAL RADIOGRAPHS CAN BE DETERMINED ONLY AFTER REVIEWING
SONS WITH SPECIAL HEALTH CARE NEEDS 4HE GUIDELINE CAN BE USED THE PATIENTS MEDICAL AND DENTAL HISTORIES COMPLETING A CLINICAL
TO OPTIMIZE PATIENT CARE MINIMIZE RADIATION BURDEN AND AL
EXAMINATION AND ASSESSING THE PATIENTS VULNERABILITY TO ENVI
LOCATE HEALTH CARE RESOURCES RESPONSIBLY RONMENTAL FACTORS THAT AFFECT ORAL HEALTH
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PATIENT AGE AND DENTAL DEVELOPMENTAL STAGE
Child with Primary Child with Adolescent with Adult, Dentate or Adult, Edentulous
Dentition (prior to Transitional Dentition Permanent Dentition Partially Edentulous
TYPE OF ENCOUNTER eruption of first (after eruption of first (prior to eruption of
permanent tooth) permanent tooth) third molars)
New patient* Individualized Individualized Individualized radiographic exam consisting of Individualized
being evaluated for dental radiographic exam radiographic exam posterior bitewings with panoramic exam or radiographic exam,
diseases and dental consisting of selected consisting of posterior posterior bitewings and selected periapical images. based on clinical signs
development periapical/occlusal bitewings with A full mouth intraoral radiographic exam is and symptoms.
views and/or posterior panoramic exam or preferred when the patient has clinical evidence of
bitewings if proximal posterior bitewings and generalized dental disease or a history of extensive
surfaces cannot be selected periapical dental treatment.
visualized or probed. images.
Patients without
evidence of disease and
with open proximal
contacts may not
require a radiographic
exam at this time.
Recall patient* with Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot Posterior bitewing Not applicable
clinical caries or at be examined visually or with a probe exam at 6-18 month
increased risk for caries** intervals
Recall patient* with no Posterior bitewing exam at 12-24 month intervals Posterior bitewing Posterior bitewing Not applicable
clinical caries and not at if proximal surfaces cannot be examined visually exam at 18-36 month exam at 24-36 month
increased risk for caries** or with a probe intervals intervals
Recall patient* with Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal Not applicable
periodontal disease disease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images of
areas where periodontal disease (other than nonspecific gingivitis) can be identified clinically.
Patient for monitoring of Clinical judgment as to need for and type of Clinical judgment as to Usually not indicated
growth and development radiographic images for evaluation and/or need for and type of
monitoring of dentofacial growth and development radiographic images for
evaluation and/or
monitoring of
dentofacial growth and
development.
Panoramic or periapical
exam to assess
developing third molars
Patient with other Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances.
circumstances including,
but not limited to,
proposed or existing
implants, pathology,
restorative/endodontic
needs, treated periodontal
disease and caries
remineralization
*Clinical situations for which radiographs may 9. Clinically suspected sinus pathology **Factors increasing risk for caries may
be indicated include but are not limited to: 10. Growth abnormalities include but are not limited to:
11. Oral involvement in known or suspected 1. High level of caries experience or
A. Positive Historical Findings systemic disease demineralization
1. Previous periodontal or endodontic treatment 12. Positive neurologic findings in the head and 2. History of recurrent caries
2. History of pain or trauma neck 3. High titers of cariogenic bacteria
3. Familial history of dental anomalies 13. Evidence of foreign objects 4. Existing restoration(s) of poor quality
4. Postoperative evaluation of healing 14. Pain and/or dysfunction of the 5. Poor oral hygiene
5. Remineralization monitoring temporomandibular joint 6. Inadequate fluoride exposure
6. Presence of implants or evaluation for 15. Facial asymmetry 7. Prolonged nursing (bottle or breast)
implant placement 16. Abutment teeth for fixed or removable partial 8. Frequent high sucrose content in diet
prosthesis 9. Poor family dental health
B. Positive Clinical Signs/Symptoms 17. Unexplained bleeding 10. Developmental or acquired enamel defects
1. Clinical evidence of periodontal disease 18. Unexplained sensitivity of teeth 11. Developmental or acquired disability
2. Large or deep restorations 19. Unusual eruption, spacing or migration of 12. Xerostomia
3. Deep carious lesions teeth 13. Genetic abnormality of teeth
4. Malposed or clinically impacted teeth 20. Unusual tooth morphology, calcification or 14. Many multisurface restorations
5. Swelling color 15. Chemo/radiation therapy
6. Evidence of dental/facial trauma 21. Unexplained absence of teeth 16. Eating disorders
7. Mobility of teeth 22. Clinical erosion 17. Drug/alcohol abuse
8. Sinus tract (“fistula”) 18. Irregular dental care
* From: American Dental Association, US Food & Drug Administration. The Selection of Patients For Dental Radiograph Examinations.
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