Dental X-rays
Why? What Kind? How Often?

Dr. Al Danenberg Nutritional Periodontist

July 24, 2022 [printfriendly]

When you go to the dentist, do you ever wonder …

  • “Why do I need dental x-rays?”
  • “What kind of dental x-rays are necessary?”
  • “How often do I need to have dental x-rays?”

Let’s talk about all these questions.



Dental x-rays make visible what the naked eye cannot see.

Think about this:

If you noticed that your car was making a funny noise, you might want to go to the mechanic to check it out. When you got to the auto shop and the mechanic put your car into the bay, he probably asked you a few questions. He then asked for you to pop open the hood so he could do a few diagnostic tests. But you then told him, “No. I don’t want you to do any tests, I just want you to tell me what is wrong with my car!”

How silly would that be?

Of course, the mechanic would need to do some diagnostic tests to determine what was wrong and how he would attempt to fix it.

So dental x-rays are those “diagnostic tests” that the dentist needs so he or she can see what is going on that is not visible with just an oral exam.

Even more importantly, the proper dental x-rays may show areas of disease and damage that you as a patient are not aware of. There may not be bleeding, pain, or swelling. But there may be serious things going on in your teeth and jawbone that could cause irreparable damage to your body if not detected and treated early.

So, dental x-rays are necessary to see what the eye cannot see by itself.


What Kind?

There are many kinds of dental x-rays for different purposes. The most common are …

  • Bitewings
  • Periapicals
  • Full-mouth series
  • Panoramic

Other specialized x-rays include …

  • Occlusal
  • Cephalometric
  • Cone Beam CT Scan


Bitewings are x-rays that show the upper and lower teeth coming together in the back of the mouth. They help the dentist look for tooth decay between the teeth that are touching one another. They can be taken as “horizontal” or “vertical” bitewings. The “vertical” bitewing can also identify the level of jawbone between the teeth.

Here is an example of vertical bitewings:


Periapical x-rays show the jawbone that surrounds the complete tooth. These x-rays can help identify damage to the jawbone from excessive wiggling of the teeth (bruxism), an abscess from a dying tooth, periodontal disease, and other lesions in the bone.

Here is an example of a periapical x-ray of the lower front teeth:


A Full-Mouth Series (FMX) are various individual x-rays of all the teeth in the mouth. An FMX consists of bitewing x-rays of the back teeth and periapical x-rays of all the erupted teeth. This complete set of x-rays gives the dentist a comprehensive view of all the teeth.

Here is an example of an FMX:


A Panoramic x-ray does not show the detail around the individual teeth as an FMX. But a panoramic x-ray shows the sinuses of the upper jaw, the condyles, and more of the entire jawbone than can be seen in an FMX. This type of x-ray helps the dentist to evaluate bone structures and the position of the wisdom teeth, other impacted teeth, and various types of lesions that could be present.

Here is an example of a panoramic x-ray:


Other x-rays include …

Occlusal x-rays show the view of the teeth as if you were looking down at the chewing surfaces of the teeth of the upper jaw and of the lower jaw. They can show the alignment of the teeth in the dental arches.

A Cephalometric x-ray is used by orthodontists to evaluate the alignment and spacing of the teeth. It can also help the dentist evaluate the temporomandibular joint (TMJ) and other facial structural issues.

A Cone Beam CT Scan is unique. All the other x-rays show the teeth and jawbone in a two-dimensional relationship. A Cone Beam CT Scan is a three-dimensional image that is more accurate than 2-dimentional x-rays since it allows the dentist to view any area in sections of 360 degrees.


How Often?

You may not need dental x-rays every time you go to your dentist.

Certainly, our primal ancestors never had a “dental cave” to go to where x-rays were taken. And for the most part, our primal ancestors had healthy mouths.

This is a photograph of a lower jaw from 300,000 years ago. It is from one of the oldest known Homo sapiens. This individual had no tooth decay and no jawbone disease.


But we are not our primal ancestors. We live in an environment with chemicals that can be toxic to our body, with emotional stress that can damage our gut and oral microbiomes, with ways of eating that include poor food choices, etc.

Our environment and lifestyle choices can damage our mouth without us being aware. So, x-rays can help you and your dentist determine if there is something potentially harmful going on that needs attention.

The first time you see your dentist, an FMX and panoramic x-ray could be extremely helpful to determine if there are issues of concern. These x-rays would become a baseline of the health or disease existing in your mouth.

Thereafter, x-rays should be taken on a “need only” basis.

For example, you may need x-rays once or twice a year if …

  • You have a history of frequent areas of decay
  • You have active periodontal disease
  • You have “dry mouth” (from specific diseases, medications, surgery, cancer treatment, etc.)
  • You have crowns, bridges, implants, existing root canals or other existing dental procedures
  • You are emotionally and chronically stressed
  • Your choices of food encourage tooth decay (sodas, sugars, grains)
  • You do not follow an efficient and effective oral hygiene program
  • You are a smoker
  • You have a metabolic disease or an unhealthy gut

But you may require a Cone Beam CT Scan. If you have potential lesions in the jawbone from necrotic teeth, poorly extracted teeth, or other reasons, then your biologically oriented dentist may suggest this three-dimensional scan. In addition, if you have an area that is going to be replaced with a dental implant or have airway obstruction, your dentist may need the information that can only come from a Cone Beam CT Scan.

Just like with your overall health, you are in control of your dental health. If you are following the Better Belly Blueprint style of eating, taking good care of your mouth, and have no medical or dental issues, you probably don’t need to do x-rays at every checkup! But you’ll want to make sure you are seeing a biologically oriented dentist.

If your dentist pushes the issue, you have every right to refuse provided you are taking care of your mouth; eating nutrient-dense, anti-inflammatory foods; and maintaining a healthy gut. If you need a second opinion or guidance, I’m happy to help. You can set up a consultation with me HERE.


My Thoughts About Dental X-Ray Radiation

Think of this:

Every day, we’re exposed to radiation. It comes from the sun, our cell phones, and riding in an airplane. Yet when you get a set of four Bitewing X-rays, the total amount of radiation is less than an average daily dose of radiation in everyday life. And if you took a 7-hour plane ride, you would be exposed to approximately the amount of radiation from 16 small dental X-rays.

To protect you from any scatter radiation, the dentist will drape a lead apron over other parts of your body.

In addition, most dental offices use “digital dental x-rays”. Digital x-rays require less radiation to capture a high-resolution image than the traditional x-rays used several decades ago. Digital dental x-rays may reduce radiation exposure up to 90% from that of traditional dental x-rays years ago.

Also, digital x-rays allow …

  • The images to be available on a computer screen a few seconds after being taken.
  • The images to be enhanced and enlarged many times their actual size.
  • These images to be electronically sent to another dentist or specialist.
  • The dentist to easily compare the current image to an image taken in the past to determine changes.

Infrequent dental x-rays do not expose you to large amounts of low dose ionizing radiation. But if your dentist does not need x-rays to diagnose a potential problem or an existing problem, you would be better off not having routine x-rays unless there is a medical reason as I described above.


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  1. Dr. Danenberg,

    What are those bright white spots on x-ray images? For example, in the panoramic x-ray above there are bright white spots on the upper teeth. I’ve been curious about this ever since I read “Nutrition and Physical Degeneration” by Weston Price, which contains numerous x-ray images with these bright areas.

    • The “bright white spots” are either amalgam fillings (mercury fillings) or metal crowns.

  2. Dr. Al,

    I was wondering since I developed Burning Mouth Syndrome do you think it’s a good idea to get
    request from my dentist a Cone Beam 3D Scan to rule out any underlining causes? Please share your
    thoughts and if you have any other recommendations?

    Thank you,

  3. Thanks Dr. Al this is good to know. As someone who is dental-hygienically retarded, my dentist requires xrays yearly from me. I once refused and was told they wouldn’t work on my teeth because insurance required it. I’ve never refused again.

  4. This is so good to know. I just had my six month check up and was due for x-rays at my holistic dentist and I declined them, and they didn’t push it at all. Thank you for all the info here.

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