Panoramic tooth shot

If a person has a toothache, he rushes for help to a dentist and insists on treatment, not to delete the same value. But the dentist is not the Lord God, he can not see the state of the aching tooth from the inside. Acting at random in this matter is impossible. After all, if the whole problem is in bare roots, then the treatment will be one, but in case of purulent inflammation of the gums, the approach to therapy will be completely different. And then to help the doctor comes the well-known X-ray, which in stomatology is called an orthopantomogram or a simpler panoramic snapshot of teeth. It is this procedure, or rather the information obtained with its help, that allows the doctor to act purposefully and efficiently, seeing before himself the entire front of work in the future.

[1], [2], [3]

Indications for the procedure

We are used to the fact that doctors give the direction to the x-ray of the teeth if the caries has penetrated deep inside the tooth and touched the nerves, causing severe pain during bite of the tooth or ingestion of food and acids. But after all, similar symptoms can be observed in the inflammatory process in the root area, which can be accompanied by a pus accumulation. This situation is dangerous because in one far from perfect moment pus can leave the affected cavity into the bloodstream and with it penetrate to the brain, causing blood infection and inflammatory processes already in the brain itself.

The question arises whether there is a sense to remove the nerve from the tooth, under which inflammation progressing, which is a danger to human life, or it will be more correct to remove the diseased tooth, facilitating access to the cavity with pus for further treatment of the gums. It is this important question that helps to solve the problem of a tooth X-ray.

But so far we have considered only a special case of dental X-ray, in which on a small piece of tape we can observe a couple of our teeth. Such a picture is needed right here and now in order to solve an existing problem that caused pain, while a panoramic snapshot of teeth, which is gaining popularity, allows you to see even those moments that the patient has not yet felt in terms of discomfort and pain . The thing is that on the orthopantomogram not 2-3 teeth are visible, as in the usual picture, but completely 2 rows of your teeth, including dairy ones.

What is a sin to conceal, not everyone is in a hurry to the dentist, even as problems arise with the teeth, unless the pain forces you to seek help. Needless to say, preventive examination has long been out of fashion among patients in dental surgeries. And very vain, because it's worth taking one panoramic shot to reliably learn information about the state of all your teeth and gums in one fell swoop.

But orthopantogram of teeth is not only a preventive procedure, which allows fixing the problem in its very beginning. This is an opportunity to seriously prepare for various types of dental operations and manipulations involving several teeth or gums at the same time, on which the teeth are attached.

Indications for the procedure for the X-ray of the teeth on both jaws are:

• Any surgical operations on the jaw, including the removal of problem teeth,
• implantation,
• procedure for equalizing the teeth of the upper and lower jaw, setting braces
• Prosthetics of teeth (assessment of teeth, gums, bone tissue),
• determination of the degree of gum disease in periodontal disease, evaluation of the effectiveness of treatment,
• complex cases of diffuse dental pain, which are associated with inflammation of the bone tissue,
• assessment of the formation of the jaw and the growth of permanent teeth in children,
• Evaluation of the consequences of traumatic lesion of the jaw,
• determining the degree of development of wisdom teeth.

Let us dwell on some points in more detail. Some readers may not understand the meaning of a panoramic image of teeth when setting braces. In fact, it is of great importance, because such a picture allows you to assess the degree of development of teeth and jaw, the possibility of installing braces and the recommended load.

Usually this research is conducted in childhood. If this is about 12 years old (recommended for orthodontic treatment, whose goal is alignment of the dentition), then there is no problem, since the dento-mandibular structures have already fully formed. In young children, a panoramic snapshot of the teeth allows you to make predictions about the possibility of changing the jaws in the future, the degree of formation of the roots, as well as to determine whether the teeth hold firmly in the holes. This information affects the decision of the doctor about the timeliness of treatment for the alignment of the teeth.

A panorama is often taken to assess the condition of third molars, which are also called wisdom teeth. Their location is such that it is very difficult to make a normal sighting, so strong distortions are possible. But these teeth are quite a lot of trouble: they later erupt (usually in adulthood), cut and grow very slowly, painfully, and not always right (for example, tilted or sideways). Sometimes doctors even have to intervene in the process of erupting them, if the "wise" teeth can not do this on their own, or they can be removed when the 3 molars prematurely collapse or cause noticeable discomfort.

A panoramic snapshot of the teeth allows you to assess the state of each wisdom tooth and assess the prospects for its growth. Especially useful is this picture, if one of the teeth is not shown for a long time, causing periodic painful pains or not showing itself in any way.

X-ray photography will be of great service to dentists and patients with jaw injuries. It is clear that a fracture or a bruise of the jaw is in the competence of a traumatologist. However, such a trauma can damage the teeth or their roots. But if everything is clear with a fracture, then the bruise for the time being may not manifest itself in any way, although it carries a great danger associated with a certain risk of the formation of a cyst in the place of a bruise. It is this pathology that will help to reveal a panoramic snapshot of teeth.

[4], [5], [6]

Preparation

Panoramic tooth image is one of the varieties of x-ray research in dentistry. Like the usual fluorogram, which a person is obliged to take every year, the procedure does not require special preparation. You can take a panoramic shot both for medical purposes and in preventive ones.

Many readers immediately have the question: how safe is it? Their excitement is understandable, because any irradiation (including X-ray) can cause harm to health. But in our case, scanty doses of irradiation are used, which will not harm even the child. If we compare the radiation doses with a lung fluorogram and an orthopantomogram, then in the latter case the radiation dose will be more than 10 times smaller. The same dose of radiation can be obtained during a 2-hour flight on an airliner.

The maximum permissible annual dose of irradiation during the treatment of the patient is about 15 millisieverts, with prevention and even less - 10 millisievert. As for the X-ray panoramic image, the dose is almost 40 times smaller when it is used. Probably, even with the most active treatment of teeth during the year, it is very difficult to get the maximum dose of radiation, except to take pictures every week. And if you also take into account that only the jaw is subject to irradiation, and the remaining parts of the body are protected by special devices (protective apron), then the harm to the body is minimal at the same time.

It is also worth noting that during a targeted film image of teeth, higher radiation doses are used than with a digital panoramic image. This is another important plus of this method of research in dentistry.

Low doses of radiation, however, are not a reason for self-designation of such studies. This procedure should be conducted after consultation with a doctor who decides whether it is appropriate. During this consultation, it is necessary to warn the doctor about such nuances as pregnancy or breastfeeding. 

Like the foliography, a panoramic snapshot of teeth does not require special preparation. The only thing a doctor can ask for is to remove metal jewelry from the head and neck, as they can introduce some distortion into the information received by the receiver of the device for analyzing the condition of the jaws and teeth.

[7], [8]

The device for carrying out the procedure

Apparatus for radiography of teeth called orthopantographs. They can be both film and digital. At the same time, a digital panoramic snapshot of the teeth is considered preferable, because its performance requires a dose of radiation more than 2 times than for a picture on the film. This is due to the fact that the very exposure of the film material to X-ray panoramic images of teeth requires higher doses of X-rays.

The moments that speak in favor of digital images is the possibility of longer storage of high-quality photos on various media (disks, flash drives). Plus, on the computer, you can increase individual segments of the image and change their contiguity to examine to the smallest detail the suspicious areas. A digital snapshot can be quickly transmitted by email to both the patient and other doctors for urgent advice.

When the X-rays are illuminated by the X-ray dental tomograph, it is possible to obtain not just one photograph, but several, made from different projections. And in computer processing on the monitor you can see not a flat image, but a three-dimensional model of jaws and teeth, i.e. A panoramic picture of a teeth 3d.

Apparatus that gives a panoramic image of teeth and jaws, in terms of size and structure, differs from the usual equipment used for sighting the teeth, but the patient does not have to sit, holding the film to his teeth, trembling in his hands, and who strives to move. But a protective lead apron has to be worn in both cases.

Technique of the panoramic tooth

The device for panoramic roentgenology of the jaw in its dimensions is slightly inferior to the booth of the fluorograph, and the procedure is carried out again in a standing position. The patient is brought to the appliance and asked to put the chin on a specially designed device. Thus, the head is easier to fix in the static position, which eliminates unwanted blur of the frame. The neck should be straightened during the procedure, the jaw must be closed, and the teeth should be bitten by a special block that does not allow the teeth to close tightly and overlap each other.

Next, the doctor turns on the apparatus, and the X-ray tube begins to rotate around the patient's head. This movement takes place within 10-15 minutes. The signal receiver has a reverse direction of motion. This is necessary to obtain an image in different projections.

The entire procedure time with preparation does not exceed 30 seconds. The patient does not feel any discomfort or pain.

The received signals are transmitted to the computer, where they are processed and output to the monitor as a solid image. The dentist examines the image on the screen, decrypts it and displays a photo or prints it digitally, dropping onto media.

An adult panoramic snapshot of teeth can be done at any age. However, in some cases, ionizing radiation may present a certain danger. It is about pregnant women and nursing mothers.

Despite the fact that the dose of irradiation in the orthopantomogram is very small, it can still have a negative effect on the developing fetus, causing various cell mutations. Especially dangerous is exposure in the first two semesters of pregnancy, when there is an active formation and growth of the body. Radiography of the tooth for acute indications can be carried out only from the 7th month of pregnancy, and then only if the period is set accurately.

Panoramic snapshot of teeth during lactation can also be dangerous for the baby, if you do not take all the precautions, because breast milk with a certain dose of radiation from the mother during feeding enters the baby's body. True, X-ray rooms, where such studies are conducted, are equipped with a special protection against radiation: lead aprons and collars, preventing the ingress of radioactive particles into the body.

But whatever it is, the X-rays of nursing mothers, like pregnant women, are made only in case of emergency. In doing so, all measures are taken to reduce the degree of radiation: increase the distance from the source, reduce exposure time, apply all protective measures, prefer digital images in which radiation does not exceed 0.02 millisievert.

X-ray of teeth in children

In childhood, the x-ray of the teeth is allowed to do from the age of six. The truth for acute indications is that it can be carried out at an earlier age. In this case, the x-ray is carried out with the exposure mode, which makes it possible to reduce the irradiation area. Adjustable and the trajectory of the tube according to the size of the children's jaws and their shape. And, of course, all kinds of measures to protect the baby from exposure are used.

When asked why you need to take a panoramic picture of your teeth with a baby with baby teeth, if you can remove them painlessly if necessary, you can answer directly - very often the health of permanent teeth depends on this diagnosis, which is still in its infancy.

It is a mistake to think that the milk teeth have no roots. There are roots, it's just that in a certain period of development they begin to resolve, so that baby teeth are very easily removed even on their own. The roots of the baby teeth are widely spaced and penetrate the gum between the rudiments of permanent teeth located under the dairy.

Caries can also develop on the milk teeth, and even more often than on permanent teeth. Yes, and he hides often in the most secret places, invisible to the eye. In this case, untimely treatment of carious teeth often leads to their premature removal. The removal of such teeth from the root leads to the formation of a cavity between the permanent teeth, which makes it possible for them to move in one direction or another. Thus, if this is not envisaged, a permanent tooth may not be cut out where it is necessary, breaking the bite.

For different indications, a child may be assigned: an aiming snapshot of the teeth, a panoramic image or a 3D tomography. The first is prescribed if there is a need for treatment of a particular tooth. 3D tomography is of great value in the treatment of dental canals, implant placement and orthodontic treatment.

But a panoramic snapshot of the teeth gives a complete picture of the condition of the teeth and gums of both jaws of the child, which is useful not only for curative, but also for preventive purposes. Such diagnostics is useful in order to avoid early removal of both dairy and permanent teeth, and therefore it makes it possible to prevent bite disorders.

On a panoramic photograph of the teeth, both the incised permanent teeth are visible, and those that for some reason can not erupt. It is entirely possible that the cause is the wrong position in the jaw, which can be quite corrected by modern methods at this stage, so that in the future one does not have to resort to removing a tooth that interferes with others and complicated orthodontic treatment. In the same picture you can see hidden for the time being anomalies of bone tissue, inflammatory processes, neoplasms.

Normal performance

A panoramic photograph of the teeth is a kind of passport of the dental system of man, because he has complete information that is indistinguishable to the naked eye. At the same time, from the point of view of dentistry, not only teeth, but also bone structures can be of interest.

The X-ray panoramic image of an adult's teeth ideally contains 32 teeth, which are clearly visible on the roentgenogram in the form of light gray rectangles of irregular shape with branches. In the picture they can be identified by Arabic (permanent teeth) or Roman (temporary) figures, because in addition to the name (cutter, canine, premolar, molar), teeth also have their number.

There is another kind of numbering, according to which the last tooth (the bottom wisdom tooth on the right side) is number 48. The world classification of teeth divides the dentition into 4 equal parts, which should contain 8 teeth (in an adult). Numbering goes from incisors to molars. The teeth of the upper right segment have numbers from 11 to 18, and the upper left - from 21 to 28. Lower segments: right numbered from 41 to 48, the left - from 31 to 38.

The orthopantomogram of the child contains more teeth than the adult, although with an external examination the picture is quite different. The reason for this curious situation is that not only the milk teeth are seen on the X-ray image, but also the uncut permanent ones (20 dairy ones with the numbering 51-55, 61-65, 71-75, 81-85 and 28 permanent except for the wisdom teeth). The rudiments of permanent teeth, depending on the age of the patient, may have different sizes and shapes, but in any case, their number is always visible, i. E. The doctor knows in advance if the number of teeth is different from the norm.

Orthopantomogram - is a mirror reflection of the jaw, which should also be taken into account when decoding. It is very important to pay attention to the quality of the image. It is important not only the sharpness and contrast of the image, but also the angle from which the radiograph was taken.

Normal radiograph indicators include the following:

• a kind of smile in the picture (if the corners of the jaw are on the contrary omitted, the picture is made incorrectly with distortions),
• the presence of a normal number of incised teeth with a common number of root branches,
• teeth have a normal shape and size, their contours are clear and do not contain unevenness and darkness,
• there are no areas of localized darkening with a light border or limited light areas (in the tooth region such elements may indicate caries and tartar)
• in the gum region, there are no restricted areas that differ in color and indicate inflammatory processes and neoplasms,
• there are no signs of bone tissue destruction of the jaws, which are also visible to the specialist in the panoramic image of the teeth (they are characterized by clear contours and even shape without interruption and thickening).

[9], [10], [11]

Caries on a panoramic picture of teeth

Let us dwell in more detail on the situation with caries, the most popular tooth pathology, which affects both tooth enamel and dentin, reaching the roots of the tooth and the nerves hidden in it, which provokes acute pain. With the help of a panoramic snapshot of the teeth, you can identify both its explicit shapes and hidden ones.

For example, when the caries begins, you can not outwardly notice any changes in the tooth, and the X-ray image will show the clarified demineralized area, which will subsequently be destroyed. In a hidden way, recurrent caries can also occur, when tooth decay occurs under a seal that can remain intact from above. In the picture, a light portion of the filling and a dark element of the carious cavity will be seen.

An extensive picture is also helpful in case of overt caries, especially when the patient can not indicate the exact localization of pain. The degree of caries damage can be seen on the target image of the tooth, but it is possible to determine which tooth caused the pain before it is opened with the help of an objective image of the teeth. Sometimes the difference between the tooth pointed to by the patient and the cause of the pain is quite noticeable (plus or minus 2 teeth).

In some cases, a person may even feel that half of the jaw or even another jaw hurts, which greatly complicates the diagnosis. And again a panoramic snapshot of teeth comes to the aid. And some types of caries at an early stage can be detected only with the help of 3D-projection. Plus, at the same time see other possible deviations.

A fairly frequent and dangerous complication of caries is the formation of a cyst inside the gums. The cyst is a neoplasm with dense walls and liquid purulent contents. Provoke its formation can open carious cavity or poor-quality tooth filling, when part of the channel remains open.

We must immediately say that caries on the surface or inside the tooth is much easier to treat than to fight with a purulent inflammation deep in the gum. But if you still can not prevent the pathology, you need to take urgent measures to treat it, because getting pus in the blood with the growth of the cyst is fraught with sad consequences (sepsis, phlegmon, etc.).

If the cyst is formed on the site of a destroyed or removed tooth and reminds oneself of pain, then it is possible to confine oneself to the sighting image. But sometimes the cause of the pain remains hidden, as in the case of tooth decay, then without a panoramic image of the teeth simply can not do. By the way, quite often a cyst in the form of a limited darkened area in the area of the root of the tooth or on its lateral surface in a panoramic image of the teeth is detected by chance. The patient can either not feel pain, or simply ignore it. Thus, the orthopantomogram helps to prevent the development of a dangerous condition, which in the most negative way can affect the health and life of the patient.

Proceeding from the above, a panoramic snapshot of teeth can be considered the most informative form of X-ray study. After all, it provides an opportunity not only to accurately diagnose and treat existing diseases or to carry out effective preparations for orthodontic treatment, but also to make assumptions about possible pathologies, which is especially important in childhood. In just one survey, you can get information about the state of the entire dentition, as well as the musculoskeletal system of the jaws, which allows revealing even hidden pathologies that in the future can turn into big trouble.

[12], [13], [14]