The Panoramic X-Ray Gives Dentists the Big Picture

Sharma RDH

Sharma Mulqueen RDH

The Panoramic X-Ray Gives Dentists the Big Picture

One advantage of the panoramic X-ray is its ease of use. Unlike other X-rays where the film is placed inside the patient’s mouth, the panoramic film is contained in a machine that moves around the patient’s head. Some people may be familiar with the panoramic X-ray because it is usually taken when the wisdom teeth are being evaluated. The X-ray will also reveal deep cavities and bone loss.  The panoramic X-ray has many other applications, including evaluating patients with past or present TMJ jaw joint problems; those who require full or partial removable dentures and partials; those who are at risk or suspected of having oral cancer or other tumors of the jaw, have impacted teeth such as wisdom teeth or have had any recent trauma to the face or teeth.

The panoramic X-ray can also identify some not so common problems, such as calcification within the carotid artery that may indicate the potential for a stroke. In one situation, my father-in-law had not been to the dentist in several years.  I referred him to my Friday office so he would be comfortable with another Dental Hygienist.  Full mouth series of X-rays, Panoramic X-ray, and charting were completed.    After the Dentist reviewed the panoramic X-ray it revealed a Bi-lateral calcification of the carotid artery.


The Dentist asked when the last time he was at his cardiologist.  He stated he was there yesterday and everything looked good according to his Doctor.   After discussing his findings he referred him back to his cardiologist for a follow up appointment.  After calling the Cardiologist office they got him in the following day and a test was done a week later.  The test revealed a 50% blockage on the left side.  To treat the blockage there are a few options.  Treat with medication, perform carotid angioplasty (a thin tube with a balloon on the end is threaded to the narrowed or blocked carotid artery) or Carotid Endarterectomy (a surgeon makes an incision in the neck and removes plaque buildup from a carotid artery, which helps restore normal blood flow through the artery. My father-in-law is in the early stages of these findings. He will have one more test to determine treatment.

The panoramic X-ray captures more than just the teeth. Normally, you don’t see the carotid artery on a panoramic X-ray because it doesn’t have any calcium in it and it’s like other soft tissue.  If there’s calcification in the carotid artery, then it will stand out.  It is recommended that if your Dentist notices this on your Panoramic X-ray, they should refer you to the appropriate specialists for further evaluation and treatment.

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What’s the Deal with Wisdom Teeth?


Becky Larson, RDH

What’s the Deal with Wisdom Teeth?

Everyone has them, but not everybody knows what to do with them.  “Wisdom teeth” or 3rd molars can cause a number of problems in the mouth.

Wisdom teeth are believed to be evolutionary and were helpful to our distant ancestors who frequently ate rougher foods.  Wisdom teeth would erupt as replacements for worn out or missing teeth.  Nowadays modern advancements, better hygiene, and softer diets allow us to keep most of our teeth so we really don’t need wisdom teeth at all! For most people, wisdom teeth erupt in the late teen years or early 20’s, usually earlier for females.  They are the most posterior (towards the back) teeth.  Most people have 4 wisdom teeth total, but sometimes they can be congenitally missing.  Other times people may have extra (supernumerary) wisdom teeth.

Even if there is sufficient space in the mouth and the wisdom teeth are in alignment with the other teeth, they can still cause problems.  Because of their location, wisdom teeth are extremely hard to brush and floss.  If they are not kept clean, they can cause periodontal pocketing, which can lead to tooth loss in other areas of the mouth.  Unfortunately, most people don’t have enough space and when wisdom teeth erupt, they can push on the surrounding teeth.  This can cause crowding and misalignment throughout the entire mouth.  Wisdom teeth can also be impacted – meaning they are enclosed in the gum tissue or jawbone.  When this happens they can partially erupt or even try to erupt horizontally.  When teeth are only partially erupted, it allows bacteria to enter the tooth.  This can lead to infection, pain, swelling, jaw soreness, cysts, and other systemic illnesses.

X-ray showing impacted wisdom teeth:


A dentist will usually take a panoramic x-ray to view the wisdom teeth to determine when/if they need to be extracted.  If extractions are indicated, getting them out at a younger age is preferable for recovery time.  If wisdom teeth are fully erupted and not impacted in the gums or bone, they can be extracted as easily as a regular tooth.  If they are impacted, the gums and/or bone need to be cut open in order to extract.  Wisdom teeth can be extracted with local anesthetic only, though other pain/anxiety management techniques can be used.  These include nitrous oxide, conscious sedation, and/or anti-anxiety pre-medication.

Recovering time is usually about 2 weeks.  During the recover a person may experience bleeding and facial swelling.  Pain medications and antibiotics are often prescribed as well.  Possible complications of wisdom teeth extractions include dry socket and parasthesia.  Dry socket occurs when a blood clot fails to form or falls out and is extremely painful.  A person should not drink from a straw for several days after the extractions to avoid dry socket.  During wisdom teeth extractions the nerves can sometimes become damaged or bruised.  This results in prolonged numbness or parasthesia, which can last weeks or months and can sometimes be permanent.  Parasthesia is more rare and generally the numbing sensation wears off after several hours.  Dry socket and/or parasthesia don’t always occur after wisdom teeth are extracted.

So you can see that wisdom teeth can cause many headaches (literally)!  Be wise and get your wisdom teeth extracted as soon as your dentist recommends it.

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