Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

Why Does the Orthodontist Need Another X-ray?

Posted by Dr. Jorgensen on November 26th, 2012

Bald PanoYour son just had “X-rays” taken at the dentist last month. Why does the orthodontist need to take another one? In fact, why do orthodontists need X-rays at all?

X-rays, officially called radiographs, are images created when a beam of radiation passes through the body and hits a sensor (or a piece of film in older machines) on the other side. X-rays have the ability to create pictures revealing the differences in the densities of the tissues through which they pass. The “shadows” cast on the digital sensor or film allow doctors to see objects hidden by the skin and bone. The most common X-rays taken by general dentists are called bitewings. In a bitewing, the dentist gets a detailed picture of a small group of teeth that reveals the health of the enamel, inner canals, and roots. Enamel and fillings are dense and appear white in color on the radiograph. The bone around the teeth, the root canals, and decay are less dense and therefore appear darker. Dentists are trained to interpret the light and dark patterns so they can distinguish normal tissues from abnormal ones.

X-rays are essential in orthodontics for many reasons. First, orthodontists are also dentists and, although they are focused on different things, they share the responsibility of identifying pathologies if they are present. These include abscesses, tumors, and other things that are not necessarily directly related to straightening the teeth. Although rare, such pathologies are many times identified for the first time by orthodontists and lives can be saved as patients are referred for treatment.

The second reason orthodontists take X-rays is to help them diagnose and treat orthodontic problems. Orthodontic X-rays focus more on the position and form of the teeth and jaws than on individual teeth like bitewings. Orthodontists are especially interested in missing, extra, impacted, or misplaced teeth, and short, long, or misshaped roots. Problems with the jaws include bones that are too big, too small, asymmetrical (off center), too far apart, too close together, or misshapen. X-rays provide orthodontists with essential information that helps them determine where problems exist and the best way to correct them. The size, shape, and position of the teeth and bone in X-rays dictate if surgery or tooth extraction will be necessary.

Orthodontists also take X-rays during treatment so they can monitor how treatment is progressing. Not all effects of orthodontic treatment are visible to the naked eye. Although very rare, moving teeth in some individuals (about 2%) causes the roots to shorten. Orthodontists must check for this during treatment so they can determine if and how long tooth movement should continue. Sometimes orthodontists observe how the teeth are moving to help them finalize the treatment plan. I prefer not to remove permanent teeth if possible, so in many borderline crowding cases I will begin to align the teeth just to see how the teeth and bone respond. If the progress X-ray reveals that there is not enough bone to accommodate all of the teeth, I can always have some removed along the way.

After treatment, a final X-ray is taken to evaluate the outcome of treatment and make recommendations for other necessary procedures (i.e. wisdom teeth). Ideally then, I take one radiograph at the beginning of treatment, one after about six months, and one after the braces come off. Each of these X-rays exposes a patient to less radiation than they would receive taking a typical airplane flight. All dentists are taught to use the ALARA principle (As Little As Reasonably Achievable) when it comes to radiation. I am careful to take X-rays on my patients only when it is in their best interest, and I assume that my colleagues also do the same. Don’t be afraid to ask your orthodontist the reason for your next X-ray.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

20 comments so far in response to “Why Does the Orthodontist Need Another X-ray?”

  1. R. Dinesh Kowsky says:

    Dear Dr.Jorgensen , I came across your website recently while i was searching the web about root resorption induced by orthodontics. Your opinions and comments are excellent and seem to be evidence based. What is your opinion about 3D CBCT, do you recommend them for any specific complex cases or not. Does CBCT exposes patients to any significant radiation exposure?. Thanks

    • CBCT, like all forms of radiography, does expose the patient to radiation. When set to the lowest doses and properly shielded, patients receive little more or no more than a standard lateral film and a panoramic. In fact, some of the new CBCT machines actually expose patients to LESS radiation than older standard machines (iCat Flex). I love the improved diagnostic information I get from a cone beam image. My patients are three dimensional and their problems are three dimensional. Not only can I see where things are better, the structures are presented in an 1:1 ratio. No magnification or distortion. I feel that my diagnostic skills and treatment planning are much better with this technology.

  2. Juanita says:

    Sir, my dentist didn’t required me for an x-ray. Is it safe? Thanks.

  3. JESSICA says:

    DOCTOR I AM PREGNANT AND VISIT AN ORTHO AND THEY TOLD ME I CAN START MY TREATMENT WITH OUT XRAYS AND GET THOSE DONE ONCE I DELIVER IN FEBUARY. IS THIS SAFE?

    • I think this is perfectly reasonable. You should also know that in August 2013, the American College of Obstetricians and Gynecologists published a paper stating that modern x-ray equipment is so safe that it is now safe for pregnant women to have films taken while they are pregnant.

  4. Steve says:

    Doctor, I am a 60 year old just finished up with Invisalign and I debated with the orthodontist about the need for the final xray. It seemed it was more important for him rather than the patient . I am always concerned about being unnecessarily exposed. The doctor told me it was equivalent to a airplane exposure. Well I have been in n three plane trips in the past three months does this increase my risk? I had my dentist send the orthodontist last years X-rays and they said they were inadequate funding what they needed. I do by see how. I let the orthodontist take the xray against my better judgement. Should I be with worried?

    • You have nothing to worry about. The exposure levels in dental x-rays are so small that it is just not an issue any more. You truly do get more radiation flying in airplanes. Having said that, pilots that fly all the time do not have a higher cancer rate and there has never been a sickness or cancer tied to a dental x-ray. Relax!

  5. Jaroslav Procházka says:

    Hello, I am 16 y.o male. I just got my braces removed today. But I mean I had xrays taken almost all the time at his office. I got one at the dentist and one at the orthodonist today. Which means I will get brain cancer. What should I do ? Thank you

    • All dentists are taught the ALARA principle which states As Little As Reasonably Achievable with respect to the amount of radiation we expose our patients to. We take radiographs when we feel they are necessary. I do not think you will get brain cancer. In fact, there are no know cases of patients getting sick from dental x-rays so you can relax.

  6. HK says:

    Hello, I have been having braces since december 2011 and today when I saw a different orthodontist to get a 2nd opinion she said by looking at the radiographs I have got reduced root canals and should take my braces off within 6 to 8 wks otherwise my teeth will become wobbly and fall off. Whereas my original orthodontist had told me the braces will come off some time next yr. Now I have decided to change my orthodontist and if possible sue the old one because she tortured me with the treatment. 1st 2 yrs i saw her once every 4 wks, 3rd yr I saw her once a wk and during the past yr I saw her every 2 wks. (I got braces only because I had slight overbite and for the past 2yrs she has been working on the faults caused during treatment ie teeth moving in the wrong direction!
    I will highly appreciate it if you could tell me that based on this information I have taken the right decision.
    Best regards.

    • You need to talk to the original orthodontist about the length of your roots. Severe root resorption can lead to the loss of your teeth. If she will not change your treatment plan and timing, you need to change doctors.

  7. Alfred Goodier says:

    My daughter who is now 14 1/2 started treatment when she was 11 1/2 with the orthodontist using the alternative procedure of a plate worn create roomfor teeth thenfinished with the standard braces . After the initial xray they did no further xrays until 2 years after start of treatment and found that one of her adult teeth had gone sideways and would result in the destruction of one tooth under the tooth going sideways as it comes out .

    This will result in one missing tooth which will need an implant.

    My question is it not reasonable for me to have expected that they would xray in the 2 year period so that the problem with the sideways moving adult tooth might could have been picked up? I indicated I was not happy at the time because I thought they should have done subsequent X Rays over the two year period ,personally I felt they failed to adequately monitor her orthodontic progress .Am I being unreasonable ? I was told basically they had not seen this before and that I could refer to other orthodontists re the lack of xrays as this is usual with children to limit xrays but I thought 1 and then nothing for 2 years didn’t seem right .?

    • I’m sorry to hear about the root resorption on your daughter’s tooth. It is impossible to judge what happened here. While I take x-rays at least once a year, there is no standard time period between exposures. Unfortunately root resorption happens and even if your orthodontist had discovered it happening earlier, there may not have been much that could have been done to stop it short of surgical intervention. Teeth touch other teeth all the time and most do not lose their roots. The research indicates that what you have seen in your daughter occurs in less than 5% of patients and you can’t predict who they are until the damage is enough that it is visible.

  8. Lori says:

    I have an 8 yr old boy who had xrays done in Dec 2015 by his dentist for his cleaning. She gave me an orthodontic referral and I have been shopping around for an orthodontist. Last week I took him to see an orthodontist and he had an xray taken and today he was seen by another orthodontist and had xrays again. Is that too much radiation exposure? Should I be concerned? Any health consequences? I’m planning to see more orthodontists within the next couple of weeks. Please advice.

    • Why are you seeing so many orthodontists? What are you looking for? Of course getting so many x-rays should be avoided, but the bigger question is why are you shopping for a doctor like you do a deal on a used car?

  9. Tiffany says:

    Ive had braces years ago, the ortho didnt take xrays following brace removal. He gave me the retainer. Now years later, I am one of the cases where I had 6 wisdom teeth instead of four. My top wisdom teeth were doubled on each side. Since there was no room, my wisdom teeth pushed my front tooth out where it is no longer aligned. I need braces to fix that tooth. Originally, I paid cash for my braces over 4k, no insurance payments what so ever. I am older than 21 and even if younger I believebelieve I am below the 26 point system insurance carriers require, so I wouldnt qualify through insurance regardless. Should the ortho be responsible for fixing this issue? Can you give me some advice?

    Thank you so very much,
    Tiffany

    • Wisdom teeth do not move the front teeth. The only way to keep them straight are retainers. Your orthodontist was only responsible for aligning your teeth, providing retainers, and explaining how to use them. Had you worn retainers, your front teeth would still be straight with or without wisdom teeth.

  10. Valencia says:

    My pans were sent to an oral surgeon re: bottom left wisdom tooth extraction. They have called and said they would like to schedule a consultation and do a 3D x-ray. Do you have any insight as to why they would need to do this?

    Thank you in advance 🙂

    Valencia

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