Are periapical (not bitewing) x-rays necessary to spot tartar below the gumline of ALL surfaces of a tooth?

Question

A dentist I saw for the first time informed me from the x-rays taken that I had tartar build-up below the gumline on only the mesial of one tooth. In other words, he informed that all the other surfaces (of all my teeth) were tartar free (at least below the gumline).

He did not do a visual exam. And he took only bitewing x-rays which, I understand, give a picture only of what is going on in between the teeth. The implication, to me, is that he would have had to take a set of FULL-tooth (periapical) x-rays in order to reach his conclusion. Am I wrong?

Answer 1

Here is a set of four bite wing x-rays. http://www.flickr.com/photos/samfeinstein/2102584534/ The gums do not show very distinctly on x-rays. The sort of spongey looking stuff between the roots of the teeth is the bone. The gums pretty much fill the dark triangular areas between the teeth. You can see that pretty much all of the tooth above the bone is visible in a set of bite wing x-rays.

I would never tell someone that they did not have any tartar based simply on an x-ray examination. First of all, unless it is a pretty significant chunk of tartar, it would either barely show or not show at all on an x-ray. If you can see tartar in an x-ray on one surface of one tooth, you can bet that there is a lot more tartar on other surfaces that just doesn't show yet. If you just had your teeth cleaned, it is possible that there was one piece remaining that had been missed in the cleaning, but you did not stipulate that.

So, I have two comments in answer to your question.

1. You do not need a "full tooth" periapical x-ray to conclude whether there is tartar below the gums.
2. X-rays are not the "bottom line" in diagnosing the presence or absence of tartar.

Answer 2

You can detect "tartar" under the gumline on a bitewing xray, but to state it is only on one surface without a visual exam is hard to grasp. An xray is a two dimentional picture of a three dimentional object. I have had many a patient in my chair and thought "oh, just a little bacteria on the mesial" only to find a whole ring of "tartar" during the cleaning. A thorough exam needs to be visual and radiographic. Bitewing xrays are fine, as long a you have had a full mouth series within the last 3-5 yrs. And you are correct in stating that bitewing xrays detect what is going on between the teeth, but they also show a certain amount of supporting bone and the roots of the teeth. Do yourself a favor and make sure you get a full mouth periodontal exam with periodontal charting (measurments of the space between the gums and your teeth) to rule out any periodontal activity. Oh yeah, and let the hygienist clean your teeth.

Answer 3

Since he only took bwx x-rays then he can't see the whole tooth. It is not unusual for a dentist to want a FMX (full mouth series of x-rays) to see all of the area. He is looking for other places that might harbor tarter, which means you may have bone loss associated with periodontal disease. Just because he only saw one piece of tarter, on one film, does not mean that there won't be other places that have deep tarter under the gum-line. He needs these x-rays in order to make a full diagnosis of your mouth. He wants to check out the bone levels, as well as the roots of the teeth (for abscesses, fractured roots, etc.) An FMX is a great way to have a look at all of your teeth. Most dentists only do them every three to five years (an FMX that is) so don't worry about it. It is a great diagnostic tool.

Answer 4

A new patient examination, on an adult, should consist of either a full set of peri-apical x-rays and bite wings [which give the most accurate assessment] or bite wings and a panorex scan.

Answer 5

ANY RADIOGRAPH TAKEN WILL SHOW THE PRESENCE OF CALCULUS.
BITE WINGS ARE THE STANDARD FOR THIS.
THE REASON FOR THE PERI-APICAL PHOTOS IS TO SEE ANY RADIO-GRAPHIC PATHOLOGY AT THE LEVEL OF THE TIP OF THE ROOT.
THE PROFESSIONAL STANDARD IS TO DO A FULL MOUTH COMPLETE SET OF RADIO-GRAPHS SO NOTHING IS MISSED. BITE WINGS ARE A USEFUL COMPONENT OF THIS SERIES.
THE BITE WINGS WOULD REVEAL THE CALCULUS AS WELL AS DECAY BETWEEN THE TEETH.