Introduction

Radiographs are an important part of dental diagnosis and treatment planning. Patients may be prescribed radiographs that will be used along with a clinical examination. Bitewing radiography is a commonly used dental x-ray technique and may be a component of the radiologic examination. Bitewing radiographs provide vital information to aid in the diagnosis of the most common dental diseases; specifically tooth decay and periodontal bone loss or gum disease. Additional important findings may be detected on bitewings, including the condition of fillings and the presence of calculus or tartar.

Background

Bitewing radiographs provide an image of the crowns of the top and bottom teeth on a single film. The type of film used for this examination provides a high resolution image that is able to detect the subtle changes that occur with dental diseases. Bitewings are usually prescribed in a series of 4 films, positioned on both sides of the mouth, examining the structures from the eye teeth, or canines, back.

Bitewing Procedure

1. The patient is seated in an upright position in the dental chair.
2. The patient is covered with a lead apron and thyroid collar.
   Accepted standards for infection control will be followed, with the operator wearing gloves and some of the surfaces covered in a protective barrier.
3. A film is placed into the patient’s mouth using a cardboard film holding device. This device holds the film in position while the patient bites his or her teeth together onto a portion of the cardboard tab.  It is important that the patient closes his or her teeth completely in their natural bite. Sometimes a plastic film holder with an attached ring may also be used.
4. Once the film is in position, the operator directs the cone of the x-ray unit toward the film.
5. The patient is instructed to hold still while maintaining the correct position. The operator leaves the room where he or she will press a button, to expose the film, which produces an audible beep.
6. The operator re-enters the operatory and removes the film from the patient’s mouth. This procedure may be repeated for different areas of the mouth as required.
7. Once the series of bitewing radiographs has been completed, the operator will remove the thyroid collar and lead apron and ensure that the patient is comfortable, while waiting for the films to be processed.
8. Following film processing, the films are examined. This initial assessment does not examine the films for disease; rather, the films are assessed to determine whether all areas can be visualized adequately. Anatomical variations, as well as local restorations may obscure the image so that all the required areas cannot be clearly seen, necessitating a re-take of that film.

The patient exposure dose of radiation is kept as low as possible in order to maximize diagnostic value while minimizing risk. Radiation doses from dental radiography are considered comparable to the levels of radiation that we are exposed to every day from natural sources, such as the earth and space. Bitewing radiographs provide the dental professional with important information that is vital in the diagnosis and treatment planning for our patients.