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Your child 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.

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, one radiograph is taken at the beginning of treatment, one six months to a year later to monitor treatment 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. Dr. Hughes is careful to take X-rays on her patients only when it is in their best interest. Don’t be afraid to ask the reason for your next X-ray.

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When should your child see an orthodontist?
The American Association of Orthodontists (AAO) recommends that every child see an orthodontist by age 7. You may think this sounds very young for the first visit to an orthodontist. However, many orthodontic problems are easier to correct if treated early rather than when jaw growth has slowed. Catching an issue early will reduce the need for surgery, extractions and further orthodontic in the future.

The majority of 7-year-olds have a limited number of permanent front teeth as well as all four permanent first (six-year) molars. An orthodontist can generally determine whether or not there will be adequate room for the remaining permanent teeth at this time. This determination is often aided by a panoramic X-ray. If the orthodontist determines that there will not be adequate room for the permanent teeth, early treatment can be initiated and may consist of appliances to expand the jaws or the early removal of deciduous teeth. This approach greatly increases the chance that the remaining permanent teeth erupt ideally aligned.
In addition to treating dental crowding early, many orthodontists will also advise treating certain bite problems (malocclusions) early as well. One of the most important bite problems to correct early is a crossbite. A crossbite occurs when the upper teeth fit inside or behind the lower teeth. When left untreated, crossbites may lead to permanent deformation of the lower jaw as well as severe wear of permanent teeth and may require future oral surgery to correct. Treatment may be as simple as an upper retainer or may involve appliances to expand the palate and stimulate forward growth of the upper jaw.

Another commonly treated orthodontic problem is an overbite (more correctly termed overjet) or "buck teeth." An overbite may result when the upper jaw grows more rapidly than the lower jaw or may simply result from protrusive front teeth. If the jaw is involved, treatment will usually consist of an orthopedic appliance to help stimulate lower jaw growth. In addition, limited upper braces are often placed on the front teeth. The advantages of treating the overbite early include improved chewing function, speech, facial esthetics, increased self-esteem and reduced risk of dental injuries.

Finally, orthodontists generally recommend treating harmful habits such as thumb sucking, tongue thrusting and mouth breathing at a young age. There is strong evidence that these habits can lead to significant orthodontic problems.

While it is recommended for your child to see an orthodontist by age 7, individual problems will determine the ideal time to start orthodontic treatment. The majority of patients seen at this age will not require treatment and will be monitored during annual dental exams by the orthodontist, enabling necessary treatment to begin at the optimal time for their individual circumstances.

Call our office to book your child’s first orthodontic exam at 508 319 1545. The first appointment is complimentary and includes an oral exam, x-rays and pictures, and a consultation with Dr. Janeen Hughes.

Benefits of choosing an orthodontist
The number of general dentist who are offering orthodontic treatment is rising and many patients are wondering – what is the difference between a dentist and an orthodontist? The most important differences have to do with training, experience, and value.

Orthodontists are highly trained specialists that have received education in an accredited orthodontic residency program for an additional 2-3 years full time after dental school. General dentists who practice orthodontics do not have this additional education. The additional education an orthodontist receives concentrates on growth and development, and in the diagnosis, prevention, and treatment of all types of malocclusions and jaw growth discrepancies. This education gives orthodontists an advantage at recognizing both existing issues and potential issues that may arise with growth before they happen and equips them with the knowledge to properly treat all cases, simple or complex

The next thing that differentiates an orthodontist from a general dentist is experience. Because an orthodontist specializes in straightening teeth, correcting facial profiles, and creating beautiful smiles, they treat hundreds of new orthodontic cases each year. A general dentist, on the other hand, may see only a hand-full of cases per year in between the other procedures they regularly perform. Due to an orthodontists’ combination of specialized training and greater amount of experience, the orthodontist is more prepared to properly diagnose orthodontic complications and handle unexpected problems as they arise.

Finally, there is the issue of affordability and value. Many patients are surprised that the orthodontist fees are usually nearly the same as a general dentists’. The reason is efficiency. An orthodontist and their expertly trained staff are set up and equipped to devote all their efforts and attention towards orthodontic care. On the other hand, a general dentist and staff may have an occasional orthodontic appointment in between drilling and filling. As a result of this efficiency, fees are nearly the same, even though the specialist possesses significantly higher expertise and experience.

There are many well trained and highly capable general practitioners that can treat less complicated cases with great results. However, there are many advantages to seeing an orthodontist when it comes to creating the beautiful smile you've always wanted!