A Panorex Primer

Just as with adult patients, at our NYC pediatric dental practice we take x-rays of children’s teeth to identify cavities, tooth alignment, the status of incoming second molars, jaw development and the like. You may wonder what a Panorex is and how it’s like or different from other dental x-rays you may have had in your past.

For many parents, when I say “dental x-rays,” they think of small cardboard-encircled rectangles, called “bitewings,” that are placed in the mouth one at a time, after which a dental technician or hygienist snaps a photo with a pointy piece of equipment that swings in from the side of the dental chair. These types of x-rays generally include 3-5 teeth at a time, depending upon the size of the teeth. While not uncomfortable, these standard type x-rays often make children gag, and they take more time than a Panorex. However, bitewing x-rays are still very important, as they are an excellent tool to reveal the location and extent of dental decay

Here’s a standard x-ray result:

What is a Panorex X-ray?

A Panorex is an x-ray that reveals both upper and lower jaws, teeth, temporomandibular joints (TMJs for short) and the sinus cavities. As you can see, this is much more comprehensive than an x-ray showing teeth alone. A Panorex enables us to identify cysts or other lesions in the mouth, second molars waiting to enter the mouth when the “baby” teeth fall out, and other items, such as extra teeth. Panorex x-rays show the current state of the mouth, but also help us plan for future needs, such as orthodontic treatment and extractions of extra teeth.

Here is an example of a Panorex x-ray, with notations to identify some of the teeth you see there:

Why Panorex?

Because Panorex x-rays show so much more than just your child’s teeth, this comprehensive view of the oral cavity allows me to:

Evaluate your child’s dental growth and development.

• Identify disturbances in tooth eruption, such as:
• Missing teeth (primary or permanent),
• Extra teeth and
• Teeth that will likely create crowding because of size or direction of tooth growth.
• Identify any pathology of the tooth or the bone, including the sinuses and the jaw.
• Whether (and where) your child may have 3^rd molars (i.e., “wisdom teeth”).
• Identify needs for orthodontic treatment.

Panorex allows me to identify any problems in the bone, in the sinuses, and in the jaw. For example, we may find impacted teeth—sometimes the permanent (2^nd) molars become impacted due to impacted wisdom teeth, meaning the child is missing several back teeth. This situation is not that uncommon and often overlooked by both the child and parents, who don’t realize that some of the back teeth aren’t there!

When I Take Panorex X-rays of Children

Panorex x-rays are something I normally take three times:

• When the first permanent teeth start to grow in (usually the 6 year molars);
• When the child starts to lose more teeth around 11-12;
• When the child reaches the age of 16-17.

Bottom line, a Panorex is an amazing tool that equips us, your Lower Manhattan pediatric dental team, to diagnose oral pathologies before there is any chance of permanent damage to your child’s oral health, such as a loss of permanent teeth. Timing is everything. With a Panorex, we can “see into the future” in a way not available with traditional x-ray technology.