4. Oral Pathology and Imaging

Dental radiographs can show hidden dental structures such as cavities, anomalies, malignant or benign masses, impacted wisdom teeth, periapical lesions and bone resorption that cannot be seen during a visual examination. Dental materials for tooth restoration with filings and crowns, or root canal obturation and sealing can appear lighter or darker depending on the density of the material. Most dental materials contain a radiopaque material such as Barium sulphate to help visualize the material in radiographs. Bitewing radiographs are routinely used to detect tooth decay and recurrent caries under existing restorations. Periapical radiographs are taken to visualize the root apex, periapical tissues and bone surrounding teeth that a patient is complaining of being painful or/and has swelling and/or the symptoms of infection. Occlusal radiographs are taken to visualize the skeletal or pathologic anatomy of either the floor of the mouth or the palate. Panoramic radiographs are occasionally taken using extraoral films and show a broad view of the jaws, teeth, sinuses, nasal area, and temporomandibular joints and anatomic structures. Digital radiographs are an acceptable first choice for the diagnosis and treatment of dental pathology. Cone beam computed tomography (CBCT) imaging is becoming a complementary technology and in many instances can provide 3-dimensional oral pathology information that might have been overlooked on 2-dimensional images. Odontogenic cysts and tumors can be identified using radiology, clinical diagnosis and histopathology. The most common odontogenic cysts of the jaws are Periapical cysts, also called Radicular cysts, Root End Cysts, Periodontal Cysts, Apical Periodontal Cysts, and a Dental cyst; they are most commonly seen in patients aged 20 to 60 years old. Patients can worry about the radiation from radiographs, even though the amount is very low, care must always be taken to reduce your own and the patient’s exposure to radiation. But do not be afraid of re-taking radiographs that are needed to diagnose pathology and to decide on an accurate treatment plan. It is better to have good quality radiographs than have to interpret poor-quality radiographs that are out of focus and angled incorrectly.