No single birthday applies to every child. Dental guidelines say the decision should rest on each child’s own situation.1Pediatric Dentistry. Guideline on Prescribing Dental Radiographs for Infants, Children, Adolescents, and Persons with Special Health Care Needs The usual reasons are to check how the adult teeth are coming in, plan braces, look at an injured jaw, or explore a swelling. A panoramic X-ray gives a wide picture of all the teeth and both jaws at once, so it shows problems hidden below the gums that a mirror or a small X-ray can’t. Because it carries a small radiation dose and its fine detail is limited, a fair question for any parent is what specific question this picture will answer.
The Ages When Dentists Most Often Suggest One
Some pediatric dentists take the first one around age 7 or 8, when permanent teeth begin coming in, and another around 12 once baby teeth are mostly gone.2Your Site Title. Panoramic X-ray — Smiles For Kids Pediatric Dentistry Other practices use ages 9, 12 and 16, with the mid-teen image used to plan for wisdom teeth.3Lake Baldwin Dental. What Is a Panoramic X-Ray? Does My Child Need One In 2023? In a large review of children’s X-rays, age 9 was the best single age for spotting any tooth anomaly, with 12 and 15 also useful.4PubMed. Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies
The 7 to 9 window makes sense because of what is happening in the jaw. The front adult teeth and first molars are arriving, while the canines and premolars are still forming in the bone. An image now shows whether teeth are missing, extra or heading the wrong way before they erupt. Catching a problem at that stage often allows a simpler fix, like removing a baby tooth to clear a path.
At this age, dentists use the image to count the developing adult teeth and confirm each one is present, since a mouth full of baby teeth can hide a missing adult tooth. They also look at whether the tooth buds sit where they should, and whether any baby teeth have roots that aren’t dissolving on schedule. An unexpected finding usually moves the plan from “wait and watch” to “watch more closely or involve an orthodontist,” not to immediate treatment. A normal image is useful too. It tells the family development looks on track and reduces the need for more pictures soon.
Age is a guide, not a rule. European pediatric guidelines require every X-ray to be justified for that specific patient.5PubMed. Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document A child whose teeth are developing on schedule with no concerns may not need one at the first suggested age.6Pediatric Dentistry. Guideline on Prescribing Dental Radiographs for Infants, Children, Adolescents, and Persons with Special Health Care Needs
An earlier pano is more likely to be worthwhile when there is a visible clue. Examples are a baby tooth that stays long after its neighbors have fallen out, or an adult tooth that arrives on one side but not the other. Crowded or crooked front teeth, an unusual gap, or a family history of missing teeth can also make a dentist want a view below the gums. So can teeth that are late to arrive, or a baby tooth lost very early after injury or decay. With none of these clues and a normal exam, it is reasonable to ask whether the picture can wait until your child is a little older.
If the dentist proposes one at a routine visit, ask what they are looking for in your child specifically. Ask whether a previous pano exists that could be used instead. And ask what would change in treatment depending on the result.
What a Panoramic X-Ray Can Find in a Growing Mouth
Panos are considered essential for diagnosing extra teeth, missing teeth and impacted teeth, meaning teeth stuck under the gum.7Journal of Clinical Pediatric Dentistry. Classification of presence of missing teeth in each quadrant using deep learning artificial intelligence on panoramic radiographs of pediatric patients Among children with findings on a first-visit pano at a pediatric clinic, about 6 in 10 problems were missing teeth and 3 in 10 were an extra tooth between the upper front teeth.8PubMed. Evaluation of panoramic radiographs taken at the initial visit at a department of paediatric dentistry Rarer findings in that group included other extra teeth, a small tooth-like growth, a cyst and a tooth stuck under the gum.9PubMed. Evaluation of panoramic radiographs taken at the initial visit at a department of paediatric dentistry
A mirror exam can’t find these problems. Adult teeth form deep inside the jawbone and stay hidden for years, so a child’s mouth can look normal, with a full row of baby teeth, while an adult tooth is missing underneath.
Upper canines are among the teeth most often seen erupting off-course, which dentists judge on a pano by the tooth’s tilt and position.10East Journal of Medicine. Prevalence of Ectopic Maxillary Canine And Its Association With Other Dental Anomalies In Children: An Observational Study Spotting a misdirected canine early lets the dentist act before it becomes stuck in the bone. Many jaw cysts in children cause no symptoms and are found by chance on a pano.11PubMed. Cystic Lesions of the Jaw in Children: A 15-Year Experience
When an adult tooth is missing, the baby tooth above it may be kept for as long as it stays healthy, which holds the space and the bone for years. In other cases an orthodontist plans whether to close the gap with braces or hold it open for a replacement later, usually once growth is nearly finished. An extra tooth between the upper front teeth can block the adult front teeth from coming in, so it is often removed, with timing chosen by the specialist. Most findings lead to monitoring or a referral, not urgent surgery.
Injuries, Swelling and Other Reasons for a Pano Anytime
A pano is the image of choice for finding a broken lower jaw.12Contemporary Pediatrics. Oral and facial trauma It shows both sides of the lower jaw in one picture, so the clinician can compare a suspect side with the other. In a group of children with lower-jaw fractures, about half were diagnosed with a pano alone, and a 3D scan was added when the pano was unclear.13PubMed Central. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients A complicated break may also call for the scan. Broken or loosened teeth are often checked with small, close-up X-rays instead, since those show a single tooth and its root more clearly.
After a fall or a hit to the chin, signs that the jaw may be injured include teeth that no longer meet the way they did, pain when opening or closing, trouble chewing and swelling along the jaw. A blow to the chin can break the jaw near the joint in front of the ear, far from where the child was hit, so pain in that area matters. A child with these signs should be examined promptly, and the clinician decides whether an X-ray is needed rather than assuming it’s only a bruise. Trouble breathing or swallowing, or a heavy blow to the head, is an emergency and not a reason to book a dental image. Jaw growths in children are uncommon, but a swelling of the jaw can signal one, and a dentist may order a pano to look for it.14PubMed. Benign Pediatric Jaw Lesions at Massachusetts General Hospital Over 13 Years
Orthodontic planning is the other common reason. How developed the teeth are tells orthodontists a child’s dental age, which can differ from birthday age.15Libyan Journal of Dentistry. Age Estimation in Libyan Children Based on Dental Panoramic Radiography Decisions about early braces, space holders and growth timing depend on that dental age, which the pano shows.16PubMed Central. Dental age prediction from panoramic radiographs using machine learning techniques Orthodontists often want one before starting treatment to check that every tooth is present, and it also shows the root positions they will be moving. A recent image from the family dentist can sometimes be shared to avoid a repeat.
What a Pano Can’t Do Well
The machine flattens a curved jaw into a flat picture, so teeth and bone at different depths can overlap and blur their edges. Front teeth often look stretched or shortened, and the image is less sharp there. It is built to show the whole jaw at once, not tiny cavities or small cracks.
Bitewings are small X-ray films held between the teeth that show the back teeth up close; for cavities between teeth, bitewings were read more accurately and consistently than panos.17PubMed Central. Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography A dentist may therefore order both a pano and bitewings at the same visit.18Pediatric Dentistry. Guideline on Prescribing Dental Radiographs for Infants, Children, Adolescents, and Persons with Special Health Care Needs
If a dentist proposes a pano for development, a child may still need bitewings for cavities, depending on cavity risk. It’s reasonable to ask which problem each picture is meant to answer, so that neither is taken without a reason. Experts reviewing the research say high-quality studies on when children benefit from panos are still lacking.19PubMed. A systematic review of relative indications and contra-indications for prescribing panoramic radiographs in dental paediatric patients
How Much Radiation a Child Gets
A pano gives an average dose of about 23 microsieverts.20PubMed. EFFECTIVE DOSES AND RADIATION RISKS FROM COMMON DENTAL RADIOGRAPHIC, PANORAMIC AND CBCT EXAMINATIONS That’s roughly what a person receives from natural sources in about three days. It is far less than a typical medical CT scan of the body, so it sits at the low end of imaging. A 3D dental scan averaged about 530 microsieverts, over 20 times more.21PubMed. EFFECTIVE DOSES AND RADIATION RISKS FROM COMMON DENTAL RADIOGRAPHIC, PANORAMIC AND CBCT EXAMINATIONS The reason to avoid unneeded panos is that doses add up over a lifetime, not that a single one is dangerous.
Children’s thyroid glands, in the neck, are more sensitive to radiation than adults’. In model tests, a 6-year-old’s thyroid received more dose than an 11-year-old’s at the same settings.22PubMed. Determination of relative dose of ionizing radiation in the thyroid gland using a panoramic device with different protocols A lead-lined thyroid collar substantially lowered the thyroid dose in children.23PubMed. Radiation exposure during panoramic radiography in children Child settings on some machines cut thyroid dose by more than half, though not on every model.24PubMed. Paediatric absorbed doses from rotational panoramic radiography
A collar is sometimes skipped because it can sit in the path of the beam and block part of the lower jaw in the picture, forcing a retake. Some clinics therefore use a child setting that lowers the dose instead. It’s fine to ask what the clinic does for children, and why.
Helping Your Child Get a Clear Picture
The child stands or sits still, bites on a small plastic guide and rests the chin on a support. The machine then circles the head for roughly 15 seconds and doesn’t touch the child. It doesn’t hurt, and nothing goes in the mouth except the bite guide.
Errors are common. In one large review, about 9 in 10 panos had some positioning error, most often the tongue not pressed to the roof of the mouth.25PubMed Central. Positioning errors and quality assessment in panoramic radiography Children had more errors than adults, often from moving and small head size.26Journal of Stomatology. Comparison of positioning errors on panoramic radiographs in Indonesian children, adults, and elderly patients
A little rehearsal helps. Practice standing still like a statue for about 15 seconds, since movement is a common reason for a blurry picture. Practice pressing the tongue to the roof of the mouth and keeping it there, because tongue position was the most common error. Explain that a machine will move slowly around the head, so the sound and motion aren’t a surprise.
On the day, tell your child that the clinician will say when to hold still and when it’s over, so there is a clear end point. Earrings, hair clips, glasses and any other metal near the head should come off first, since they can cast shadows and spoil the image. A parent usually can’t stand beside the child during the exposure, so say in advance that you’ll be close by. If the first image is blurred, ask whether a retake is truly needed, since a retake adds another dose.
Children with developmental disabilities had more errors of every type, with movement most common, and more low-quality images.27PubMed Central. Panoramic errors in pediatric patients with special needs Tell the clinic in advance so they can plan extra time, practice, or an alternative.
Your Say and What Insurance Covers
Parents have a right to hear the reason for any X-ray and approve it, and the dentist should respect their preferences.28European Journal of Paediatric Dentistry. EAPD guidelines for use of radiographs in children In practice, you can ask the dentist to explain why the image is recommended in your child’s case and what it will show. You can agree, ask to delay it or decline it, and the dentist should respect that choice while explaining any risks of not having it. A dentist may strongly recommend one when it’s clearly beneficial.29European Journal of Paediatric Dentistry. EAPD guidelines for use of radiographs in children If a dentist departs from accepted guidelines, the reason should be discussed and noted.30European Journal of Paediatric Dentistry. EAPD guidelines for use of radiographs in children
If you’re unsure, ask whether waiting a year would change anything about your child’s care. If you decline, ask what signs, such as a tooth failing to come in or pain, would change your mind.
Many dental plans cover a pano about once every 3 to 5 years, or for specific needs like wisdom teeth or orthodontics.31C. Patrick Gray, DDS. Dental Exam X-Ray Insurance Coverage Explained | C. Patrick Gray, DDS. in Flint, MI Check your plan before a repeat image, especially if the orthodontist and dentist both want one. Call the plan or ask the office to check eligibility, since the frequency limit is where many claims are denied. It also helps to ask what the out-of-pocket cost would be if the plan doesn’t pay, so a bill doesn’t come as a surprise.