X-rays – Beyond the Bite

By Dr. John Paul, FDA Editor

If you are a dentist, and you practice in Florida, you are more than likely to have a patient walk into your office and ask to have their dentures relined. Many are convinced that this is a simple procedure handled entirely by a technician, and the dentist is just a toll collector on their highway to better eating and speaking. “I’m paying you good money, just put the stuff in my teeth so I can be happy.”

I focus on the “make me happy” part. I want you to have comfortable, functional dentures that allow you to speak and eat with confidence. You know they “don’t fit.” I want to know why you aren’t comfortable. That requires an examination and evaluation. I will definitely want to look at your mouth and touch the parts that support your dentures. I may want to take an X-ray to determine the quality of your bones.

More often than you might guess, the patient’s dentures fit their jaws fine, but do not stay in under function. The teeth don’t mesh together properly and that is why they seem “loose.” No need for a reline, just adjust the bite. There are times when the bones have changed shape and the denture no longer fits. That’s when we take an X-ray to determine if the bones are healthy but a different shape, or if the reason for the change is disease in the bones, like cancer. We need the X-ray to make that diagnosis, and the treatment plan may be something much different than “just a reline.”

Without a proper examination, evaluation and treatment plan, it isn’t possible to provide appropriate treatment. What makes for a proper examination and evaluation is specific to each patient and is something you should discuss with your dentist. I can’t make my diagnosis based solely on information provided over the internet, and you shouldn’t rely only on what you read on the internet to make your decision.

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.

By Dr. John Paul, FDA Editor

Lately, I’ve had a run of patients who are reluctant to have — or are flat-out refusing — dental radiographs. I’ve let a few patients go because I believe it is beneath the standard of care to routinely practice without the aid of radiographs; although, I think they should be prescribed for each case and use the ALARA principle (As Little As Reasonably Acceptable). I try to use the refusal as the introduction to a conversation with the patient.

“Dr. Paul, I don’t want any X-rays today.”

“Mrs. Gruntbuns, why don’t you want any X-rays today?”

“They cost too much and there’s too much radiation.”

“Mrs. Gruntbuns, radiographs are important enough to me to evaluate your health that I will take them for you today at no charge. Will that change your mind?”

“No, radiation makes people sick, it gives them cancer and I don’t want any radiation.”

“Mrs. Gruntbuns, dental radiographs (X-rays) are safe when used properly. With the X-rays I take during a checkup, you get about 1/600^th of the amount of radiation¹ you can expect to receive just from walking around — it’s even less because you walk around outdoors in Florida. Because you take good care of your teeth, do all the things we ask you to do at home and come in as often as we ask for professional maintenance, we have prescribed radiographs for you every two years. This is the bonus you get for keeping up your oral health. You are at low risk of decay or gum disease, and unless something changes, we won’t change by taking more radiographs.”

Most patients accept the radiographs when they find out I think they are important enough to take them for free. I only offer this to a patient one time. I have released several patients (less than 10) for refusing radiographs because I believe this patient is asking me to provide care with one hand tied behind my back and one eye closed. Some days I do miracle dentistry, but I don’t have time to do tricks. I hope this patient didn’t leave my office for yours.

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.
¹The amount of radiation is based on an article in JADA, September 2011, Volume 142, Issue 9, Pg. 1101.

Tag: X-rays

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